nutrition considerations for trans athletes: supporting performance beyond the binary
When it comes to nutrition guidance for transgender individuals, especially athletes, there’s a significant and concerning gap. Most mainstream sports nutrition resources assume a cisgender audience, leaving transgender athletes to piece together advice that doesn’t reflect their physiology, goals, or lived experiences. This oversight can leave trans individuals feeling unseen, confused, or pressured to follow guidance that doesn’t actually fit their needs.
Current research confirms this lack of direction. A 2020 study by Dr. Whitney Linsenmeyer, Dr. Theresa Drallmeier, and Dr. Michael Thomure, for instance, explicitly found that “no standards of care exist to inform clinicians on nutrition assessment methods for transgender and gender non-conforming patients.” They write: “Clinicians may opt to use the values related to a patient’s gender identity, may individualize nutrition care based on the patient’s stage of medical transition, or may utilize a range of values where appropriate.”
These broad recommendations, coupled with insufficient ongoing research, mean transgender athletes often lack the clear, supportive guidance they deserve. Even the seemingly neutral language we use in nutrition (what’s assumed to be “normal” or “standard”) can unintentionally exclude or alienate trans individuals. Building truly inclusive and individualized care requires us to rethink these foundational assumptions.
THE PROBLEM WITH BINARY NUTRITION GUIDELINES
Most traditional nutrition recommendations, including calorie ranges, vitamin needs, or protein targets, are rigidly divided into “male” or “female” categories. This binary approach leaves anyone outside the definitions with generic or often inaccurate guidance, particularly when they’re trying to fuel effectively for sport or use common nutrition tracking tools (apps, online calculators, etc.).
Relying solely on sex assigned at birth, for instance, can lead to significant under- or overestimations of an individual's actual needs. Consider how hormone use, existing muscle mass, or menstrual status can dramatically alter requirements. For example, someone who is menstruating typically has higher iron needs, while an individual on testosterone may also see increased iron requirements due to changes in red blood cell production.
Beyond macronutrients, body composition assessments can be misleading or even distressing when interpreted through a cisgender-centric lens. When you add the pervasive influence of diet culture, it's easy to see how traditional advice simply doesn't fit the reality of many transgender athletes.
Building a Personalized Nutrition Plan for Trans Athletes
We can (and must!) move beyond binary nutrition guidelines. A truly personalized approach looks at more than sex or gender. Instead, it accounts for:
Muscle mass and body composition;
Activity level and training volume;
Dieting history or signs of metabolic adaptation;
Hormone therapy (HRT) status and duration.
These individual factors are crucial for shaping a nutrition plan that effectively supports performance, recovery, and personal identity. And while a person's needs may evolve throughout their transition, it’s important to remember that many of the same foundational nutrition principles still apply to all athletes.
Nutrition Foundations: What Every Athlete Needs
While individualized care is paramount, certain core nutrition principles apply to all athletes. Here’s a look at the foundational elements and how to personalize them:
ENERGY BALANCE (CALORIES)
To support peak performance, adequate fuel is non-negotiable. Consuming at least "maintenance" calories (meaning you're eating roughly as much as you're burning) is vital for recovery, training intensity, and maintaining lean muscle mass.
>> Understanding your calorie needs: Start with your height, weight, age, training load, dieting history, and HRT status, not just a gender checkbox.
PROTEIN NEEDS for recovery
Protein is crucial for repairing and building muscle tissue. This is especially important if you're engaging in strength training, pushing hard in your workouts, or experiencing changes in lean mass due to HRT. Consistent protein intake throughout the day supports better recovery and strength gains.
>> Calculating your protein needs: Aim for 0.7–1 gram of protein per pound of body weight per day.
Why Carbs Are Essential for Athletes
Carbs are your body's primary and most efficient fuel source for athletic performance. For most athletes, a baseline of 40–50% of daily calories from carbohydrates is a solid starting point. If you're doing longer sessions, training multiple times a day, or focusing on endurance, you might need to increase this to 60–70%.
The Role of Fats in Health and Hormones
Fats are essential for numerous bodily functions, including hormone production, brain health, joint lubrication, and the absorption of fat-soluble vitamins. Maintain fat intake at or above 30% of your daily calories, which is particularly relevant if you're on HRT, as it can influence how your body processes fats.
Timing Your Nutrition for Better Performance
Once your daily intake of macros is consistent, strategic nutrient timing can further enhance your performance and recovery. Try consuming around 30% of your daily carbohydrates (paired with some protein) before your workout for energy, and another 30% (also with protein) after training to aid recovery and manage hunger.
How to Measure Progress Without the Scale
When your body is undergoing changes, the scale and progress photos aren't always the most helpful or affirming metrics. Instead of focusing solely on appearance, track indicators like your strength gains, how energized you feel during and after training, and the consistency of your workouts. This approach provides a more holistic and empowering view of your progress.
Nutrition recommendations don't need to be rigid or fit into a binary. The goal is to individualize your approach with nuance and flexibility. Providing a range for these needs (rather than strict targets) allows room for body feedback and ongoing adjustments.
How Hormone Therapy Changes Nutrition Needs
Hormone replacement therapy (HRT) introduces significant physiological shifts that can profoundly influence metabolism, appetite cues, body composition, and specific nutrient needs. As a result, nutritional requirements may evolve over time and benefit from regular check-ins and adjustments.
Testosterone therapy usually leads to an increase in muscle mass and lean body mass, which often translates to higher calorie and protein requirements. Testosterone can also boost red blood cell production, enhancing oxygen-carrying capacity and endurance. This change, however, also means an increased need for adequate iron intake. Keep in mind that a higher muscle mass typically results in an increased metabolic rate.
Estrogen therapy often results in a shift in fat distribution and may lead to some reduction in muscle mass. Estrogen can also impact bone health, frequently necessitating increased intake of calcium, vitamin D, and protein to support bone density and overall strength and recovery.
These changes may affect your metabolism, hunger cues, or how your body responds to training. But here’s the key: the principles of performance nutrition (fueling enough, recovering well, and eating to support movement) still apply.
If you’re not on HRT: Using nutrient ranges based on sex assigned at birth may currently offer the most physiologically accurate starting point. While this might feel misaligned with your identity, remember it's just one data point. When combined with affirming care that honors your identity and goals, it serves as a flexible guide, not a rigid rule.
If you’ve been on HRT for 6+ months: Your physiology has likely shifted enough that it often makes more sense to transition towards using reference ranges aligned with your gender identity. However, this is not a strict rule; the timing and extent of this shift largely depend on your individual response to HRT and your current physiological state.
Ultimately, instead of trying to fit into a binary framework, focus on practical indicators. Consider your lean mass, training volume, recovery quality, and energy levels as your primary guides for nutrition. It's not about pinpointing a single "right number," but rather about staying flexible and paying close attention to what genuinely works for your body.
Resource: https://pmc.ncbi.nlm.nih.gov/articles/PMC10899494/
Nutrition for Gender-Affirming Surgery Preparation
If you’re preparing for gender-affirming surgery, nutrition becomes an even more critical component of your care. Strategic fueling during this time can significantly support your body's healing process.
For instance, UCSF guidelines recommend increasing protein to 2g/kg of body weight and adding ~500 extra calories per day for at least four weeks before surgery. This proactive nutritional support can greatly assist with tissue healing, muscle retention, and minimizing potential complications.
This type of focused nutritional planning is often overlooked, yet it's an integral part of providing comprehensive, affirming, and body-supportive care for trans individuals.
Navigating Body Image, Eating Disorders, and Dysphoria in Sport
It's critical to acknowledge that transgender athletes face a significantly higher risk for disordered eating and body image distress. This vulnerability is particularly pronounced within sports environments that emphasize leanness, adherence to weight classes, or specific aesthetics.
This can show up as restricting to suppress body changes; overexercising to qualify for surgery; and using food to cope with dysphoria, discrimination, or lack of affirming care.
By intentionally shifting the focus of nutrition from appearance to fueling for strength and capability, we can help foster body trust and significantly reduce the intensity of dysphoria. This approach is especially powerful in athletic spaces where individuals are often viewed through a narrow, gendered, or appearance-based lens.
WHAT TO REMEMBER: THERE IS NO ONE-SIZE-FITS-ALL
It’s time to move beyond rigid, "cookie-cutter" nutrition advice and embrace an approach that is truly effective and affirming. For trans athletes, this means:
Prioritize your body's unique data, not binary norms. Your individual physiology and lived experience are your most important guides.
Consider your complete picture: Factor in your hormone status (if applicable), specific training style and volume, and any relevant dieting history.
Work within flexible ranges, not strict targets. Nutrition needs aren't static; allow room for your body's feedback and adjust as needed.
Tune into how food makes you feel and perform. Your energy levels, recovery, and overall well-being are key indicators and will give you the most valuable feedback.
Measure progress by what truly matters: Focus on gains in strength, improved energy, and training consistency, rather than relying solely on aesthetic changes or scale numbers.
This personalized approach empowers you to fuel your body in a way that truly supports your performance, health, and identity.
The Power of Affirming, Individualized Care
For many trans athletes, the common advice to “just learn to love your body” can feel profoundly hollow when gender-affirming care is absent or inaccessible. Often, the primary goal is simply to feel safe and at home in their body again. This is where focusing on your body’s capability can be a more realistic and powerful goal: respecting and caring for your body for what it does (like allowing you to train and experience life) rather than solely how it looks.
Resources:
For the past two years, I’ve had the privilege of supporting athlete cohorts through The OUT Foundation - including working closely with trans athletes whose needs are often overlooked in mainstream nutrition guidance.
Research in this area is still limited, despite key differences in nutritional needs for trans athletes, especially those undergoing HRT or gender-affirming surgery. At the same time, we’re often navigating body dissatisfaction and dysphoria, which can be especially prevalent among gender-diverse individuals.
There’s so much more work to be done, but these considerations can be a starting place: