[Intro music]
AJ (he/they): Hello and welcome to another episode of Gender Queries, a podcast about trans and gender-diverse healthcare in Atlantic Canada.
I'm AJ and I use he/they pronouns.
Jess (they/she): I'm Jess and I use they and she pronouns.
Sam (they/them): And I'm Sam and I use they/them pronouns.
AJ: Over the next two weeks, we're going to dive into the very broad topic of physical health in the trans and gender-diverse population. This week, we'll look at the effect of trends in exercise and diet in the trans and gender-diverse population, how those affect overall physical health and well being.
And next week, we'll dip into the different organ systems and how they're affected by some lifestyle factors as well as gender-affirming hormone therapy.
You'll hear how, even though we don't always have a lot of research in these topics, we can use patient experiences and clinical expertise to help guide us as we work to improve our ability to counsel trans and gender-diverse patients on their health.
[Music]
AJ: Let's talk about exercise.
Sam: Love it.
AJ: We know that there are a lot of benefits to regular activity. One hundred and fifty to 300 minutes a week of vigorous activity or 300 to 600 minutes of moderate activity can reduce all-cause mortality by 40%, according to Lee and colleagues in 20221.
Sam: Nice.
AJ: Do these recommendations change for trans people?
Sam: If it's just a standard number for people in general, I would imagine it doesn't.
AJ: But trans individuals, particularly trans women, are getting a lot less exercise per week than cisgendered individuals2.
Genderqueer nonbinary people actually have the highest levels on average.
Jess: Why?
AJ: Yeah, so there was a research paper that I was looking at by Lightner and colleagues in 2024 and they thought that this might be because genderqueer/nonbinary people are more likely to not need medical or surgical treatment as part of their gender affirmation3.
So, perhaps exercise is a form of gender-affirming care for that population.
Sam: As somebody who is nonbinary and who needed to have gender-affirming surgery to be more comfortable, I wouldn't have fit that statistic. I would actively avoid the gym. But that said, you have the nonbinary identity encompassing so many things. I feel like it's such a large umbrella term that it's kind of hard to apply a statistic to…
AJ: To apply a statistic to, yeah.
In terms of factors that might contribute to reduced physical activity: feeling uncomfortable, locker rooms feeling uncomfortable, or even unsafe, discrimination, exclusion, even violence, binaries in sports leagues, making it difficult for people to find a place where they can participate in sports.
Cyrus Campbell (he/they/she): My name is Cyrus, I'm originally from Plaster Rock, New Brunswick. I use he/ they/she pronouns. I would like to play sports; I'm an athletic person. However, I'm bigender, so, like, where are they going to put me? I don't want to navigate that whole aspect. I don't want to deal with gendered stuff. So, that's why I stick with co ed sports.
AJ: The last thing that this study mentioned was self-image3. This can present in different ways. For a transmasculine person, it can present with less exercise or with excessive exercise. For transfeminine people, it tends to be more avoidance of exercise, but of course this depends on the individual.
Nikki Valentine (she/her): My name’s Nikki Valentine, pronouns she/her. I am a trans woman from Cumberland County, Nova Scotia, and I've been navigating gender-based healthcare since about 2019, 2020.
Generally, a lot of trans women have a lot of anxiety about exercising, in general. It is not easy for me to feel like I can pass in athletic spaces, just because, by nature of me sweating, by nature of me having to wear exercise clothing, things like that, it really does make my body, my transness, visible.
I started, sometime last year, getting pretty into swimming and I go to the Dalplex semi-regularly to use their pool. And I found myself really wishing I had the confidence to join the swim team at Dalhousie. But there was a massive amount of anxiety with that. Knowing that trans female athletes participating in swimming sort of domino-affected into the insane restrictions we're seeing on trans participation in sports worldwide. And that felt like too heavy of a cross for me to bear, as someone who just wanted to partake in swimming and have a timer. Didn't want to win anything, didn't want to compete, even, necessarily. And if I did compete, it was for me, it wasn't to do better than anybody. Not even in, like, a trans sense of, you know, that's the stigma. I just wanted to partake in the sport for the fun of it, you know? If I lost everything I ever did, that would be totally fine because it was just a personal thing for me. I just want to do better than I did yesterday. I don't need to do better than other people are doing.
There are, like, trans female athletes who partake in swimming that are known based on how regurgitated false accusations about their morality and about their intent have spread. So many trans people I know were already so anxious about swimming in the first place, based on how we feel about our own bodies, that for that anxiety to sort of have doubled-down because of that stigma associated with the sporting aspect of it, was really frustrating to me because I really would have, especially after my orchiectomy, wanted to have partaken in that space as a sort of affirming, you know, thing for myself.
AJ: Regardless of identity, a big factor in physical activity participation is self-esteem. So, what is going to make a trans person exercise more?
Sam: Gender-affirming care.
Jess: Gender-affirming care and…
Sam: And reducing stigma and addressing bullying.
Jess: And probably in, yeah, environments maybe with other queer people where they can all go exercise together.
Sam: Yeah.
AJ: Yeah, exactly. And for a lot of people, as they transition, whatever that might look like for them, they do build confidence and self-esteem and the data support that as well. So, in a lot of cases, you can see the exercise levels going up after people have had access to gender-affirming care2.
Sam: Mhm.
AJ: It doesn't remove all the barriers, lack of inclusion and the strict binaries for sports leagues, but it does kind of show how gender-affirming care is influencing someone's life in, like, a lot of different ways that maybe aren't the obvious ones that you think of right away, for sure.
Pascale Fortin-Daigle (any pronouns): I'm Pascale Joëlle, you can also call me PJay, it's shorter and easier to pronounce. I identify myself as a transmasculine, nonbinary, genderfluid person, and I really don't care about my pronouns.
I'm not playing now, but I was playing when I was a kid, I played soccer, I played judo. And the one that really bothered me the most was gymnastic and swimming because those are the two that my body was the most exposed, right? And for a reason, I didn't have the right to put on other gear. And then swimming, I had to wear a sports bra or other garments. I stopped swimming when my body started developing because I was just not comfortable, right? So… kind of took away a little bit because I really loved swimming.
So, when I discovered that having a top surgery was even possible, it, like, light up a fire in me. And I was like, “that's where I want to be”. I ended up going into surgery on October 2022. And now I can enjoy the pool and the beach and it's great.
AJ: A lot of this research is done on teenagers. You can imagine that for these kids, gym class and change rooms can be really distressing to the point of avoiding physical activity, skipping class.
Trans and gender-diverse youth have been shown to get less physical activity, overall. Approximately a quarter of trans and gender-diverse adolescents participate in sports, compared to a third of people who are questioning, and then over half of cisgender adolescents.
Eleanor (she/her): My name is Eleanor, I am 24 years old. I'm a trans woman, pronouns she/her. Gym class was never really my favourite. I did not like going into the change rooms, getting into gym strip or anything. And I feel like there was rarely activities that I enjoyed, especially when I was younger, and, you know, you'd be like, split into boys and girls for gym class. That always rankled me. It was also just another thing where a lot of the other boys my age did things that I didn't really want to do, and it just felt like I didn't fit in with the culture at all. That could feel isolating, make you feel like you're doing something wrong, there’s something wrong with you. Why aren't you like the rest of the class? So, it was always a spot where I felt like an outsider.
AJ: As an adult, how do you find athletic environments?
Eleanor: To be perfectly honest with you, I tend to avoid them. I don't really like any sort of organized group sport or, like, competitive sport. They just really aren't spaces that I feel super welcome and I've never felt that drawn to them anyway. I prefer hiking, things like that. Things where, you know, no one's going to object to me, you know.
AJ: Do you think that if there were sports leagues or groups that were more accepting and welcoming that you would be more interested in that kind of organized sport, or is it just not something you're interested in?
Eleanor: I'd definitely be more willing to give it another shot if it felt more welcoming. I mean, who knows? But it would be nice to do something more team-oriented every now and then, just to, you know, be a little bit social.
AJ: As much as we emphasize the physical benefits, sports also offer an opportunity to socialize and to learn about commitment and teamwork and maybe even a bit about yourself.
Pascale Fortin-Daigle: I see esport as an outlet. For me, growing up anyway, it was a way to experience with various things because you can be whoever you want to be in those things. More and more we see flexibility in the way we can build a character, and I think that allows a lot of folks, especially the young ones, to be able to explore a bit more of who they feel comfortable with being.
For instance, I'm a big Pokémon fan. That's my jam. At the beginning, you choose, are you a boy or are you a girl? Right? I was always just picking the boy because that's the only place I could be more masculine or whatever.
But even just those, like, 12 pixels on my screen made me feel a type of way that I couldn't necessarily attain or achieve in the real life. So, esport definitely had an impact on my journey, in itself, and I'm sure it's having an impact on the journey of a lot of folks out there.
And it's easier to be than in person. In person, people can judge you for what they see outwardly. And in a persona, yeah, they judge you on what they see, but it correlates more to what you are on the inside.
AJ: On a population level, we see lower rates of exercise, and we've talked about some of the different reasons why that might be. But we've also heard how people have found a way to make it work, whether that's by joining coed teams, sticking to individual sports, or outdoor activities, or esports. And there are athletic spaces where people do feel safe and they do feel welcome. Many times, that's a queer league or team. But you also might find that space somewhere where you're not expecting.
Justine Ward (they/them): My name is Justine Ward. I am a 25-year-old nonbinary professional wrestler. I prefer they/them pronouns.
For a majority of the time that I was an athlete, I didn't know that I was nonbinary.
AJ: And when you did come out as nonbinary, what was that like?
Justine Ward: It was just accepted. I didn't feel like I didn't belong. And that's probably one of the best things I can say about the training school that I'm at. While you may never see a rainbow in the logo or you might not see the very obvious, we are LGBTQ-friendly, if you happen to be a part of the LGBTQ, that's cool, we're good with it. You're still safe.
[Music]
AJ: Emotional health, physical health, mental, spiritual health, they're all interrelated and inseparable.
Maeka Wright (they/them): I'm Maeka. My pronouns are they/them, and I identify as queer, nonbinary, and my experience of gender is very fluid. So, I've come to terms with not having any sort of fixed gender state over the years.
I'm a certified yoga therapist and I'm a lifelong student of yoga. When I talk about yoga, I really mean moving, breathing, meditating, ritual, chanting, lifestyle pieces. It's a really vast set of experiences and practices that we can draw on.
AJ: And how does yoga fit into healthcare?
Maeka Wright: There's a lot of passive therapies where practitioners are like, “you need to take this pill”, “you need to do this thing”, and I think if you're going through any kind of health crisis, you feel like you don't have a lot of control over yourself and your body. And yoga is this thing that you can do for yourself, it starts to give you a little bit of your power back because you can actively do something for your own health.
My experience being nonbinary out in the world, a lot of times I just feel like I'm living in my head, and I sort of ignore my body and there's just a lot of thoughts in my head. I go out in public and I'm like, “can they tell that I'm queer? Can they tell that I'm nonbinary? Do I want them to know? Do I not want them to know?”. With the increase in hate that we've seen over the last couple years, there's a whole other piece that's like, “do they hate me? Do they want me here? Do they think I'm disgusting? Do I look the way that they think I should look?”. Also, like, being a parent, I'm like, “do the other parents not want their kids to hang out with my kids because of the way I am? Or will my identity negatively affect them in some way?”.
Just traveling through life, there's always this other portion of my mind that's being taken up with, “what are people thinking about me?”. And I think it's common with a lot of people in our community.
AJ: Is that something that yoga helps with?
Maeka Wright: Yes. I think one of the things that yoga can really bring to Two Spirit, gender-diverse, and trans people is to experience your body in a different way. We experience our bodies by looking at them and saying, like, “oh, do I look the way that I want to be perceived today?”. But yoga can teach us that we have this whole world inside our bodies, that we can feel our toes from the inside, or learn to bring our attention out of our heads and into our bodies in a way that has nothing to do with gender or how it looks or anything other than this universe that opens up inside your body. And when you feel that, you sort of learn that you can trust the things that you know about yourself. You can build this intimate relationship with your body in a totally different way.
And then your body kind of becomes your home and it's super empowering.
[Music]
AJ: Another important element of health and wellbeing is nutrition.
What kinds of things are providers supposed to monitor when they have patients who are on hormone therapy?
Sam: Hematocrit?
Jess: Cholesterol, et cetera, like monitoring for heart disease.
AJ: Yeah, so the WPATH version 8 emphasizes that you should be monitoring metabolic parameters that can be altered by hormones. So, things like lipids, glucose, hematocrit, hemoglobin, and if you think about those things, it is easy to see why diet would be important, because diet can also affect all of those things4.
Ken Mullock (he/him): My name is Ken Mullock. My pronouns are he/him, and I'm a registered dietitian in Regina, Saskatchewan. I work in the area of chronic disease prevention and management. Before that, I worked as a trans health navigator, helping trans people navigate the healthcare system and also helping with trans health and research. And, so, now I really like to combine those things and help educate others about the importance of nutrition in trans care.
The lived experience that I bring is I'm a trans man. I'm also gay. I've been through hormone therapy, but also top surgery, and a few bottom surgeries. So, I think my lived-experience is important as well as my education and clinical experience.
The literature that we do have is often just saying, hey, there is no studies on this. So, it's frustrating being a trans person and being like, “I want to know more about my health, my body, what my needs are, as well as my clients”. And we're left out of research. And even when we're looking at practice guidelines, standards of care, that sort of thing, for eating disorders or nutrient requirements, chronic disease, trans people just aren't talked about, aren't really included, everything's based on this cis binary. And, so, it is frustrating, but I think it's inspiring to be like, okay, it's important that we're doing this work, but also it's an opportunity to really focus on client experiences and clinical experiences.
That's our evidence. Our evidence is in our practice.
AJ: Something that I came across was about disordered eating being more common in the trans and gender-diverse community2,5,6.
Ken Mullock: Definitely, within the trans community, we see higher rates of eating disorders. Kind of depends on what studies we look at, again, there aren't a ton of studies on this, so we don't really know what the rates are.
We see some things saying, you know, “trans people are four times more likely to report an eating disorder”, some studies say 2 to 18%. What I see in my day-to-day work and living in the community, I would say it's much higher than that. And what I like to say about this is, there's many different reasons we see these higher rates of eating disorders.
The one thing it kind of comes down to is seeking control when the way that the world perceives us or our friends and family and peers see us feels like it's out of our control. So, controlling food and eating is one way to kind of seek that control.
We see it at the onset of biological or natal puberty as a coping mechanism to deal with that puberty starting or to alter one's body to avoid the changes from that puberty.
We also see trans people using food and eating to change their physical body. Kind of as, you know, some people may call it DIY gender-affirming therapy. So, if someone isn't able to access gender-affirming surgery or hormones, they may restrict their intake or greatly increase their intake of food in order to change their physical features.
We also see surgeons setting BMI cutoffs for gender-affirming surgery. So, that can start to change someone's relationship with food. They purely see food as something to change their weight and start to develop unhealthy behaviours in order to meet cutoffs.
And just, you know, especially these days, there's a lot of pressure and fear, discomfort, around being a trans person trying to navigate the world, trying to navigate transition in a very transphobic and scary world right now. And so, food can be control and comfort.
AJ: If you were to look at people from, maybe, before they transition, or if they can't access gender-affirming care and then people that are further along in that process, whatever that looks like for that person, would you say that the rates would decrease7?
Ken Mullock: Yes, definitely. And we see that in a bit of the literature, but also just in practice is, steps toward and through social transition and medical transition lead to an improved relationship with food. And that's really positive to see. And something I like to say around this is, eating disorders don't exist in a vacuum, therefore treatment cannot be in one either. Any sort of treatment, without focusing on gender-affirming care, will likely be ineffective.
There's a study done on trans people's experiences with eating disorder treatment, and one of the participants gave this quote:
My eating disorder would never, ever have eased up as it did if I hadn't been able to transition and thus have the experience of liking and identifying with m y body in that way first8.
So, I think that's… That's really beautiful. And, as someone who's also been through a history of an eating disorder, I completely identified with that as well. I struggled a lot with an eating disorder, and when I was able to come out, start my transition, I felt so much more comfortable in my body. I didn't need to control it. I was able to develop this newfound love for my body, and thus, want to take care of it, want to nourish it and provide it what it needed to stay well and grow.
AJ: Another thing that I came across was that the trans population has a poorer diet in general9.
Ken Mullock: Yes. So, we do see in some of the studies that most trans people don't meet their nutritional requirements, have lower intakes of fruits and vegetables and less physical activity too. So, we do see those poor markers of health and wellness among the trans community.
That can come, I think, from various things. You know, we do see lower rates of employment among trans people, higher rates of food insecurity. So, that leads to lack of access to quality foods. Trans people often live in areas where there are more food deserts, so less access to fresh fruits and vegetables and that sort of thing. That could be one reason.
We do see lower education rates among trans people. And with lower education, we see poor-quality diets. And I think it does also come back to this altered relationship with food among trans people. And when your relationship with food isn't positive, you often don't eat as much variety and enjoy fresh foods and home cooked meals and that sort of thing as much.
I think an important piece, too, is enjoying food, eating food with others, your family traditions, cultural foods. And if a trans person is feeling isolated or discriminated against, scared to go out, you're missing that social piece of food. And that social piece of food often leads us to enjoy a more varied diet. So, I would suspect, you know, just from what I've seen in my practice, that that could be a reason that we see those generally more poor diets among the trans community.
And I would say, an important piece for providers to recognize is, the education piece is really important. When we're talking to our clients and patients about whether it be nutrition or just health, oftentimes if we're talking about eating disorder care, we may just tell people like, “oh, it's important that you eat, you know, you need to grow to be big and strong”. Or if someone's lost their period, you know, “it's normal, you need your period back”, that sort of thing, that's going to be quite triggering for trans people. It's not going to create any positive change. But educating your patients on a positive view of nutrition and wellness is important.
There's so much demonizing and negative talk about food and health. “Don't do this, it's bad. Don't eat this, it's terrible. You need to do this”. But how about we celebrate food and wellness and say, “hey, it's really exciting that if we honour our body's needs, we get to have more energy and prevent certain chronic diseases and have more longevity, that sort of thing”.
AJ: Are there different nutrient requirements for trans people who are on hormone therapy?
Ken Mullock: Currently, there are no guidelines or standards for nutrient needs among trans folks. Even though, right now, our nutrient requirements are solely sex-based, sex is just one factor for our nutrient requirements among many. So, our age, our stage of life, our activity, those things all affect our nutrition requirements, too.
Hormones do affect our calorie needs. Those often correlate to our muscle mass. So, if someone has been on hormones for just a couple months, we probably don't see much muscle mass change. Likely, then, their calorie requirements would be more closely associated with their sex assigned at birth. Six months is kind of where we see that onset of a lot of the muscle mass changes. So, for someone taking testosterone, that would cause an increase in calorie needs. For somebody taking estrogen, we often see muscle mass decrease, so that would decrease their calorie needs. And then usually around three to five years is when we see those maximum changes. So, that's when we see it more closely reflect the gender or sex they're transitioning to.
There's a lot of ways we can calculate energy requirements. If we are using one that's based on sex, so, we have the Mifflin-St. Jeor equation or the Harris Benedict equation, if somebody's kind of in those in between stages of starting to transition on hormones, I say, either take an average of the male and the female or use a range. So, you can kind of see, okay, what would maybe be the minimum, what would be the maximum, how long have they been on hormones, what's the extent of change they've seen?
Or you know, instead of doing that, using a weight-based equation. So, for calorie needs, we could say we'll just use 25 to 30 calories per kg of body weight to base our decision making off of. So, you do kind of have to get creative.
You can also think about physiology when it comes to certain vitamins and minerals. So, for example, iron requirements are different for cis males and cis females due to menstruation. So, if we do have a patient who is transitioning, then it would come down to is this someone assigned female at birth on testosterone who's no longer menstruating? Then we probably look at the male iron requirement. If they are still menstruating, then we use the female requirement.
We do see different things for testosterone and estrogen. So, for example, for people taking testosterone, we see increased LDL cholesterol and decreased HDL cholesterol. So, increase of bad cholesterol, decrease of good cholesterol, which is not typically what we want to see. Testosterone can also cause increased blood pressure, cardiovascular risk, type 2 diabetes risk, when other factors are present, too. It's quite likely that testosterone increases somebody's weight, that being muscle mass, but also increased fat mass. And typically, on testosterone, we see it more around the abdominal region. So, with those increased lipids and blood pressure and abdominal weight, that can come with increased risk for chronic diseases.
And so, we do have to be kind of mindful of these risks. It shouldn't be a deterrent, and we don't necessarily need to see it in a negative light, but just something that we should continue to monitor.
When somebody is taking those hormones, and then with testosterone, we often see an increase in appetite as well. And if there's someone who struggles with disordered eating, that can cause distress, all of a sudden, they're ravenous, feel like they can't control some of their cravings and appetite. And if they're not used to that, it can be quite an abrupt change. It can be difficult to deal with. So, those are kind of the main changes with testosterone.
And then, with estrogen, we see more of a decreased muscle mass, increased fat mass, and that can sometimes cause more functional changes, like more weakness. Estrogen can do different things to lipids. Sometimes we actually see them improve.
Blood pressure can increase or decrease, kind of depending on the individual or the type of testosterone blocker that's used. If somebody's taking spironolactone as a blocker, we can see hyperkalemia or dehydration risk because it's a diuretic. And then with estrogen, we can see those same increased risks of hypertension, hypertriglyceridemia, type 2 diabetes. And that's of course, when other risk factors are present.
Again, we don't need to see this as a negative thing, but just something that we'd want to monitor.
Nutrition can help mitigate those risks and can help keep some of those lipid and blood pressure changes more within ideal ranges.
I do think part of the initial stages of prescribing hormones, something that can be included is a discussion with the patient saying, “hey, you know, there may be some nutrition considerations. Would you like me to send a referral to a dietitian or is this something that you want to continue to monitor and then go from there?”. Doesn't need to be a fear-based thing, though.
Providers should also recognize that all food plays a role in someone's diet. As a dietitian, I'll have patients come and see me and say, “well, my doctor said I can't eat this”, and “this other doctor told me I need to start doing this because this level's high”, and all of this. But we need to make sure that we're all on the same page and not giving in to too much of diet culture or establishing fear around certain foods. If a trans person is able to even access food, that's a win. So, making sure that we're not putting too much emphasis on certain diets or eliminating foods and that sort of thing.
Many of the patients I see are people living with diabetes or heart disease or COPD or other chronic diseases. And I always say the fears that are instilled on them about their health, or food and nutrition, are more harmful than really any food would ever be. So, we’ve got to be careful about how we approach discussion around health with our clients and patients.
We also need to recognize that those risks aren't necessarily higher than the ones that cis people live with, or anything else that we do, you know, day-to-day. You know, everything has risk to it. Doesn't mean that we shouldn't be doing those things.
AJ: So, we've talked about hormones, what about surgery?
Ken Mullock: Yes. So, it's something that's not talked about enough or goes unrecognized, the importance of nutrition during surgery and especially trans related surgeries because we're seeing higher rates of food insecurity, more poor diets among trans people. And one thing we know about all surgeries is adequate nutrition helps to prevent or fight infection, increases positive outcomes from surgery, decreases risks of complications. So, nutrition is really important in all stages of surgery.
So, going into surgery adequately nourished, having good nutrition stores is really important. I think that's something that we want to increase the knowledge of in the trans community but also among healthcare providers. Making sure that people know, okay, leading up to surgery, it's not a time to try to lose weight or try any diets, but just focusing on adequately nourishing yourself.
And then, after surgery, so, everything that comes along with your body healing from surgery, nutrition is important. So, for example, vitamins that are key for healing, vitamin A, E, D, K. The minerals, like zinc and copper, are really important for wound healing. Your protein needs are higher, hydration needs are higher, and fibre to deal with post-op constipation.
But what can be difficult after gender-affirming surgery is your ability to be able to cook and prep food without using, you know, your arms, if you had top surgery or if you've had any lower surgeries, being able to get up and move around to make food, buy food, clean up. All of those steps around food preparation can be really difficult.
AJ: People often recommend meal-prepping before surgery, but meal prepping can be very expensive and time consuming.
Ken Mullock: Meal prepping is daunting, too. I think a lot of people get scared when they think of meal prep because there's all these things you got to do and buy and, and that sort of thing.
But oftentimes when I'm educating individuals about this, we talk about convenience foods that have high nutrition quality. So, like, canned vegetables and frozen vegetables that you can just have on hand, or if you are relying more on processed convenience foods like packaged noodles or Kraft dinner, that sort of thing, how can we add to it to add nutrition rather than trying to make whole meals from scratch? So, adding frozen vegetables or canned vegetables to those packaged noodles, or, you know, like, canned tuna and eggs as a protein source instead of having to cook fresh meats from scratch.
I worked with a team of dietician students a few years ago and we actually made a nutrition guide for gender-affirming surgery. So, we provided certain recommendations and help with planning and understanding the different vitamins and minerals that are important for pre-surgery, post-surgery, and then also some information for support on how to best help your loved one going through that with nutrition.
[Music]
AJ: Science and medicine know that wellbeing is multifactorial. Those factors include lifestyle factors, like exercise and diet. But those factors themselves are also influenced by many different things. The social determinants of health affect if, and how, someone can access things like physical activities and nutritious food.
We know that these factors will influence someone's health. And, on the foundation of that knowledge, next week we'll look at a few different organ systems, like the cardiovascular system and the pulmonary system, and how those are impacted, in a broad sense, in the trans and gender-diverse community.
[Music]
AJ: Thank you for joining us for another episode of Gender Queries and thank you to our guests for their stories and expertise.
You can check out the shownotes to find our transcript sources and resources recommended by our guests. You can contact us at genderqueeriespod@gmail.com or find us on Instagram @genderqueriespod.
[Outro music]
AJ (he/they): Hello and welcome to another episode of Gender Queries, a podcast about trans and gender-diverse healthcare in Atlantic Canada.
I'm AJ and I use he/they pronouns.
Jess (they/she): I'm Jess and I use they and she pronouns.
Sam (they/them): And I'm Sam and I use they/them pronouns.
AJ: Over the next two weeks, we're going to dive into the very broad topic of physical health in the trans and gender-diverse population. This week, we'll look at the effect of trends in exercise and diet in the trans and gender-diverse population, how those affect overall physical health and well being.
And next week, we'll dip into the different organ systems and how they're affected by some lifestyle factors as well as gender-affirming hormone therapy.
You'll hear how, even though we don't always have a lot of research in these topics, we can use patient experiences and clinical expertise to help guide us as we work to improve our ability to counsel trans and gender-diverse patients on their health.
[Music]
AJ: Let's talk about exercise.
Sam: Love it.
AJ: We know that there are a lot of benefits to regular activity. One hundred and fifty to 300 minutes a week of vigorous activity or 300 to 600 minutes of moderate activity can reduce all-cause mortality by 40%, according to Lee and colleagues in 20221.
Sam: Nice.
AJ: Do these recommendations change for trans people?
Sam: If it's just a standard number for people in general, I would imagine it doesn't.
AJ: But trans individuals, particularly trans women, are getting a lot less exercise per week than cisgendered individuals2.
Genderqueer nonbinary people actually have the highest levels on average.
Jess: Why?
AJ: Yeah, so there was a research paper that I was looking at by Lightner and colleagues in 2024 and they thought that this might be because genderqueer/nonbinary people are more likely to not need medical or surgical treatment as part of their gender affirmation3.
So, perhaps exercise is a form of gender-affirming care for that population.
Sam: As somebody who is nonbinary and who needed to have gender-affirming surgery to be more comfortable, I wouldn't have fit that statistic. I would actively avoid the gym. But that said, you have the nonbinary identity encompassing so many things. I feel like it's such a large umbrella term that it's kind of hard to apply a statistic to…
AJ: To apply a statistic to, yeah.
In terms of factors that might contribute to reduced physical activity: feeling uncomfortable, locker rooms feeling uncomfortable, or even unsafe, discrimination, exclusion, even violence, binaries in sports leagues, making it difficult for people to find a place where they can participate in sports.
Cyrus Campbell (he/they/she): My name is Cyrus, I'm originally from Plaster Rock, New Brunswick. I use he/ they/she pronouns. I would like to play sports; I'm an athletic person. However, I'm bigender, so, like, where are they going to put me? I don't want to navigate that whole aspect. I don't want to deal with gendered stuff. So, that's why I stick with co ed sports.
AJ: The last thing that this study mentioned was self-image3. This can present in different ways. For a transmasculine person, it can present with less exercise or with excessive exercise. For transfeminine people, it tends to be more avoidance of exercise, but of course this depends on the individual.
Nikki Valentine (she/her): My name’s Nikki Valentine, pronouns she/her. I am a trans woman from Cumberland County, Nova Scotia, and I've been navigating gender-based healthcare since about 2019, 2020.
Generally, a lot of trans women have a lot of anxiety about exercising, in general. It is not easy for me to feel like I can pass in athletic spaces, just because, by nature of me sweating, by nature of me having to wear exercise clothing, things like that, it really does make my body, my transness, visible.
I started, sometime last year, getting pretty into swimming and I go to the Dalplex semi-regularly to use their pool. And I found myself really wishing I had the confidence to join the swim team at Dalhousie. But there was a massive amount of anxiety with that. Knowing that trans female athletes participating in swimming sort of domino-affected into the insane restrictions we're seeing on trans participation in sports worldwide. And that felt like too heavy of a cross for me to bear, as someone who just wanted to partake in swimming and have a timer. Didn't want to win anything, didn't want to compete, even, necessarily. And if I did compete, it was for me, it wasn't to do better than anybody. Not even in, like, a trans sense of, you know, that's the stigma. I just wanted to partake in the sport for the fun of it, you know? If I lost everything I ever did, that would be totally fine because it was just a personal thing for me. I just want to do better than I did yesterday. I don't need to do better than other people are doing.
There are, like, trans female athletes who partake in swimming that are known based on how regurgitated false accusations about their morality and about their intent have spread. So many trans people I know were already so anxious about swimming in the first place, based on how we feel about our own bodies, that for that anxiety to sort of have doubled-down because of that stigma associated with the sporting aspect of it, was really frustrating to me because I really would have, especially after my orchiectomy, wanted to have partaken in that space as a sort of affirming, you know, thing for myself.
AJ: Regardless of identity, a big factor in physical activity participation is self-esteem. So, what is going to make a trans person exercise more?
Sam: Gender-affirming care.
Jess: Gender-affirming care and…
Sam: And reducing stigma and addressing bullying.
Jess: And probably in, yeah, environments maybe with other queer people where they can all go exercise together.
Sam: Yeah.
AJ: Yeah, exactly. And for a lot of people, as they transition, whatever that might look like for them, they do build confidence and self-esteem and the data support that as well. So, in a lot of cases, you can see the exercise levels going up after people have had access to gender-affirming care2.
Sam: Mhm.
AJ: It doesn't remove all the barriers, lack of inclusion and the strict binaries for sports leagues, but it does kind of show how gender-affirming care is influencing someone's life in, like, a lot of different ways that maybe aren't the obvious ones that you think of right away, for sure.
Pascale Fortin-Daigle (any pronouns): I'm Pascale Joëlle, you can also call me PJay, it's shorter and easier to pronounce. I identify myself as a transmasculine, nonbinary, genderfluid person, and I really don't care about my pronouns.
I'm not playing now, but I was playing when I was a kid, I played soccer, I played judo. And the one that really bothered me the most was gymnastic and swimming because those are the two that my body was the most exposed, right? And for a reason, I didn't have the right to put on other gear. And then swimming, I had to wear a sports bra or other garments. I stopped swimming when my body started developing because I was just not comfortable, right? So… kind of took away a little bit because I really loved swimming.
So, when I discovered that having a top surgery was even possible, it, like, light up a fire in me. And I was like, “that's where I want to be”. I ended up going into surgery on October 2022. And now I can enjoy the pool and the beach and it's great.
AJ: A lot of this research is done on teenagers. You can imagine that for these kids, gym class and change rooms can be really distressing to the point of avoiding physical activity, skipping class.
Trans and gender-diverse youth have been shown to get less physical activity, overall. Approximately a quarter of trans and gender-diverse adolescents participate in sports, compared to a third of people who are questioning, and then over half of cisgender adolescents.
Eleanor (she/her): My name is Eleanor, I am 24 years old. I'm a trans woman, pronouns she/her. Gym class was never really my favourite. I did not like going into the change rooms, getting into gym strip or anything. And I feel like there was rarely activities that I enjoyed, especially when I was younger, and, you know, you'd be like, split into boys and girls for gym class. That always rankled me. It was also just another thing where a lot of the other boys my age did things that I didn't really want to do, and it just felt like I didn't fit in with the culture at all. That could feel isolating, make you feel like you're doing something wrong, there’s something wrong with you. Why aren't you like the rest of the class? So, it was always a spot where I felt like an outsider.
AJ: As an adult, how do you find athletic environments?
Eleanor: To be perfectly honest with you, I tend to avoid them. I don't really like any sort of organized group sport or, like, competitive sport. They just really aren't spaces that I feel super welcome and I've never felt that drawn to them anyway. I prefer hiking, things like that. Things where, you know, no one's going to object to me, you know.
AJ: Do you think that if there were sports leagues or groups that were more accepting and welcoming that you would be more interested in that kind of organized sport, or is it just not something you're interested in?
Eleanor: I'd definitely be more willing to give it another shot if it felt more welcoming. I mean, who knows? But it would be nice to do something more team-oriented every now and then, just to, you know, be a little bit social.
AJ: As much as we emphasize the physical benefits, sports also offer an opportunity to socialize and to learn about commitment and teamwork and maybe even a bit about yourself.
Pascale Fortin-Daigle: I see esport as an outlet. For me, growing up anyway, it was a way to experience with various things because you can be whoever you want to be in those things. More and more we see flexibility in the way we can build a character, and I think that allows a lot of folks, especially the young ones, to be able to explore a bit more of who they feel comfortable with being.
For instance, I'm a big Pokémon fan. That's my jam. At the beginning, you choose, are you a boy or are you a girl? Right? I was always just picking the boy because that's the only place I could be more masculine or whatever.
But even just those, like, 12 pixels on my screen made me feel a type of way that I couldn't necessarily attain or achieve in the real life. So, esport definitely had an impact on my journey, in itself, and I'm sure it's having an impact on the journey of a lot of folks out there.
And it's easier to be than in person. In person, people can judge you for what they see outwardly. And in a persona, yeah, they judge you on what they see, but it correlates more to what you are on the inside.
AJ: On a population level, we see lower rates of exercise, and we've talked about some of the different reasons why that might be. But we've also heard how people have found a way to make it work, whether that's by joining coed teams, sticking to individual sports, or outdoor activities, or esports. And there are athletic spaces where people do feel safe and they do feel welcome. Many times, that's a queer league or team. But you also might find that space somewhere where you're not expecting.
Justine Ward (they/them): My name is Justine Ward. I am a 25-year-old nonbinary professional wrestler. I prefer they/them pronouns.
For a majority of the time that I was an athlete, I didn't know that I was nonbinary.
AJ: And when you did come out as nonbinary, what was that like?
Justine Ward: It was just accepted. I didn't feel like I didn't belong. And that's probably one of the best things I can say about the training school that I'm at. While you may never see a rainbow in the logo or you might not see the very obvious, we are LGBTQ-friendly, if you happen to be a part of the LGBTQ, that's cool, we're good with it. You're still safe.
[Music]
AJ: Emotional health, physical health, mental, spiritual health, they're all interrelated and inseparable.
Maeka Wright (they/them): I'm Maeka. My pronouns are they/them, and I identify as queer, nonbinary, and my experience of gender is very fluid. So, I've come to terms with not having any sort of fixed gender state over the years.
I'm a certified yoga therapist and I'm a lifelong student of yoga. When I talk about yoga, I really mean moving, breathing, meditating, ritual, chanting, lifestyle pieces. It's a really vast set of experiences and practices that we can draw on.
AJ: And how does yoga fit into healthcare?
Maeka Wright: There's a lot of passive therapies where practitioners are like, “you need to take this pill”, “you need to do this thing”, and I think if you're going through any kind of health crisis, you feel like you don't have a lot of control over yourself and your body. And yoga is this thing that you can do for yourself, it starts to give you a little bit of your power back because you can actively do something for your own health.
My experience being nonbinary out in the world, a lot of times I just feel like I'm living in my head, and I sort of ignore my body and there's just a lot of thoughts in my head. I go out in public and I'm like, “can they tell that I'm queer? Can they tell that I'm nonbinary? Do I want them to know? Do I not want them to know?”. With the increase in hate that we've seen over the last couple years, there's a whole other piece that's like, “do they hate me? Do they want me here? Do they think I'm disgusting? Do I look the way that they think I should look?”. Also, like, being a parent, I'm like, “do the other parents not want their kids to hang out with my kids because of the way I am? Or will my identity negatively affect them in some way?”.
Just traveling through life, there's always this other portion of my mind that's being taken up with, “what are people thinking about me?”. And I think it's common with a lot of people in our community.
AJ: Is that something that yoga helps with?
Maeka Wright: Yes. I think one of the things that yoga can really bring to Two Spirit, gender-diverse, and trans people is to experience your body in a different way. We experience our bodies by looking at them and saying, like, “oh, do I look the way that I want to be perceived today?”. But yoga can teach us that we have this whole world inside our bodies, that we can feel our toes from the inside, or learn to bring our attention out of our heads and into our bodies in a way that has nothing to do with gender or how it looks or anything other than this universe that opens up inside your body. And when you feel that, you sort of learn that you can trust the things that you know about yourself. You can build this intimate relationship with your body in a totally different way.
And then your body kind of becomes your home and it's super empowering.
[Music]
AJ: Another important element of health and wellbeing is nutrition.
What kinds of things are providers supposed to monitor when they have patients who are on hormone therapy?
Sam: Hematocrit?
Jess: Cholesterol, et cetera, like monitoring for heart disease.
AJ: Yeah, so the WPATH version 8 emphasizes that you should be monitoring metabolic parameters that can be altered by hormones. So, things like lipids, glucose, hematocrit, hemoglobin, and if you think about those things, it is easy to see why diet would be important, because diet can also affect all of those things4.
Ken Mullock (he/him): My name is Ken Mullock. My pronouns are he/him, and I'm a registered dietitian in Regina, Saskatchewan. I work in the area of chronic disease prevention and management. Before that, I worked as a trans health navigator, helping trans people navigate the healthcare system and also helping with trans health and research. And, so, now I really like to combine those things and help educate others about the importance of nutrition in trans care.
The lived experience that I bring is I'm a trans man. I'm also gay. I've been through hormone therapy, but also top surgery, and a few bottom surgeries. So, I think my lived-experience is important as well as my education and clinical experience.
The literature that we do have is often just saying, hey, there is no studies on this. So, it's frustrating being a trans person and being like, “I want to know more about my health, my body, what my needs are, as well as my clients”. And we're left out of research. And even when we're looking at practice guidelines, standards of care, that sort of thing, for eating disorders or nutrient requirements, chronic disease, trans people just aren't talked about, aren't really included, everything's based on this cis binary. And, so, it is frustrating, but I think it's inspiring to be like, okay, it's important that we're doing this work, but also it's an opportunity to really focus on client experiences and clinical experiences.
That's our evidence. Our evidence is in our practice.
AJ: Something that I came across was about disordered eating being more common in the trans and gender-diverse community2,5,6.
Ken Mullock: Definitely, within the trans community, we see higher rates of eating disorders. Kind of depends on what studies we look at, again, there aren't a ton of studies on this, so we don't really know what the rates are.
We see some things saying, you know, “trans people are four times more likely to report an eating disorder”, some studies say 2 to 18%. What I see in my day-to-day work and living in the community, I would say it's much higher than that. And what I like to say about this is, there's many different reasons we see these higher rates of eating disorders.
The one thing it kind of comes down to is seeking control when the way that the world perceives us or our friends and family and peers see us feels like it's out of our control. So, controlling food and eating is one way to kind of seek that control.
We see it at the onset of biological or natal puberty as a coping mechanism to deal with that puberty starting or to alter one's body to avoid the changes from that puberty.
We also see trans people using food and eating to change their physical body. Kind of as, you know, some people may call it DIY gender-affirming therapy. So, if someone isn't able to access gender-affirming surgery or hormones, they may restrict their intake or greatly increase their intake of food in order to change their physical features.
We also see surgeons setting BMI cutoffs for gender-affirming surgery. So, that can start to change someone's relationship with food. They purely see food as something to change their weight and start to develop unhealthy behaviours in order to meet cutoffs.
And just, you know, especially these days, there's a lot of pressure and fear, discomfort, around being a trans person trying to navigate the world, trying to navigate transition in a very transphobic and scary world right now. And so, food can be control and comfort.
AJ: If you were to look at people from, maybe, before they transition, or if they can't access gender-affirming care and then people that are further along in that process, whatever that looks like for that person, would you say that the rates would decrease7?
Ken Mullock: Yes, definitely. And we see that in a bit of the literature, but also just in practice is, steps toward and through social transition and medical transition lead to an improved relationship with food. And that's really positive to see. And something I like to say around this is, eating disorders don't exist in a vacuum, therefore treatment cannot be in one either. Any sort of treatment, without focusing on gender-affirming care, will likely be ineffective.
There's a study done on trans people's experiences with eating disorder treatment, and one of the participants gave this quote:
My eating disorder would never, ever have eased up as it did if I hadn't been able to transition and thus have the experience of liking and identifying with m y body in that way first8.
So, I think that's… That's really beautiful. And, as someone who's also been through a history of an eating disorder, I completely identified with that as well. I struggled a lot with an eating disorder, and when I was able to come out, start my transition, I felt so much more comfortable in my body. I didn't need to control it. I was able to develop this newfound love for my body, and thus, want to take care of it, want to nourish it and provide it what it needed to stay well and grow.
AJ: Another thing that I came across was that the trans population has a poorer diet in general9.
Ken Mullock: Yes. So, we do see in some of the studies that most trans people don't meet their nutritional requirements, have lower intakes of fruits and vegetables and less physical activity too. So, we do see those poor markers of health and wellness among the trans community.
That can come, I think, from various things. You know, we do see lower rates of employment among trans people, higher rates of food insecurity. So, that leads to lack of access to quality foods. Trans people often live in areas where there are more food deserts, so less access to fresh fruits and vegetables and that sort of thing. That could be one reason.
We do see lower education rates among trans people. And with lower education, we see poor-quality diets. And I think it does also come back to this altered relationship with food among trans people. And when your relationship with food isn't positive, you often don't eat as much variety and enjoy fresh foods and home cooked meals and that sort of thing as much.
I think an important piece, too, is enjoying food, eating food with others, your family traditions, cultural foods. And if a trans person is feeling isolated or discriminated against, scared to go out, you're missing that social piece of food. And that social piece of food often leads us to enjoy a more varied diet. So, I would suspect, you know, just from what I've seen in my practice, that that could be a reason that we see those generally more poor diets among the trans community.
And I would say, an important piece for providers to recognize is, the education piece is really important. When we're talking to our clients and patients about whether it be nutrition or just health, oftentimes if we're talking about eating disorder care, we may just tell people like, “oh, it's important that you eat, you know, you need to grow to be big and strong”. Or if someone's lost their period, you know, “it's normal, you need your period back”, that sort of thing, that's going to be quite triggering for trans people. It's not going to create any positive change. But educating your patients on a positive view of nutrition and wellness is important.
There's so much demonizing and negative talk about food and health. “Don't do this, it's bad. Don't eat this, it's terrible. You need to do this”. But how about we celebrate food and wellness and say, “hey, it's really exciting that if we honour our body's needs, we get to have more energy and prevent certain chronic diseases and have more longevity, that sort of thing”.
AJ: Are there different nutrient requirements for trans people who are on hormone therapy?
Ken Mullock: Currently, there are no guidelines or standards for nutrient needs among trans folks. Even though, right now, our nutrient requirements are solely sex-based, sex is just one factor for our nutrient requirements among many. So, our age, our stage of life, our activity, those things all affect our nutrition requirements, too.
Hormones do affect our calorie needs. Those often correlate to our muscle mass. So, if someone has been on hormones for just a couple months, we probably don't see much muscle mass change. Likely, then, their calorie requirements would be more closely associated with their sex assigned at birth. Six months is kind of where we see that onset of a lot of the muscle mass changes. So, for someone taking testosterone, that would cause an increase in calorie needs. For somebody taking estrogen, we often see muscle mass decrease, so that would decrease their calorie needs. And then usually around three to five years is when we see those maximum changes. So, that's when we see it more closely reflect the gender or sex they're transitioning to.
There's a lot of ways we can calculate energy requirements. If we are using one that's based on sex, so, we have the Mifflin-St. Jeor equation or the Harris Benedict equation, if somebody's kind of in those in between stages of starting to transition on hormones, I say, either take an average of the male and the female or use a range. So, you can kind of see, okay, what would maybe be the minimum, what would be the maximum, how long have they been on hormones, what's the extent of change they've seen?
Or you know, instead of doing that, using a weight-based equation. So, for calorie needs, we could say we'll just use 25 to 30 calories per kg of body weight to base our decision making off of. So, you do kind of have to get creative.
You can also think about physiology when it comes to certain vitamins and minerals. So, for example, iron requirements are different for cis males and cis females due to menstruation. So, if we do have a patient who is transitioning, then it would come down to is this someone assigned female at birth on testosterone who's no longer menstruating? Then we probably look at the male iron requirement. If they are still menstruating, then we use the female requirement.
We do see different things for testosterone and estrogen. So, for example, for people taking testosterone, we see increased LDL cholesterol and decreased HDL cholesterol. So, increase of bad cholesterol, decrease of good cholesterol, which is not typically what we want to see. Testosterone can also cause increased blood pressure, cardiovascular risk, type 2 diabetes risk, when other factors are present, too. It's quite likely that testosterone increases somebody's weight, that being muscle mass, but also increased fat mass. And typically, on testosterone, we see it more around the abdominal region. So, with those increased lipids and blood pressure and abdominal weight, that can come with increased risk for chronic diseases.
And so, we do have to be kind of mindful of these risks. It shouldn't be a deterrent, and we don't necessarily need to see it in a negative light, but just something that we should continue to monitor.
When somebody is taking those hormones, and then with testosterone, we often see an increase in appetite as well. And if there's someone who struggles with disordered eating, that can cause distress, all of a sudden, they're ravenous, feel like they can't control some of their cravings and appetite. And if they're not used to that, it can be quite an abrupt change. It can be difficult to deal with. So, those are kind of the main changes with testosterone.
And then, with estrogen, we see more of a decreased muscle mass, increased fat mass, and that can sometimes cause more functional changes, like more weakness. Estrogen can do different things to lipids. Sometimes we actually see them improve.
Blood pressure can increase or decrease, kind of depending on the individual or the type of testosterone blocker that's used. If somebody's taking spironolactone as a blocker, we can see hyperkalemia or dehydration risk because it's a diuretic. And then with estrogen, we can see those same increased risks of hypertension, hypertriglyceridemia, type 2 diabetes. And that's of course, when other risk factors are present.
Again, we don't need to see this as a negative thing, but just something that we'd want to monitor.
Nutrition can help mitigate those risks and can help keep some of those lipid and blood pressure changes more within ideal ranges.
I do think part of the initial stages of prescribing hormones, something that can be included is a discussion with the patient saying, “hey, you know, there may be some nutrition considerations. Would you like me to send a referral to a dietitian or is this something that you want to continue to monitor and then go from there?”. Doesn't need to be a fear-based thing, though.
Providers should also recognize that all food plays a role in someone's diet. As a dietitian, I'll have patients come and see me and say, “well, my doctor said I can't eat this”, and “this other doctor told me I need to start doing this because this level's high”, and all of this. But we need to make sure that we're all on the same page and not giving in to too much of diet culture or establishing fear around certain foods. If a trans person is able to even access food, that's a win. So, making sure that we're not putting too much emphasis on certain diets or eliminating foods and that sort of thing.
Many of the patients I see are people living with diabetes or heart disease or COPD or other chronic diseases. And I always say the fears that are instilled on them about their health, or food and nutrition, are more harmful than really any food would ever be. So, we’ve got to be careful about how we approach discussion around health with our clients and patients.
We also need to recognize that those risks aren't necessarily higher than the ones that cis people live with, or anything else that we do, you know, day-to-day. You know, everything has risk to it. Doesn't mean that we shouldn't be doing those things.
AJ: So, we've talked about hormones, what about surgery?
Ken Mullock: Yes. So, it's something that's not talked about enough or goes unrecognized, the importance of nutrition during surgery and especially trans related surgeries because we're seeing higher rates of food insecurity, more poor diets among trans people. And one thing we know about all surgeries is adequate nutrition helps to prevent or fight infection, increases positive outcomes from surgery, decreases risks of complications. So, nutrition is really important in all stages of surgery.
So, going into surgery adequately nourished, having good nutrition stores is really important. I think that's something that we want to increase the knowledge of in the trans community but also among healthcare providers. Making sure that people know, okay, leading up to surgery, it's not a time to try to lose weight or try any diets, but just focusing on adequately nourishing yourself.
And then, after surgery, so, everything that comes along with your body healing from surgery, nutrition is important. So, for example, vitamins that are key for healing, vitamin A, E, D, K. The minerals, like zinc and copper, are really important for wound healing. Your protein needs are higher, hydration needs are higher, and fibre to deal with post-op constipation.
But what can be difficult after gender-affirming surgery is your ability to be able to cook and prep food without using, you know, your arms, if you had top surgery or if you've had any lower surgeries, being able to get up and move around to make food, buy food, clean up. All of those steps around food preparation can be really difficult.
AJ: People often recommend meal-prepping before surgery, but meal prepping can be very expensive and time consuming.
Ken Mullock: Meal prepping is daunting, too. I think a lot of people get scared when they think of meal prep because there's all these things you got to do and buy and, and that sort of thing.
But oftentimes when I'm educating individuals about this, we talk about convenience foods that have high nutrition quality. So, like, canned vegetables and frozen vegetables that you can just have on hand, or if you are relying more on processed convenience foods like packaged noodles or Kraft dinner, that sort of thing, how can we add to it to add nutrition rather than trying to make whole meals from scratch? So, adding frozen vegetables or canned vegetables to those packaged noodles, or, you know, like, canned tuna and eggs as a protein source instead of having to cook fresh meats from scratch.
I worked with a team of dietician students a few years ago and we actually made a nutrition guide for gender-affirming surgery. So, we provided certain recommendations and help with planning and understanding the different vitamins and minerals that are important for pre-surgery, post-surgery, and then also some information for support on how to best help your loved one going through that with nutrition.
[Music]
AJ: Science and medicine know that wellbeing is multifactorial. Those factors include lifestyle factors, like exercise and diet. But those factors themselves are also influenced by many different things. The social determinants of health affect if, and how, someone can access things like physical activities and nutritious food.
We know that these factors will influence someone's health. And, on the foundation of that knowledge, next week we'll look at a few different organ systems, like the cardiovascular system and the pulmonary system, and how those are impacted, in a broad sense, in the trans and gender-diverse community.
[Music]
AJ: Thank you for joining us for another episode of Gender Queries and thank you to our guests for their stories and expertise.
You can check out the shownotes to find our transcript sources and resources recommended by our guests. You can contact us at genderqueeriespod@gmail.com or find us on Instagram @genderqueriespod.
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