NUTRITION FOR TRANS ATHLETES, PT 3
NUTRITION FOR TRANS ATHLETES, PT 3:
Fueling Through Transition, Recovery, and Body Change
So far, we’ve talked about the nutrition basics and how to build a plan that fits your body, not some outdated binary framework. But what about when your body is changing? What about when hormone therapy or gender-affirming surgery layers additional needs onto your care?
These shifts impact everything from metabolism to recovery, and understanding how to adapt your nutrition through these changes can make a big difference in how you feel, perform, and heal.
HOW HORMONE THERAPY IMPACTS NUTRITION
HOW HORMONE THERAPY IMPACTS NUTRITION
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.
Increased lean mass → higher calorie and protein needs
More red blood cells → increased iron needs (whether or not you are menstruating)
Increased metabolic rate → higher overall energy demand (more calories needed)
Note: Pay attention to how training feels. As strength increases, you may need to fuel more than you’re used to.
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.
Shift in fat distribution → may reduce lean mass over time
Increased need for bone support → prioritize calcium, vitamin D, and protein
Potential drop in metabolism → doesn’t mean automatically needing to eat less, but monitoring energy balance matters
Note: Supporting bone health through strength training and nutrient intake becomes even more important.
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.
WHAT 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.
WHEN HRT HAS BEEN ONGOING (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/
PRE- AND POST-SURGICAL NUTRITION SUPPORT
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.
BODY IMAGE, DISORDERED EATING, AND DYSPHORIA IN ATHLETICS
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.
AFFIRMING CARE MATTERS
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.
WHAT TO REMEMBER: THERE IS NO ONE-SIZE-FITS-ALL
Fitness, nutrition, and wellness spaces must 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 of ideal intake, 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 most: 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.
WRAPPING UP
Nutrition during transition, recovery, or body change doesn’t need to be perfect; it just needs to be informed and responsive. The more you can step away from rigid rules and toward flexible, personalized strategies, the better equipped you’ll be to support your performance, health, and identity in the long run.
If you’re unsure where to start or feel like your current approach isn’t working for you, consider connecting with a coach or provider who understands the nuances of fueling trans athletes. Aligned support can help you train harder, recover faster, and feel more confident in your approach.
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