TW: This story deals with topics such as eating disorders and self harm which may be distressing for some readers.
If you need help with an eating disorder, resources can be found at The National Eating Disorders Association (US) and Beat (UK). If you are experiencing suicidal thoughts or a mental health crisis, call or text Suicide and Crisis Lifeline: 988 (US) or call 999 (UK).
On a hazy morning in April 2022, Daniel-José Cyan opens his deserted fridge to find a single piece of mouldy mozzarella cheese. He holds it up to the light and, knowing he has to eat something, goes against his better judgment and takes a bite.
“I would go a long time without eating because I thought it would help me lose weight. And then I had to eat at some point because I wasn’t physically well,” Cyan, a 27-year-old living in the Bronx, told Uncloseted Media. “Even looking in the fridge can cause me to shut down.”
Cyan, who wound up getting food poisoning from eating the cheese, struggles with an eating disorder. And he’s not alone.
7 in 10 trans people aged 18-24 experience an eating disorder. These disorders are so pervasive in the LGBTQIA+ community that the Biden administration earlier this month awarded a multi-million dollar grant to psychologists pioneering identity-affirming eating disorder treatment for LGBTQIA+ people.
Trans men experience even higher rates of eating disorders than their female counterparts and the highest rates of any demographic group, according to a 2023 study from the National Library of Medicine. Experts say trans people disproportionately struggle with eating disorders because they face body dysphoria, societal stigma, and a deep desire for control amidst a world that often feels hostile and invalidating.
For trans men, this is compounded by the gendered expectations of being raised as a girl, and then—once they transition—the isolation and stigma that men who experience eating disorders often face.
According to a guide for providers who treat trans patients, trans men may develop an eating disorder in a quest to look more masculine by reducing curves and breast size, and lose their period. “By engaging in eating disorder behaviors and modifying their bodies, their goal is to appear more masculine as an intent to reduce gender dysphoria and distress,” Anne Marie O’Melia writes in the guide.
“Eating disorders are rooted in control,” Lydia Rhino, program director at The Eating Disorder Foundation, told Uncloseted Media. “It’s scary to be a trans person in the United States. When there’s no safety or acceptance in a lot of places, eating disorders are a way to express, ‘I can’t control what other people are doing outside of me, but I can control this.’”
In 2024, trans rights are under attack. President-elect Donald Trump won the White House largely on a campaign of anti-trans rhetoric with ads announcing his opponent, Kamala Harris, as being “for They/Them, while President Trump is for You.” In addition, there are hundreds of anti-trans bills sweeping through state legislatures, and last month Speaker of the House Mike Johnson banned trans women from using restrooms that match their gender identity on Capitol Hill.
On top of political animus and transphobia, Rhino says body dysmorphia also plays a role, and it is not surprising trans men are the most susceptible group.
“If you have lived in a body that does not feel like yours, where people have identified you one way, and you know that it didn’t feel accurate, why would your body be something that you respect and treat well?,” says Rhino.
“Eating disorders can be the management of gender dysphoria, they numb out emotions and give you something different to focus on so you’re not thinking about the transphobia you’re experiencing, and for a lot of people, they change the [way your body looks] without using hormones or surgery because they can slow puberty,” Emmy Johnson, a therapist who specializes in LGBTQIA+ people with eating disorders, told Uncloseted Media.
Cyan has restricted his food intake and binged for nearly 20 years. “I have struggled in my relationship to food since childhood. When I was in the fifth grade, I was heavily teased and bullied by my peers, my teachers and my family for my weight,” he says, adding that this made him learn to hate himself.
“I counted calories, I avoided meals, and food became equal to fatness and that, to me, was one of the worst things you could be,” he says. “Food became a thing for survival. I ate because being hungry would make me physically sick. I always thought I had some sort of anorexia, but according to a nutritionist I’m seeing, it’s called binge-restrict eating disorder.”
Natalie Allen, an eating disorder therapist at Toronto Psychology and Wellness Group, says that one of the reasons people raised as girls statistically experience more eating disorders than cisgender men is because of socialisation. “[People assigned female at birth] have historically received a lot more pressure to maintain specific physical beauty standards and ideals,” she says.
“I didn’t have a boyhood. I had a girlhood. That’s how I was taught to understand my body and food, because there were these impossible beauty standards of what it meant to be a girl,” says Cyan.
He remembers sitting on his couch at nine years old and watching Girl Code on MTV where they suggested viewers chew ice cubes and imagine them as food as a diet tip. “I was like, ‘This feels like the right thing, and maybe I could finally lose weight.’”
“There’s just so much pressure to fit into a role,” Rhino says. “So it’s one area that a trans person can be like, ‘If I can change my body and make my body look this way, then I can communicate to people that this is who I am, and how I identify.’ A lot of it has to do with the social pressure to fit into a box.”
As Cyan went through puberty and his body began to change, his disorder escalated and was “at its worst” as a teenager. “I would spend the entire day not eating and waiting to see how long I could go before I fainted,” he says. “[Passing out] was a goal of mine. But I thought to have an eating disorder, I had to be underweight, so it must not be that.”
Part of the barrier to recovery for trans men are the societal expectations of what kinds of people experience eating disorders.
“We have a problem understanding the problem of eating disorders in the United States,” Doreen Marshall, executive director of the National Eating Disorder Association, told Uncloseted Media.
“Most people assume those impacted are young, white, thin, and female. [But] only 6% of people who struggle with eating disorders are clinically underweight. When somebody who is not that model then has to navigate recovery in the real world, they’re also having to navigate this landscape that doesn’t see them as a person who is impacted.”
Cis, white women are the most likely to be asked about eating disorders by their doctors and receive treatment. Men have reported struggling to feel understood by therapists, feeling unwanted in the treatment environment and that their concerns are not taken into account. This means a lot of men – and especially trans men – are left untreated.
“If I am a trans person seeking treatment, even the providers I go to may carry some of that bias,” says Marshall. “That bias ultimately impacts whether I get care or not.”
Cyan experienced this bias when he was seeking gender-affirming care two years ago. When he went into the doctor to get evaluated for top surgery revision, his surgeon told him that he would not operate on him unless he lost weight and gave him “no recommendations on how to do it.”
“I didn’t realize how big of a trigger it would be until I spiraled and spent the entire year restricting myself from eating until I wound up binging. My doctor had no idea I was already struggling with an eating disorder.”
Cyan found it easier to be open about his eating disorder when he was feminine-presenting, but since he transitioned, he gets nervous talking about it.
“I feel like it’s taken less seriously because I look like a man, and it’s more embarrassing to have to deal with it as a man. When I was considering my gender, I always thought men don’t have to care about what they look like. But that was not the case.”
Cyan says men are held to standards of fitness and “pressure to be strong in a certain way.”
“There’s a sense of fitness that is still expected when it comes to peak masculinity. It’s to be muscular and strong and I thought that’s what I needed to be.”
After Cyan got food poisoning from the expired cheese last year, he realised he needed to seek care. “It was scary for me … I felt alone because I didn’t know how to have conversations about it.”
“Eating disorders by nature are isolating,” says Adee Levinstein, nutrition manager at The Eating Recovery Center. “And being part of the trans community can also feel very isolating in our current world.” She says it makes sense that they overlap.
According to Johnson, the therapist who works with transgender folks, gender-affirming healthcare can help trans people struggling with eating disorders. “I have seen how motivating it is for patients to receive gender-affirming care,” they say. “A lot of eating disorder recovery is about exploring and developing identity, and affirming gender identity” is a critical part of that.
When trans men receive gender-affirming care, studies point to a reduction in eating disorder behaviours. Another 2019 study found that when gender is affirmed and gender dysphoria is reduced, eating disorder symptoms decrease.
Eating disorder recovery is not easy. Five decades of literature suggest that fewer than half of adults with eating disorders will recover.
Johnson says that getting to the root of the problem, whether it is control, body image, body dysphoria, or external factors, is essential. “Recovery is not linear,” they say. “If you are not ready to pursue recovery, you still deserve support and we want to help you stay alive and reduce the harm that the eating disorder is causing you.”
For Cyan, his recovery was complicated after he was told he had to lose weight in order to receive top surgery revision. He wound up opting for bariatric surgery – which reduces the size of the stomach and changes the digestive system. This allowed him to feel more connected to his body.
The newfound connection also helped him begin to recover from his eating disorder. Beyond the surgery, he has been in therapy for years, seeing a nutritionist, and also uses support groups online that help with recovery. “I’m surprised with how much I ended up relying on groups. Many folks will remind me, ‘You need to eat frequently, and that’s how you end up a healthy weight, meeting your protein numbers and your hydration levels, not restricting yourself.’”
Earlier this summer, Cyan started up the burner in his kitchen for the first time in his new apartment. He grilled salmon and air-fried vegetables.
While he still has the occasional thought of disordered eating, his relationship to food is improving. “I’m actually starting to enjoy cooking again,” he says. “My relationship with food is different. For so long, eating was something that I had to force myself to do because of how the eating disorder worked. Now that my self-esteem is higher, I’m more decisive about the food that I’m putting into my body. At times, I still feel the need to binge or completely not eat, but mostly I’m doing okay.”
