Eating Behaviors in Transmasculine and Transfeminine Adults as Assessed by the Three Factor Eating Questionnaire

John Michael Taormina^1*Matthew Bolt^1,2Marc-Andre Cornier³Kerrie L Moreau¹Margaret E Wierman¹Micol S Rothman¹Kristina T Legget¹Jason R Tregellas¹Allison K Hild¹Daniel B Hammond¹Amanuail Gebregzabheir¹Mary P Mancuso¹Mary D Sammel^1,2Sean J Iwamoto¹

• ¹University of Colorado Anschutz Medical Campus, Aurora, United States
• ²Colorado School of Public Health, Aurora, United States
• ³Medical University of South Carolina, Charleston, United States

Introduction: Transgender and gender diverse people have unique influences on their eating and nutrition-related behaviors, which increase their risk for disordered eating. Understanding eating behaviors in this population may help healthcare providers screen for and treat eating pathologies. Few studies have evaluated their eating behavior traits using validated measurements. Methods: This secondary cross-sectional analysis evaluated eating behavior traits of transmasculine (TM) and transfeminine (TF) adults on testosterone-based and estradiol-based gender-affirming hormone therapy, respectively, for >1 year. The Three Factor Eating Questionnaire (TFEQ) was self-administered to assess the traits of cognitive restraint, disinhibition, and susceptibility to hunger. Linear regression models were used to estimate mean TFEQ scores to account for sample age variability, as well as estimate associations between BMI and BF% with TFEQ scores by gender group adjusted for age. Results: Of 16 participants in the TM group, actual mean scores (SD) were cognitive restraint 7.8 (4.3), disinhibition 6.7 (4.4), and susceptibility to hunger 5.9 (3.8). The actual mean scores (SD) of the 30 TF participants were cognitive restraint 10.2 (4.9), disinhibition 6.0 (3.9), and susceptibility to hunger 4.0 (3.6). The groups had similar actual TFEQ scores, though after adjustment for age, TF had a higher predicted mean cognitive restraint score while TM had a higher predicted mean susceptibility to hunger score. Eating behavior traits were generally positively associated with BMI and BF%. For TM, associations were positive between susceptibility to hunger for BMI and BF% and between disinhibition and BMI; meanwhile, for TF, associations were positive between cognitive restraint and BMI and BF%. Discussion: TM and TF had similar eating behavior traits assessed by the TFEQ that resemble TFEQ profiles previously reported for cisgender women but higher than previously reported for cisgender men. Associations of eating behavior traits with anthropometric measures of adiposity were generally positive, suggesting that TGD people with overweight or obesity may experience greater cognitive restraint, disinhibition, and susceptibility to hunger than TGD people with normal weight. Future larger studies should assess the relationships of these behaviors with other influences, such as disordered eating and gender minority stress, to further understand eating behaviors in TGD populations.