Table 1 Final adults articles retained for review

Algars et al. [28]

n = 21

Eating Disorder

11 adult transgender men participants and 9 adult transgender women participants

Qualitative interviews with brief survey

Body Mass Index and EDI-3 survey

Open ended questions such as "tell me about your relationship to food and eating", "describe what you eat during a typical day in your life" etc

A majority of both trans men and trans women participants reported past or current disordered eating. Attempts to suppress biological gender or accentuate desired gender most often drove the desire for thinness

Finland

Algars et al. [29]

n = 1,142

Body Image and Disordered Eating

698 adult women and 444 adult men

Cross-sectional survey

Derogatis Sexual Functioning Inventory body image scale, Eating Attitudes Test, Gender Identity Scale

N/A

Those with conflicted gender identity showed higher levels of body dissatisfaction. Women with a conflicted gender identity also showed more eating disturbance than controls

Finland

Auer et al. [30]

n = 154

Body Image

82 adult transgender women and 72 adult transgender men

Cross-sectional survey

Short-form Health Survey, Beck Depression Inventory II, Social Support Scale, Fragebogen zur Beuteilung des eigenen Korpers

State-Trait Anxiety Inventory Form X, Pittsburgh Sleep Quality Index, The German pain questionnaire

N/A

Insecurities about appearance and poor self-perception of body image was an independent predictor for quality of life for transgender women but not for transgender men

Germany

Bandini et al. [31]

n = 295

Body image and eating disorders

50 adult trans women participants, 50 adult trans men participants

Cross-sectional survey, Between groups comparisons

Symptom Checklist, Body Uneasiness Test

Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Transgender participants without genital reassignment surgery had higher levels of body uneasiness compared other groups. Trans women showed higher values than both controls and eating disorder subjects in the compulsive body self-monitoring domain, while no differences were observed between trans men and controls in this area

Italy

Bandini et al. [32]

n = 109

Body image

Adults

Cross-sectional

Body Uneasiness Test; Symptom Checklist-90 Revised; 19-item yes/no checklist covered childhood maltreatment and family relationships, gender identity and SRS, sexual orientation, and psychiatric history

Patients were asked to specify any current pharmacological treatment

Childhood maltreatment was associated with a higher level of body image dissatisfaction and worse lifetime mental health. Participants who reported childhood maltreatment reported higher body compulsive self monitoring and worry about certain body parts

Italy

Becker et al. [9]

n = 202

Body image

62 adolescent trans women, 20 adolescent trans women, 50 adult trans men, and 70 adult trans women

Cross-sectional

Body Image Assessment Questionnaire:

“attractiveness/self-confidence” scale, “accentuation of body appearance” scale, “insecurity/concern” scale, and “sexual-physical discomfort” scale

N/A

Adolescents had a less favorable body image compared to adults on all four scales. Transgender participants who already received medical interventions reported a less impaired body image

Germany

Bell et al. [33]

n = 317

Eating disorders

97 gay adult men, 82 lesbian adult women, and 138 TGNC adults

Racial diversity present

Cross-sectional

Patient Health Questionnaire Depression Scale, Generalized Anxiety Disorder 7, Self-Compassion Scale- Short Form, Negative Social Exchange Subscale of the Multidimensional Health Profile: Psychological Functioning, Interpersonal Needs Questionnaire, Perceived Stigma Scale; National College Health Assessment, Eating Disorders Screen for Primary Care

N/A

Lesbian women and TGNC adults were more likely than gay men to report current or past experience with an eating disorder, and TGNC adults were more likely to report dissatisfaction with eating patterns. Self-compassion was inversely associated with ED proneness among TGNC adults

Australia

Bozkurt et al. [34]

N = 160

Body image

36 gay adults, 52 trans women adults, and 72 controls

Cross-sectional

Body Cathexis Scale; Eysenck Personality Questionnaire

N/A

The trans women participants were more satisfied with their waist, hips, eye shape, and weight compared to control participants, as well as height, legs and body postures, but were not satisfied with their shoulder width, arm length, or genitals

Turkey

Brewster et al. [4]

N = 205

Body image and Eating Disorders

205 transgender adult women. Racial diversity present

Cross-sectional

Heterosexist Harassment, Rejection, and Discrimination Scale;

Interpersonal Sexual Objectification Scale; internalization general subscale of the Sociocultural Attitudes Toward Attractiveness Questionnaire-3; body surveillance subscale of the Objectified Body Consciousness Scale;

Body Image Ideals Questionnaire;

Eating Attitudes Test

N/A

Dehumanization was found to have a positive relationship with internalization and a positive direct and indirect relationship with disordered eating. Internalization was found to have a positive relationship with body surveillance, body dissatisfaction, and a direct and indirect relationship with disordered eating

United States

Carretta et al. [35]

N = 192

Eating disorders and body image

192 adult drag queens,

Racial diversity present

Cross-sectional

Drag Queen Performance Style Scale developed for this study, Internalization (general) subscale of the Sociocultural Attitudes Toward Appearance Questionnaire-3, Upward Comparison subscale of Upward and Downward Appearance Comparison Scale, Centrality subscale of the In-Group Identification Scale, Eating Attitudes Test, Acceptance of Cosmetic Surgery Scale

N/A

Hyper-feminine drag was positively associated with disordered eating while gender-fluid drag was not. Further, this relationship between disordered eating and hyper-feminine drag is mediated by both internalization of cultural standards of beauty and upward appearance comparison, but was not mediated by identity salience

United States

Case et al. [36]

N = 16

Body image

8 trans men and 8 cisgender women adults

Cross-sectional

Somatosensory evoked fields recorded via magneto-encephalographic scanner followed by diffusion tensor imagining

N/A

Trans men participants demonstrated differences in neural processing of incongruent-feeling body parts between transgender participants and controls. Trans men participants on testosterone therapy rated their pre-op chests as belonging to them more than those not on hormone therapy, however this difference was not demonstrated on MEG imaging

United States

Castellano et al. [37]

N = 120

Body image

46 transgender adult women, 14 transgender adult men, 45 cisgender women, and 15 cisgender men

Cross-sectional

Quality of Life general score, Quality of sexual life subscore, quality of body image subscore, and hormone levels

N/A

The transgender group and control group did not differ in quality of body image or in quality of life. In addition, there was an inverse relationship between LH levels and both body image score and quality of sexual life score, while there was a non-significant relationship between quality of life and LH levels

Italy

Cella et al. [38]

N = 325

Body image and eating disorders

85 gay adult men, 47 gay women, 89 heterosexual men, 89 heterosexual women, and 15 TGNB adults

Cross-sectional

The Eating Disorders Inventory-2; the Eating Disorders Inventory-2-Symptom Checklist; The Body Uneasiness Test

N/A

Transgender participants reported higher levels of eating pathology and higher frequency of weight gain compensation strategies compared to the other study groups. Feminine participants score higher than masculine participants on drive for thinness, bulimia, body dissatisfaction, weight phobia, and body image concern

Italy

Chivers and Bailey [39]

N = 39

Body image

21 trans men gay participants and 17 non-gay trans men participants

Racial diversity present

Cross-sectional

Modified Kinsey scale,

The Childhood Gender Nonconformity scale, The Continuous Gender Identity scale, The Preference for Partner Masculinity scale

Items for scales assessing concern with partner status, partner attractiveness, and youth, The Sexual vs. Emotional Jealousy Scale, The Passive Sexual Role scale, Interest in Uncommitted Sex and Interest in Visual Sexual Stimuli scales, and the Body Modification Scale

N/A

Higher cross-gender identification in childhood was correlated with a stronger interest in masculinizing body modification among trans men participants, with a greater desire for phalloplasty among homosexual trans men participants than non homosexual trans men participants. Continuous Gender Identity was related to desire for phalloplasty, but Childhood Gender Non-conformity was not

United States

Comiskey et al. [40]

N = 173

Body image and Disordered Eating

173 transgender women

Adults, racial diversity present

Cross-sectional

Sociocultural Attitudes Toward Appearance Questionnaire Internalization subscale, Transgender Congruence Scale Appearance Congruence subscale, Body surveillance subscale of the Objectified Body Consciousness Scale; Body Shame subscale of the OBCS; Eating Attitudes Test; Anabolic–Androgenic Steroids measure to assess for intent to use silicone injections

N/A

Internalization of cultural standards of appearance was positively associated with body surveillance, which was positively associated with body shame. Body shame was positively associated with disordered eating and intention to obtain silicone injections

United States

de Vries et al. [41]

N = 55

Body image

22 transgender women and 33 transgender men

Age diversity present

Prospective cohort

Utrecht Gender Dysphoria Scale (UGDS), Body Image Scale (BIS), Children's Global Assessment Scale, Beck Depression Inventory, Spielberg’s Trait Anger Inventory, Spielberg’s Trait Anxiety Inventory, Child/Adult Behavior Checklist, Youth/Adult Self-Report, a questionnaire created for this study used to ask the young adults about their current life circumstances, such as living conditions, school and employment, and social support, WHOQOL-BREF, Satisfaction With Life Scale, Subjective Happiness Scale

N/A

Gender dysphoria and body image difficulties persisted among transgender adolescents despite puberty suppression but remitted after cross-sex hormone therapy and gender reassignment surgery, with transgender women reporting more satisfaction with primary sex characteristics than transgender men

Netherlands

Dharma et al. [42]

N = 323

Body image

171 transmasculine participants and 152 transfeminine participants

Adults, racial diversity present

Cross-sectional

Trans-Specific Condom/Barrier Negotiation Self-Efficacy adapted from the Self-Efficacy for Negotiating Condom Use Scale; Trans-Specific Sexual Body Image Worries created by the authors; Rosenberg Self-Esteem Scale; Center for Epidemiologic Studies Depression Scale; Multidimensional Sexual Self-Concept Questionnaire; Experiences of Transphobia; Sexual Risk of AIDS

N/A

T-Barrier was significantly associated with higher self-esteem and sexual satisfaction, and with lower sexual anxiety, sexual fear, and experiences of transphobia; however, there were no significant differences in T-Barrier scores by HIV risk, past year sexual partners, and gender spectrum. T-Worries had a positive correlation with sexual anxiety, sexual fear, and depressive symptomology, as well as a negative correlation with self-esteem

Canada

Duffy et al. [43]

N = 84

Eating Disorder

6 women, 30 men, and 48 nonbinary participants

Adults, racial diversity present

Qualitative survey data

Demographics

Online qualitative questionnaire addressing psychiatric history, ED and treatment history, and experiences as a transgender person

One identified theme of this study regards the role of the body in eating disorder treatment, including the role of the physical body as the cause of the eating disorder, which was highlighted by about one third of participants. Others explained that the issue of body image is more complex for transgender clients and therefore eating disorder treatment needs to focus on more than a positive body image, and rather include transition in the eating disorder recovery process

United States, Europe, and Canada

Fagan et al. [44]

N = 66

Body Image

21 transgender individuals and 45 cisgender male participants

Adults, Caucasian only

Cross-sectional

10 scales of the Sexual Functioning Inventory: Information, Experience, Drive, Attitude, Symptoms, Affects, Role, Fantasy, Body image, and Sexual satisfaction; The Brief Symptom Inventory; History of psychiatric diagnoses and sexual history

N/A

Trans participants were significantly more psychologically distressed than cisgender controls, with more negative affects consistent with dysphoric mood and other psychological symptoms. Trans participants also had a poorer body image, particularly with relation to sexual body parts

United States

Ferrucci et al. [45]

N = 10,415

Eating Disorder

10,415 transgender people. About 59% of the sample was described as female on insurance claims

Cross-sectional

ICD 10 codes for eating disorders, Covariates included age, region of medical service within the United States, relationship to plan-holder, sex reported on claims, and type of insurance coverage

N/A

Unspecified feeding and eating disorders were the most commonly diagnosed eating disorders, followed by anorexia nervosa, other specified feeding and eating disorders, bulimia nervosa, binge eating disorder, and avoidant restrictive feeding and intake disorder. Those diagnosed with any eating disorder were more likely to be young, reported as female on claims

Feusner et al. [46]

N = 56

Body Image

16 trans men participants, 20 cisgender male controls, and 20 cisgender female controls

Adults

Cross-sectional

Unmorphed own body image (degree that the image represents self), morphed body image (degree that the image represents self), response time

N/A

Trans men participants rated their bodies morphed to the non-natal sex higher compared to the natal sex, whereas female and male controls rated their morphed bodies lower when morphed to non-natal sex compared to natal sex. The transgender participants were generally more likely to rate the image as ‘‘self’’ when it was morphed with the non-natal sex, while the opposite was true for control participants

Sweden

Feusner et al. [47]

N = 81

Body Image

27 trans men participants, 27 cisgender male controls, and 27 cisgender female controls

Adults

Cross-sectional

Body morph test; fMRI and resting state image data; the Kinsey scale; the Social Responsiveness Scale

N/A

The transgender individuals demonstrated weaker brain connections in areas related to self-referential processes and own body perception compared to control participants. Transgender participants were more likely to rate an image as ‘self’ when morphed with sex congruent with their gender identity, which was associated with greater brain connectivity in the areas studied

Sweden

Finn and Dell [48]

N = 7

Eating Disorder

3 assigned male at birth and 4 assigned female at birth

Adults

Qualitative interviews

demographic data

No structured interview format was used

Themes described the pathological body as unhealthily `visible'; the relocation of gender re-embodiment and management from the discursive realm of health and distress to that of `choice'; and the productivity of choice in terms of the non-distressed experiences and subjectivities of those who choose to manage their bodies as differently gendered

United Kingdom

Fisher et al. [49]

N = 125

Body Image

66 trans women patients and 59 trans men patients

Adults

Cross-sectional

Cross-sex hormone therapy use and dosage; levels of psychopathological distress by Italian version of the Symptom Checklist; the General Severity Index; the Body Uneasiness Test

N/A

Individuals taking CHT had significantly lower BUT-GSI scores, indicating lower body uneasiness, compared to those not taking CHT. Further, trans women participants demonstrated lower body uneasiness when taking CHT compared to those not taking CHT, but this difference was not found among trans men participants

Italy

Fisher et al. [50]

Cross-sectional study: N = 359

Cohort study: N = 54

Body Image

140 trans men and 219 trans women participants for cross-sectional analysis. The cohort study then included 28 trans women and 26 trans men participants

Adults

Cross-sectional, then prospective cohort

Height, weight, BMI, testis volume via Prader Orchidometer, breast development according to Tanner staging, hair growth evaluated by Ferriman and Gallwey scoring system, clitoral length, glutamic-oxaloacetic transaminase and glutamic-pyruvate transaminase blood levels, Body Uneasiness Test, Symptoms Checklist 90 Revised, Gender Identity/Gender Dysphoria questionnaire, Beck Depression Inventory II

N/A

Transgender participants taking CHT reported significantly lower levels of body uneasiness, depressive symptoms, and subjective gender dysphoria compared to those not taking CHT. CHT-induced body modifications, such as changes in hair growth, testis volume, and clitoral length, were associated with better psychological adjustment

Italy

Gleming et al. [51]

N = 44

Body Image

22 trans men and 22 cisgender matched control males

Adults

Cross-sectional

Body Cathexis Scale, 10-item version of Janis-Field-Eagley Self-Esteem Measure

N/A

Significant association between increased body satisfaction and increased amount of surgical gender reassignment. Moderate associations were found between a positive body image and high self-esteem for the no-hysterectomy and hysterectomy groups, while a strong associated was found for the phalloplasty group

Not reported, likely United States based on author location

Gagne and Tewksbury [52]

N = 65

Body image

27 preoperative transgender individuals, 10 postoperative transgender individuals, 4 nonoperative transgender individuals, 19 crossdressers, and 5 gender radicals

Adults, racial diversity present

Qualitative

None

Interview topic areas included background information, life stories and experiences of being transgender, and political and gender attitudes

Individuals commonly reported beginning to think of their penises as "birth defects," their bodies as false signifiers of who they really were, and their alternatively gendered selves as a medical condition in need of a cure for creating an accepted and embodied self

United States

Hartman-Munick et al. [53]

N = 98

Eating disorder

24 transgender women, 40 transgender men, 27 nonbinary adults, and 6 who identified as another gender. Racial diversity present

Qualitative, Inductive

N/A

online forum and focus group questions about experiences with ED

Three major themes emerged from the analysis: (1) Barriers to ED screening/treatment; (2) Complexity of the relationship between EDs and gender dysphoria; (3) Need for provider education in gender affirming care practices for ED screening and treatment

Results indicate an ongoing need for gender affirming care for TGD young adults in ED screening and treatment

United States

Hepp and Milos [54]

N = 3

Eating disorder

3 adult transgender patients

Case series

Demographics

Relevant medical history

Transgender individuals may have increased risk for eating disorders

Switzerland

Hiraide et al. [55]

N = 2

Eating disorder

1 trans woman individual and 1 trans man individual. Both adults

Case report

Demographics and BMI

Relevant medical history

When gender role conflict is persistent, maladaptive eating behaviors could be worsened. Gender affirming medical intervention may alleviate eating disorders

Japan

Isung et al. [56]

N = 10

Body image

10 trans women adults

Prospective cohort study of the impact of surgical treatment

Transgender Congruence Scale, Body Image Scale, Hospital Anxiety and Depression Scale, Sheehan Disability Scale, EuroQol-5-Dimensions visual analogue scale, age

None

Appearance congruence and body image satisfaction improved by gender-affirming surgery

Sweden

Jones, et al. [18]

n = 563

Body image and eating disorder

211 people assigned female at birth and 352 people assigned male at birth

Adults

Cross sectional

Eating Disorder Inventory 2, Rosenberg Self Esteem Scale, Hospital Anxiety and Depression Scale

N/A

Transgender people who were not on cross-sex hormones reported higher levels of eating disorder psychopathology than people who were

United Kingdom

Joy et al. [57]

N = 7

Eating Disorder

7 gender diverse participants

Qualitative

N/A

ED treatment experiences

Four themes around gender dysphoria were constructed from the data, including gender dysphoria and eating disorders, barriers to accessing eating disorder treatments, harmful eating disorder treatment strategies and suggestions for eating disorder programmers and health professionals. Gender dysphoria considerations were believed to be lacking in traditional eating disorder treatment programs. Participants saw the need for more awareness and training in this area for dietitians and other health professionals

Canada

Khoosal et al. [58]

N = 40

Body image and eating disorder

40 trans women gender identity disorder patients

Adults

Cross sectional

Eating Disorder Inventory

N/A

Concerns about body satisfaction, lower levels of drive for thinness, bulimia were greatly reduced after gender affirming transitioning/surgery

United Kingdom

Kilpatrick et al. [59]

N = 83

Body image

40 transgender men, 24 transgender women, and 19 controls

Adults

Cohort

Body perception test (mophed body image testing), cortical thickness, MRI data, Kinsey scale; Demographic information

N/A

Cross sex hormone therapy reduces gender dysphoria evidenced by patient report and pattern changes in the cerebral grey

Sweden

Kraemer et al. [60]

N = 45

Body image

23 preoperative and 22 postoperative transgender patients

Gender Identity

Trans women: 30,

Trans men: 15

Cohort

Body Image Measure, which consisted of the insecurity/concern scale, the attractiveness/self confidence scale, and the accentuation of body appearance scale; Demographic information

N/A

Trans women scores on measures were similar to cisgender females and trans men scores more like cisgender males (pre and post-operative). Trans women and trans men body image scores changed as expected, with increased positive body image post-gender affirming surgery

Germany

Linsenmeyer et al. [61]

N = 10

Eating disorder

10 transgender men

Case series

The EAT-26 and ecSI-2 measures were utilized

Three-day food diary and the software ESHA Food Processor Nutrition Analysis

Major nutrition-related concerns were obesity, low fruit and vegetable intake and high sodium intake; disordered eating was not a prominent concern. None fo the participants screened positive for an ED

United States

Majid et al. [62]

N = 60

Body image

30 transgender individuals and, 30 cisgender individuals

Cross-sectional

FMRI, Body perception task

N/A

Transgender participants consistently reported non-birth sex bodies looked more like "me."

Sweden

Mitchell et al. [63]

N = 130

Body image and eating disorder

41 transgender women, 42 transgender men, 47 nonbinary individuals

Cross-sectional

Misgendering frequency, transgender congruence, Body Parts Satisfaction Scale Revised, Disorder Examination-Questionnaire (EDE-Q), 10 transition steps they had undertaken

N/A

The overall sample showed significant direct effects between misgendering frequency and transgender congruence, between transgender congruence and body dissatisfaction, and between body dissatisfaction and dietary restraint. There was a significant indirect effect between misgendering frequency and body dissatisfaction through transgender congruence, and between misgendering frequency and dietary restraint through both transgender congruence and body dissatisfaction (but not through either mediator alone)

United States

Morgan and Stevens [64]

N = 6

Mind–body dissonance

5 trans women individuals and one participant identified as a crossdresser. Adults, all racially white

Qualitative

None

Semi-structure interview about gender identity development and body-mind dissonance (i.e., dysphoria)

Participants described early awareness of body-mind dissonance in early childhood. Most described waiting to do a gender transition for varied reasons

United States

Nagata et al. [65]

N = 484

Eating disorder

312 transgender men and 172 transgender women

Cross-sectional

Eating Disorders Examination Questionnaire (EDE-Q)

N/A

Transgender men and women reported any occurrence (≥ 1/week) of dietary restraint (25.0% and 27.9%), objective binge episodes (11.2% and 12.8%), excessive exercise (8.0% and 8.1%), self-induced vomiting (1.6% and 1.7%), and laxative misuse (.3% and .6%), respectively. Compared to a prior studies, our age-matched subsample of transgender men reported lower rates of objective binge episodes and excessive exercise and transgender women reported higher rates of dietary restraint but lower rates of excessive exercise

United States

Nikkelen and Kreukels [66]

N = 576

Body image

325 trans women and 251 trans men transgender people

Age diversity present

Cross sectional

Kessler Psychological Distress Scale, scale constructed by study about body image

N/A

Gender-affirming treatment can positively affect sexual feelings of desire, particularly in trans women, but body satisfaction may be a more significant factor driving sexual desire

Netherlands

Nowaskie et al. [67]

N = 166

Eating disorder

79 transgender men and 87 transgender women

Cross sectional

Eating Disorder Examination Questionnaire (EDE- Q), demographics

N/A

Compared to transgender men, transgender women reported higher EDE-Q scores and significantly higher Eating Concern. Compared to hormone/surgery-naïve and hormone-experienced/surgery-naïve patients, hormone/ surgery-experienced patients had lower EDE-Q scores. Hormone/surgery- experienced patients reported significantly lower Shape Concern and marginally lower Global Score and Weight Concern than hormone-experienced/surgery-naïve patients. There were no differences in EDE-Q scores between hormone/surgery- naïve and hormone-experienced/surgery-naïve patients

United States

Owen-Smith et al. [11]

N = 697

Body image

347 TM individuals and 350 TF individuals

Adults, racial diversity present

Cross sectional

Transgender Congruence Scale, Revised Physical Self-Perception Profile, Center for Epidemiologic Studies Depression Scale, Beck Anxiety Index

N/A

More extensive gender-affirming treatment was associated with higher body-gender congruence and body image satisfaction, and lower depression and anxiety

United States

Rabito Alcón et al. [68]

N = 52

Body image and eating disorder

30 trans woman and 22 trans man

Adult

Cross-sectional

Eating Attitudes Test, body dissatisfaction of Eating Disorder Inventory-2 sub-scale, and IMAGEN

N/A

Body dissatisfaction was associated with thinness in people with gender dysphoria. The level of body dissatisfaction associated with thinness is above the general population in people with gender dysphoria

Spain

Simbar et al. [69]

N = 90

Body Image

31% female participants and 69% male participants

Patients with no hormone therapy or surgery: 30,

Patients with hormone therapy: 30,

Patients with gender reassignment surgery: 30,

Adults

Cross sectional

Quality of Life questionnaire and Fisher's Body Image questionnaire

N/A

Surgery significantly improved the quality of life and body image of individuals with gender dysphoria. Body image, quality of life, and physical health were all positively correlated. Authors highlighted the significant social health on the quality of life scale

Iran

Testa et al. [70]

N = 442

Body Image and eating disorder

154 transfeminine people and 288 transmasculine people

Adults, racial diversity present

Cross-sectional

Non-affirmation of gender identity scale, body areas satisfaction scale, Eating Attitudes Test; Gender-Confirming Medical Interventions planning/completed questionnaire

N/A

No significant differences in eating attitudes between those who had and had not completed gender affirming medical interventions. Generally, participants who had surgery and hormone use had more body satisfaction than those who did not have these procedures

United States

Turan et al. [71]

N = 1

Eating disorder

One 41-year-old trans man

Case study

None

N/A

Being underweight enabled the suppression of menstruation and female secondary sexual characteristics, with the goal of rejecting femininity rather than to look slim. Sex reassignment surgery greatly alleviated eating disorder symptoms

Turkey

Turan et al. [72]

N = 77

Body image and eating disorder

Trans man Participants: 37

Female control participants: 40

Adults

Cross-sectional

Body Uneasiness Test, Eating Attitudes Test Symptom Checklist-90-Revised, (90-item self-report inventory that measures ten symptoms of psychopathology- Somatization, Obsessive–Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism, and Additional over a 1-week interval

N/A

Compared to baseline, after 24 weeks of cross hormone therapy participants had a decrease in body uneasiness and general psychopathological symptoms, but no difference in eating attitudes or behaviors. There was an increase in mean body weight and BMI scores

Turkey

Uniacke et al. [73]

N = 287

Eating disorder

116 transgender women, 93 transgender men, 78 nonbinary people

Cross sectional

Eating Disorder Examination; Transgender

Congruence Scale (TCS); Everyday Discrimination Scale; Brief Symptom Inventory

Data were collected using structured interviews conducted by trained interviewers in each city

Higher transgender congruence was associated with lower odds of disordered eating symptoms, whereas increased internalized transphobia (minority stress) was associated with greater odds of disordered eating symptoms. Participants with eating-related psychopathology had greater odds of having received gender-affirming psychotherapy in the year prior to assessment—comorbidity or reason to seek gender affirming medical intervention

United States

van de Grift et al. [74]

N = 485

Body image

Transgender adult men and women

Cross-sectional

Body Image Scale for transsexuals; Demographic data, information on social gender role, and previous medical treatment were taken from a standardized self-constructed background interview

N/A

Trans women participants reported strongest dissatisfaction with genitals, breasts, and social and hair growth items. The trans men respondents reported that they were most dissatisfied with their chests and genital body characteristics

Netherlands, Belgium, Germany, and Norway

van de Grift et al. [75]

N = 660

Body Image

Transgender adult men and women

Cross-sectional

Body Image Scale, Physical Appearance Scale; Gender identity disorder diagnosis and sexual orientation measured by one item from a semi-structured background interview

N/A

Trans women indicated lower body satisfaction and a less congruent physical appearance with their experienced gender than trans men. Participants with prior hormone treatment had significantly higher physical congruence with experienced gender than those without prior hormone use

Netherlands, Belgium, Germany, and Norway

van de Grift et al. [76]

N = 201

Body Image

Adults transgender sample

Retrospective cohort, then cross sectional

Utrecht Gender Dysphoria Scale, Body Image scale, Symptom Checklist 90, Satisfaction With Life Scale, the Subjective Happiness Scale, and the Cantril Ladder, Multidimensional Sexuality Questionnaire, Social Support Questionnaire

N/A

Improvements in body satisfaction followed hormone-based interventions and surgery. There was a significant association between body satisfaction at follow-up and the level of psychological symptoms and the degree of body satisfaction at baseline

Netherlands, Belgium, Germany, and Norway

van de Grift et al. [77]

N = 101

Body image

Adult transgender men

Cross-sectional

BODY-Q scores, Postoperative patients were asked: "Do you plan to apply for a secondary correction of your chest? (yes/unsure/no)" and "Do you experience feelings of anxiety/depression?"

N/A

Mastectomy had a positive effect on patient-reported satisfaction with appearance, health-related quality of life, and psychological function. A higher body mass index was associated with lower body satisfaction in both pre- and postoperative patients

Netherlands

van de Grift et al. [78]

N = 26

Body image

Adult transgender men sample

Prospective follow-up cohort

Appearance Schemas Inventory-Revised, Body Image Quality of Life Inventory, Body Image scale for Transsexuals, Multidimensional Body-Self Relations Questionnaire, Rosenbergy Self-Esteem Scale, Situational Inventory of Body-Image Dysphoria, Author developed Perceived Effect of Surgery scale

N/A

Mastectomy positively associated with body image. Positive evaluation of the body was associated with increased quality of life and self-esteem, as was decreased dysphoria during social situations

Netherlands

Velez et al. [79]

N = 304

Body image and eating disorder

Adults, racial diversity present

Cross-sectional

Heterosexist Harassment rejection and discrimination scale, Transgender congruence, Sociocultural attitudes toward attractiveness questionnaire-3, Body surveillance, Body satisfaction, Compulsive exercise

None

Internalization of sociocultural standards of attractiveness yielded a significant direct relation with compulsive exercise, and anti-transgender discrimination

United States

Vocks et al. [80]

N = 356

Body image and Eating disorder

43 trans men, 88 trans women

62 cisgender women with eating disorders, 56 control cisgender males, 107 control cisgender females. Adults

Cross-sectional

Eating Disorder Examination Questionnaire, Eating Disorder Inventory, Body Checking Questionnaire, Drive for Muscularity Scale, Rosenberg Self-Esteem Scale, Beck Depression Inventory

N/A

Trans men and trans women participants showed higher depression scores, restrained eating, weight concerns, shape concerns, body dissatisfaction, and body checking compared to controls. Between trans women and trans men participants, body checking was the only significant difference, as trans women displayed higher scores

Germany, Austria, and Switzerland

Watson et al. [81]

N = 923

Eating disorder

Adolescent sample, age and racial diversity present

Cross-sectional

School connectedness, family connectedness, perception of friends caring, Medical outcomes study social support survey, Questions regarding binge eating, lose weight by fasting/diet pills/laxatives/and vomiting

N/A

Higher rates of harassment and discrimination was linked to higher odds of disordered eating behavior such as binge eating, fasting, or vomiting to lose weight, while family and school connectedness and social support had a protective effective against odds of disordered eating

Canada

Weyers et al. [82]

N = 50

Body image

Adult sample of trasngender women

Cross-sectional

Dutch version of the Short-Form-36, visual analog scale, Dutch version of the Female Sexual Function Index, additional questions about medical history, quality of relationships, importance of sex, concerns about health, and regret concern gender transition

N/A

Results showed a connection between psychological and sexual functioning in trans women, specifically with difficulties around arousal, lubrication, and pain

Belgium

Winston et al. [83]

N = 2

Eating disorders

Two transgender people assigned male at birth

Case study

None

N/A

In both cases, the desire for thinness was associated with a wish to achieve a more feminine physique. Both patients had educational difficulties

United Kingdom

Witcomb et al. [84]

N = 600

Body image and eating disorder behavior

75 transgender males, 125

transgender females,

200 cisgender individuals with eating disorders

Adults

Cross-sectional

Eating disorder inventory 2, Hamburg body drawing scale

N/A

Those with eating disorders, cisgender females, and transgender females scored higher overall on drive for thinness. The eating disorder group had significantly higher body dissatisfaction scores than both the trans group, which had higher scores than the control group

United Kingdom

Wolfradt and Neumann [85]

N = 90

Body image

30 post-operative transgender women, 30 cisgender women, and 30 cisgender men

Adults

Cross sectional

German versions of questionnaires, including scales for depersonalization experiences, the Self-Esteem-Scale, the Body-Image Questionnaire, a Gender Identity Trait Scale, and life satisfaction

N/A

Depersonalization decreased after gender affirming surgery. The transgender participants had body attitudes that were more similar to cisgender males, but described themselves with more feminine traits

Germany