Nutritional Support for Transgender People in Transition

When transitioning to a female physiology, therapies typically include hormonal treatment with estrogen and progesterone. One biological benefit to added estrogen is the protective effect it has on bone health. [1] Unfortunately, as estrogen begins to outweigh testosterone in the system, weight gain typically ensues. Estrogen favors energy storage, and this weight gain generally parallels an increase in fat mass. [2] You could try to embrace this change as just another element of womanhood. However, it does have a history of triggering disordered eating. 

If weight gain is a health concern as you transition from male to female biology, take a close look at the nutrition requirements for a woman of your height and structure. You may find that the total calories you need each day are lower than they once were. There will also be slight differences in requirements for specific nutrients.   

The risk of cardiovascular issues is higher in biological males than females. As such, scientists used to believe that female hormones must somehow offer cardiovascular protection. Studies involving transgender subjects have shown this is not necessarily the case. [3] In fact, the combination of estrogen and anti-testosterone treatment often causes an increase in triglycerides and blood pressure, an increase in subcutaneous and visceral fat, and a decrease in insulin sensitivity. [3] All of these factors increase a person’s risk for cardiovascular trouble.  

In comparison, FTM treatment does not typically affect blood pressure, fat distribution, cholesterol balance, or insulin sensitivity. [3]  

When undergoing MTF transition, it is especially important to nurture your body in a way that protects your cardiovascular system. Omega-3 fatty acids, like those found in fish oil supplements, support a healthy cardiovascular system.* Epidemiological and clinical evidence suggests that there is a significant inverse association between long-term intake of Omega-3s, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and mortality associated with cardiovascular issues.* [4-6] Studies also measure the effects of EPA and DHA on serum lipids, plasma, platelet fatty acids, and fasting glucose concentrations.* [7] 

You can take other heart-healthy supplements in conjunction with a daily multi, such as CoQ10 and curcumin.* [8] 

In the short term, testosterone treatment will likely lead to an increase in muscle mass, fat loss, and increased facial and body hair growth. [9,10] Unfortunately, it may also be accompanied by cranial hair thinning and skin blemishes. [9] Breakouts are often triggered by a sudden change in hormones. Sebum production is significantly increased in facial hair follicles in response to testosterone. [11] Luckily this effect is not a lasting one for most people. In one study of FTM trans people, breakouts peaked at 6 months of testosterone treatment. They were no longer visible for most subjects after long-term treatment. [9]  

This effect will vary from person to person. However, having a comprehensive skincare routine may help to minimize the appearance of blemishes. Niacinamide or vitamin B3supports the healthy production of sebum.* [12]  

Although few studies have analyzed the long-term effect of testosterone treatment on bone health in trans men, estrogen is a known protector of bone density. Due to this factor, and studies showing increased bone turnover in trans men on testosterone therapy, [10] it is reasonable to hypothesize that bone density may be at risk due to FTM gender affirmation. Low bone density occurs when the creation of new bone doesn’t keep up with the breakdown of old bone. Back discomfort, stooped posture, and a higher risk of fracture are all symptoms of poor bone density. One setback is that the scoring for bone density diagnosis is based on sex. It is unclear whether the diagnoses of trans people on hormone therapy or post-gonadectomy should be a calculation based on their gender identity or their biological sex at birth. [13] 

Regardless of terminology, bone health is important to our longevity as we age. Loss of estrogen dominance may have a detrimental effect on bone density and strength, especially if we are not meeting nutritional demands for bone health. Many people know that healthy bones require calcium and vitamin D, but a 2-year, double-blind, placebo-controlled study that measured spinal bone loss in postmenopausal people showed that calcium (as calcium citrate/malate) plus trace minerals (zinc, manganese, and copper) supported bone mineral density.* [14]  

The risk for issues with cardiovascular health is significantly higher for trans women than for trans men. [15] However, hormone therapy for trans men has been shown to increase blood pressure, and unbalance cholesterol levels compared to cisgendered men of the same age group. [15]  

Omega-3 fatty acids are fantastic cardiovascular support nutrients as described above.* Another heart supportive nutrient is coenzyme Q10, also known as ubiquinone or CoQ10. Coenzyme Q10 is a mitochondrial coenzyme, essential for the production of cellular energy (ATP), and has powerful antioxidant activity.* [16] Our bodies make it naturally, but production tends to slow down as we age. Through its central role in energy production, CoQ10 supports the healthy function of cells that need and use a lot of energy such as those of the heart, blood vessels, muscles, and kidneys. [17]  

Mental health is by no means a trans-specific issue, but statistics show a significant amount of physical and psychological abuse is experienced by trans people,. [18] Additionally, there is evidence to suggest that low testosterone levels may be associated with a low mood. [19] Due to this relationship, MTF transition may come along with new, low feelings as your body adjusts to its new hormonal levels. The protective factors that serve as the best predictors against self-harm in the trans community have been analyzed to be social support from friends and family and a generally optimistic attitude and personality. [18]  

These are not problems that can be solved with nutrition alone. However, multiple studies have demonstrated the connection between the quality of our diets and mental health. By doing our best to supply body systems with the proper nutrition, we make available  the molecules to support the brain and body through change and transition. A high-quality diet has been connected to a more balanced mood and lower risk of committing self-harm. [20]

The gut in particular has been dubbed “the second brain” and the gut-brain-axis is gaining the attention it has been receiving. There are more than one million neurons making up the “enteric nervous system” of the gut, which is more neurons than the spinal cord or the peripheral nervous systems. [21] 

The enteric nervous system uses more than 30 neurotransmitters, including serotonin, melatonin, and acetylcholine, just like the brain, and 95% of the body’s serotonin is located in the gut. [21] Stress, in the form of physical or psychological trauma, excessive worry, and a chronically low mood can all have a negative effect on the health of the gut, and in turn, the health of the gut can have an effect on these mental conditions. [22]   

The trillions of bacteria in the gut “communicate” with enteric nervous system cells (which they greatly outnumber) and can have an effect on mood. Helpful, healthy bacterial species, known as probiotics, promote more than just good digestion. [20] Certain probiotic species have been linked directly to increased serotonin levels. [23] 

The health and proliferation of probiotic bacteria do require input other than probiotics alone. Probiotic microorganisms feed on non-digestible fiber oligosaccharides, also known as prebiotics.  

Due to severe consequences of folate deficiency, especially for fetal development, common food items like bread, rice, and cereals are often “fortified” with folic acid. Relatively recently, however, it was discovered that a significant portion of our population does not process synthetic folic acid properly, due to a mutation in the MTHFR gene. Folate plays a key role in methylation, and therefore the production of neurotransmitters such as serotonin, dopamine, and norepinephrine.* [19] L-Methylfolate bypasses the activation process that folic acid must go through, and is ready to use, regardless of one’s MTHFR variant.  

Methylation and the production and processing of neurotransmitters all require vitamins B6 and B12 in addition to folate.* [19] Be sure these cofactors are also plentiful in your diet or daily supplement regimen to get the most from methylfolate.* 

Disclaimer:
The information provided is for educational purposes only. Consult your physician or healthcare practitioner if you have specific questions before instituting any changes in your daily lifestyle including changes in diet, exercise, and supplement use.

Laura Lewis is a clinical researcher and science communicator with a Master of Science degree and a background in nutrition science and integrative health. She brings a decade of experience translating complex clinical data into accessible insights for healthcare practitioners and patients alike.

Laura has contributed to educational programming and strategic content development across the integrative and functional medicine space. Her strengths lie in evidence synthesis, practitioner engagement, and crafting communications that bridge the gap between scientific rigor and real-world application. At ARG, Laura supports clinical content development and educational initiatives that elevate practitioner confidence and product credibility.