Internalized transphobia and body image concerns: a cross-sectional comparison of transgender and gender diverse individuals before and after gender-affirming therapy

Objectives. Transgender and gender-diverse (TGD) individuals often face significant psychological challenges due to body dissatisfaction resulting from gender incongruence. Gender-affirming hormone therapy (GAHT) is recognized to improve overall well-being, but its impact on body dissatisfaction and the risk of eating disorders (ED) is less clear. The primary objective of this study was to examine the combined effects of gender-affirming hormone therapy (GAHT) and internalized transphobia (IT) on concerns about body image and the risk of eating disorders among transgender and gender-diverse individuals.

Methods. This cross-sectional study investigates the effects of GAHT and internalized transphobia (IT) on body image concerns and ED risk among 79 TGD individuals. Participants were divided into two groups: those who had not started GAHT (GAHT-, n = 49) and those who had been on GAHT for at least one year (GAHT+, n = 30). Body uneasiness and ED risk were assessed using the Body Uneasiness Test (BUT) and the SCOFF questionnaire, respectively.

Results. The results revealed greater body anxiety and ED risk in the GAHT- group, suggesting that GAHT may alleviate body dissatisfaction. Additionally, IT significantly influenced body image concerns, particularly weight phobia and body image dissatisfaction. The effects between GAHT and IT were significant, highlighting that people experiencing high IT and lacking GAHT face amplified body uneasiness.

Conclusions. These findings suggest that while GAHT can mitigate some distress, psychological interventions targeting IT are essential to fully address body image concerns and ED risk in TGD individuals. The study underscores the need for a holistic approach that combines medical and psychological care for this population.