Nutrition and Strength Training Guidance for Trans and Nonbinary Athletes: New Study

Whether you’re a long-time gym lover or just someone who’s trying to get a grasp on the best nutritional strategies for your body, you might have some trouble finding training advice or nutrition guidance if you’re a trans or nonbinary athlete. Everything from how much protein you need each day to how much weight you’re told to lift in CrossFit workouts forces you to choose between two boxes: “male” or “female.” But since these standards don’t include trans athletes — indeed, trans athletes are enduring attacks on their fair participation in sports across the country — trans and nonbinary people are left guessing whether or not that multivitamin marketed toward men or women is appropriate or even safe for them. 

A new study may be able to help trans and nonbinary people start taking the guesswork out of strength training and nutrition. Published in the fall of 2024 in the journal Health Promotion Practice, “Nutrition and Training Recommendations for Transgender and Gender-Diverse Athletes Involved in Strength Sports and Resistance Training: A Case Series of Nine Athletes Assigned Female at Birth” provides much-needed insight into how nonbinary and trans athletes can navigate training and nutritional decisions that are typically based on someone’s assigned sex at birth. (1) I sat down with most of the authors of the study, including one of the trainers who worked on it, to bring our readers insights into how trans and nonbinary athletes can make the best training and nutrition strategies, made with trans bodies in mind. 

Key Takeaways: Nutrition Guidance for Trans and Nonbinary People

• Trans and nonbinary people can customize nutrition advice typically designed for cis people based on their own needs using their HRT status.
  • Trans people who are not doing HRT or have been receiving it for less than one year may opt to follow the nutritional recommendations based on their sex assigned at birth. Clinicians can make this a less invalidating experience by consistently using gender-neutral and -affirming language and explaining that their biochemical needs have likely not changed enough yet to warrant certain nutritional changes.
  • Trans people who have been receiving HRT for over a year may opt to follow the nutritional recommendations for their actual gender (or, for nonbinary people, the gender typically associated with the hormone they’re taking). That’s because their bodies have likely adjusted to biochemical processes that warrant a change in nutritional intake.
  • Nonbinary people or trans people who are not on HRT may also choose to use a range to guide their nutritional choices, with one limit being recommendations geared toward cis women and the other limit being recommendations geared toward cis men.

Key Takeaways: Strength Training Guidance for Trans and Nonbinary Athletes

• Trans and nonbinary people benefit from participation in sports and equitable access to health information, but often face structural barriers to participation.
• As with any part of the population, programming for trans and nonbinary athletes depends on an individual’s training history, fitness goals, health status, preferences, and equipment availability.
• While strength training, athletes can follow the same recommendations as above (re: nutrition), basing the weights they lift on a combination of their own experience level, comfort, goals, and HRT status.
• A disproportionate number of trans people have a history of disordered eating. (2) Practitioners must be prepared to help trans and nonbinary clients take a more intuitive approach to eating instead of a numbers-based approach, as well as using culturally competent and affirming language regarding gender.
• This case study only included athletes who were assigned female at birth — no trans women or nonbinary trans femmes participated in the study. The lead researchers suggested to me that this may be because trans women are under attack across the country and may not have felt safe coming forward to participate. So, we still need much more trans femme representation in the research and literature.

Nutrition Tips for Trans and Nonbinary Athletes

When assessing the baseline nutritional strategies of the study’s participants — all of whom were assigned female at birth — lead researcher Whitney Linsenmeyer, PhD, RD, LD, noticed some commonalities. “Most athletes consume inadequate energy and fiber, adequate or marginally high levels of saturated fat and added sugars and high levels of sodium,” she explained to me. “Most athletes scored low on the Eating Competence Scale.”

Similarly, fellow researcher Bari Glassman, MS, RD, points out that as a trans person, strength training can become a refuge. But, many trans people don’t accompany this with proper nourishment. “Training is something that at times can allow you to take out a certain level of frustration, but it’s not helpful overall if it’s not supported by food properly,” he explains. Enter the 2024 study.

• Customize Your Nutritional Intake
• Pay Attention to Signs of Disordered Eating Habits

Customize Your Nutritional Intake

There is a huge lack of information available for trans and nonbinary people who want nutritional guidance. That’s because all readily available nutritional advice is geared toward cis people (that is, people who are not trans).

In their study, Glassman and Linsenmeyer examined these questions. They encourage trans and nonbinary people to follow nutritional recommendations that are more in line with their own bodies’ needs rather than just following the intake levels recommended for their sex assigned at birth.

Of course, working with a trans-affirming and competent nutritionist will be most helpful; but in the absence of access to this service, here’s how trans and nonbinary people can start making better-informed choices for themselves.

Pay Attention to Signs of Disordered Eating Habits

Nikias Tomasiello, who has a Complete Personal Training Diploma with Nutrition for Weight Management, Sport, and Exercise and a Level 5 Diploma in Advanced Nutrition Science from Mac-Nutrition Uni., helped program training for study participants. He also has some insight into the nutritional realm for trans and nonbinary people.

Tomasiello describes a relationship with food, diet culture, disordered eating habits, and excessive exercise that may be all too familiar for many trans people, who experience eating disorders at a disproportionately high rate. (2) “When I was a teenager, I went on a weight loss diet that spiraled into a restrictive eating disorder. I was exercising obsessively, I only ate a very small selection of foods I deemed ‘healthy,’ and I didn’t eat enough to support my body for fear of weight regain.“

By eating to nourish your body and paying attention when you’re not, you may be able to better access any treatment and support you may need. “It was the realization that these eating disorder behaviors were symptoms of gender incongruence that led to my full recovery, as my attitude to training and nutrition changed,” Tomasiello explains. “I was no longer trying to break down a body I was uncomfortable with; I was actively nourishing and training it to make me feel more at home in it.”

Glassman says that this relationship with food for trans people is of critical importance with this study. “Learning to nourish yourself properly is a form of psychological support; it’s a comfort that you don’t realize that you need,” he explains, expressing the hope that becoming empowered with more information about our nutritional needs can help restore health to trans people’s relationships with food.

[Related: Bodybuilding & Muscle Dysmorphia]

Strength Training Tips for Trans and Nonbinary Athletes

According to the 2024 study, participants tended to score high on both the Exercise Benefits and Barriers Scale. In other words, strength training can offer tremendous benefits to trans and nonbinary people, but there are also a lot of barriers in the way of their participation.

These barriers are sometimes on the legal front, with the recent surge of legislation targeting trans women and girls, banning them from participating in sports. (3)(4) These barriers also involve the day-to-day of strength training and sports, like gendered restrooms and locker rooms in gyms. There are also deeply ingrained assumptions about what weights women (both cis and trans) can and should lift (represented by, for example, “men’s” and “women’s” weightlifting bars and gendered weight prescriptions in certain workouts.

Here are some ways that the study found that trans and nonbinary people can improve their own participation in strength training.

• Trust Your Own Body and Experiences
• Utilize Tried-and-True Training Principles
• Honor Where You Are in Your Gender Journey
• Respect Any Dysphoria That May Arise

Trust Your Own Body and Experiences

Trusting your body and experiences as a trans person might mean seeking out community with other trans people and getting guidance from trans fitness professionals. It also means using non-gendered language for any weight recommendations made in, for example, CrossFit classes.

Over the years, personal trainer Nikias Tomasiello has worked with many trans and nonbinary clients. He’s open about his trans identity, and as a result, he says: “I’ve had the honor and privilege of working with many gender-diverse clients, who told me they wouldn’t have felt comfortable reaching out to a cis coach.”

If working with a particular trainer or at a particular gym isn’t feeling affirming to you, it’s OK to leave and explore other options. That’s another big part of trusting yourself.

Bari Glassman, MS, RD, says that the study participants shared a commonality in the joy they find in exercise. “Being an athlete is a source of joy, empowerment, and stress relief for the trans people we spoke to,” he explains. “But navigating gendered spaces, especially in CrossFit competitions, can be difficult. Finding a gym where they felt safe and affirmed was hugely important, and many times, they were able to do it after some searching.”

[Related: The Case for Moving Away from “Gendered” Weights]

Utilize Tried-and-True Training Principles

Of his trans clients, and the trans participants in the study, Tomasiello asked himself and the participants the same questions he always would when beginning a training journey with someone (regardless of gender).

He goes on to explain: “As an example of the third factor, one of the athletes couldn’t train their legs and lower abdominals due to a physical disability, and they wanted to resistance train four days per week, focusing primarily on their upper body.

For these reasons, instead of providing them with a ‘classic’ four-day upper and lower body split, I designed a program that included two upper body push sessions for chest, shoulders, and triceps, and two upper body pull sessions for back and biceps, which they could alternate as follows: Upper Body Push 1, Upper Body Pull 1, etc.”

In other words, this study found validity in training trans and nonbinary athletes with the same principles (like progressive overload) as their cis counterparts.

Honor Where You Are in Your Gender Journey

Tomasiello points out that, if you’re medically transitioning, you’ll want to be mindful of making deliberate ebbs and flows in your training to keep your body safe. He has this reminder for trans and nonbinary athletes who want to gain muscle and are undergoing HRT or pursuing gender-affirming surgeries:

Glassman notes that because several participants were undergoing HRT, the study “provided very specific, extensive warm-up and included banded options for training. Trans athletes can also benefit from some mindfulness in regards to how HRT can change other parts of your body besides muscle mass.”

So, take it slowly — sometimes, slower than you think you need to — and use light weights during vulnerable periods to help your entire body catch up to your hormone levels.

Respect Any Dysphoria That May Arise

For many trans people, the mental health benefits of exercise are profound. Indeed, this study found that most participants scored high on an Exercise Benefits assessment, meaning that working out tended to have very positive impacts on them. But in addition to the structural barriers to fair participation in fitness that trans people face, dysphoria may pose an obstacle to achieving these benefits.

“Some gender-diverse people may feel uncomfortable with training certain muscles as it may cause them feelings of gender dysphoria or incongruence,” Tomasiello explains. “When this is the case, rather than not training these muscles at all, which can cause undesirable strength and physique imbalances, I tend to emphasize the athlete’s priority muscles with more volume and frequency while keeping training the least desired muscles to a minimum that’s tolerable for the athlete and will support their physical health and development.”

[Related: Transmasculine Upper-Body Workout]

Tips for Fitness and Nutrition Professionals With Trans and Nonbinary Clients

While this study has a small sample size — and, significantly, only was able to draw participation from transmasculine clients (we’ll discuss this below) — the focus on qualitative rather than quantitative data was intentional. The lead researchers told me that they wanted to model customized training for trans and nonbinary clients because personalized plans are generally considered industry-level best practices.

Here’s what they found can help nutrition and fitness professionals work with trans and nonbinary clients most effectively.

• Treat Your Trans and Nonbinary Clients as Individuals
• Use a Client’s HRT Status for Guidance
• Always Use Gender-Affirming Language (In Person and On Your Forms)
• Don’t Rely on Calorie Counting and Numbers
• Create Protocols to Protect Your Trans and Nonbinary Clients
• Focus on the Joy of Movement

Treat Your Trans and Nonbinary Clients as Individuals

This individual approach is a core tenet of all responsible nutrition plans for athletes and personal training programs. Linsenmeyer explains further: “We wanted to model for nutrition and sports professionals how care can be individualized based on an individual’s transition. We wanted to show how programming can be customized for trans people who are transitioning socially and legally, some with HRT, and others with gender-affirming surgeries but no HRT.”

This is especially critical when you’re talking about topics like caloric intake, how much protein you need to build muscle, and designing strength training programs. “For any patient or client — cis or trans — care is meant to be individualized. When working with sex-specific data points like energy needs,” Linsenmeyer says, “you need to use clinical reasoning about the best approach based on a person’s goals and needs — our study provides a way to start doing just that.”

This is particularly important for athletes who may need to cycle their training to accommodate gender-affirming surgeries or starting HRT — which can make a transmasculine athlete vulnerable to ligament and tendon strains or tears. Stay aware of your client’s individual needs and pacing to ensure they state safe throughout their journey.

Use a Client’s HRT Status for Guidance

In the guidelines used by participants in the study, Linsenmeyer explains that trans athletes who have been on HRT for less than one year may want to follow certain physical recommendations made for their assigned sex at birth. If you’ve been on HRT for more than a year, you might shift that goal post toward your actual gender (or the gender typically associated with the hormone you’re taking). 

“We chose these time metrics based on Endocrine Society guidelines, which detail a general timeline for the onset of maximum effects of hormone therapy,” explains Linsenmeyer. “That was our guiding principle.” Of course, some trans athletes may find that their HRT takes longer to affect them than their peers (or vice versa), so paying attention to your specific client’s experience is important, too.

Always Use Gender-Affirming Language (In Person and on Your Forms)

Of course, if your client is a trans man who’s been on T for less than a year, it can feel extremely invalidating and dysphoric for him select “F” on forms like protein intake calculators and following the caloric intake recommendations for women. 

Clinicians can tweak language on their intake and other forms to say “sex assigned at birth” instead of “sex” or “gender,” as well as leaving a space for people to indicate their actual gender, pronouns, and HRT status. 

Another big source of grief for a lot of trans athletes is the gendered division of weightlifting standards, both in competitions and in traditional CrossFit workouts — which dictate a weight to be used by men, and a different (lower) weight to be used by women.

“Take the gender out of equipment language,” suggests Linsenmeyer. She explained that the coaches involved in this study, “didn’t use gender binary language for equipment. Instead, they would tell participants to use heavier or lighter weights, or to use whatever you’re feeling today.” 

Don’t Rely on Calorie Counting and Numbers

A common go-to in the industry is referring to the oversimplified notion of “calories in, calories out” and encouraging clients to keep track of their calorie intake. And of course, there may well be some trans and nonbinary clients who prefer this habit. However, it’s important to watch for signs of disordered eating habits, especially with higher-risk populations.

The 2024 study found that many trans and nonbinary participants proactively avoid calorie counts, and Glassman suggests that dietitians may want to be adaptive to the needs of trans clients. “Our participants would say things like, ‘I don’t like the [calorie] numbers; I don’t track.’ So it’s important for nutrition professionals to be adaptive to these needs. Some athletes may want to use more a more mindful or intuitive eating approach. One size does not fit all, so check out alternative methods of talking about food with your trans clients.”

Create Protocols to Protect Your Trans and Nonbinary Clients

Even beyond your individual sessions, it’s possible for dietitians and fitness professionals to create safer spaces for their trans and nonbinary clients. “Sports nutrition professionals can be strong advocates and allies for the trans community,” Glassman explained to me. “Multiple athletes talked about how they got a strong degree of support from their coaches.“

Need some ideas for how you can create safer environments for trans clients? Glassman explains: “Many nutrition professionals are out there advocating for:

• trans-inclusive physical spaces;
• non-discrimination statements;
• training their staff; and
• creating bias-related incident protocols.”

Focus on the Joy of Movement

Too many people in the fitness industry (professionals and clients alike) focus exclusively on body-changing goals like gaining weight or losing weight. This study suggests that trans clients can reap tremendous mental health benefits from weight lifting, so focusing on the joy in movement (whatever that means to the client) as itself a goal can be a game-changer for helping clients stay engaged, present, and affirmed. When roadblocks emerge, listen to clients and follow their lead, repeating back what you’re hearing with empathy.

Study Limitations

Here’s one of the problems with all typical “standards” and recommendations tossed around in the fitness industry: they don’t account for trans and nonbinary athletes. Pretty much all physical health standards have been created by and for cisgender people — that is, people who aren’t trans.

So, what’s a woman who’s trans to do? What standards should a man who’s trans follow? And what about nonbinary athletes across the gender spectrum?

Though this new study attempts to answer these questions — and provides a lot of important insight that we’ll discuss below — we’d be remiss if we didn’t chat about the study’s limitations first.

We Need More Representation of Trans Women and Femmes

The biggest pain point of this study is perhaps the lack of representation of trans femme participants. All participants were instead transmasculine. Lead researcher Whitney Linsenmeyer, PhD, RD, LD, acknowledges this problem front and center when we chat. She speculates: “I wonder if the reason we didn’t have any transfeminine athletes is because they’re already under assault and felt less safe or enthusiastic about sharing their story.”

The extreme mental and physical stress created by the current rash of laws banning trans women from participating in sports and preventing trans people from accessing necessary medical care are well-documented. (3)(4) The impacts of discrimination are felt particularly strongly among youth and trans women of color, who are the most frequently targeted by both legislation and violence. (5)(6) All this is despite recent evidence that suggests that trans athletes may in fact be disadvantaged in certain aspects of competitive athletics. (7)

We Need Larger-Scale Studies

Aside from the lack of representation of trans women in the study, the tiny sample size is the other most glaring shortcoming of the research. But Linsenmeyer knows this, and explains that the qualitative approach to data collection was intentional. In an era of dehumanization of trans people across the country — with trans athletes, especially trans women, being targeted by an overwhelming amount of legislation and vitriol — Linsenmeyer wanted the methodology to reflect trans people’s humanness and individuality. 

“We could have gone for a more generalized approach, but we chose the methods that we did because the small sample size allows us to understand participants as a whole person,” she explains. “Because of this, we were able to model for professionals how you can work with a trans client and use good old-fashioned clinical reasoning to provide them with a personalized and effective training plan.” 

We Need Longer-Term Studies

In addition for a broader range of participants, researchers also need a longer period of time to track important factors like adherence and the long-term health impacts of their recommendations. “We took it through the stages of assessment and recommendations,” explains Glassman, “but we didn’t also counsel them with the recommendations. This study stops at the recommendations stage. Further research can do further assessment and refinement.”

Final Word

Trans and nonbinary people don’t generally have research focused on their needs and experiences in fitness and nutrition spaces. A 2024 Health Promotion Practice article (funded by a research grant from BarBend) offers important insights into the ways that trans and nonbinary people can engage with current training and nutrition recommendations. Future research will hopefully encompass longer-term research including a broader range of trans experiences, especially trans women and femmes.

References

1. Linsenmeyer W, Glassman B, Tomasiello N, Walcott K. Nutrition and Training Recommendations for Transgender and Gender-Diverse Athletes Involved in Strength Sports and Resistance Training: A Case Series of Nine Athletes Assigned Female at Birth. Health Promotion Practice. 2024;0(0). doi:10.1177/15248399241286027
2. Rasmussen, S. M., Dalgaard, M. K., Roloff, M., Pinholt, M., Skrubbeltrang, C., Clausen, L., & Kjaersdam Telléus, G. (2023). Eating disorder symptomatology among transgender individuals: a systematic review and meta-analysis. Journal of eating disorders, 11(1), 84. https://doi.org/10.1186/s40337-023-00806-y
3. Barbee, H., Deal, C., & Gonzales, G. (2022). Anti-Transgender Legislation-A Public Health Concern for Transgender Youth. JAMA pediatrics, 176(2), 125–126. https://doi.org/10.1001/jamapediatrics.2021.4483
4. Abreu, R. L., Sostre, J. P., Gonzalez, K. A., Lockett, G. M., Matsuno, E., & Mosley, D. V. (2022). Impact of gender-affirming care bans on transgender and gender diverse youth: Parental figures’ perspective. Journal of Family Psychology, 36(5), 643–652. https://doi.org/10.1037/fam0000987
5. The Trevor Project. Issues Impacting LGBTQ Youth, Polling Presentation. (2023) https://www.thetrevorproject.org/wp-content/uploads/2023/01/Issues-Impacting-LGBTQ-Youth-MC-Poll_Public-2.pdf
6. Jefferson, K., Neilands, T. B., & Sevelius, J. (2013). Transgender women of color: discrimination and depression symptoms. Ethnicity and inequalities in health and social care, 6(4), 121–136. https://doi.org/10.1108/EIHSC-08-2013-0013
7. Hamilton B, Brown A, Montagner-Moraes S, et al. Strength, power and aerobic capacity of transgender athletes: a cross-sectional study. British Journal of Sports Medicine 2024;58:586-597.