Eating disorder treatment outcomes in trans and gender diverse people: a systematic review

Background Eating disorders (EDs) are severe psychiatric conditions associated with significant physical and psychosocial impairment. Trans and gender diverse (henceforth: trans) people experience disproportionately high rates of EDs, yet treatment outcomes in this population have not been systematically synthesized.Methods A systematic search was conducted across ProQuest, Medline, CINAHL, Cochrane Library, Web of Science, Scopus, and PsycINFO using a search string involving three categories of terms: gender diversity terms, ED terms, and ED treatment terms. Eligible studies were peer-reviewed, with 18 papers included in the final review. Study quality was assessed using the standardized Assessment through the Standard Quality Assessment Criteria for Evaluating Primary Research Papers From A Variety Of Fields.Results Trans patients showed reductions in disordered eating by discharge, with comparable reductions to cisgender peers in three studies. However, broader mental health outcome disparities persisted, particularly depression and suicidal ideation. Case reports and series included a total of 24 trans patients, with improvements in disordered eating reported in 17 cases. Of these, 12 had accessed gender-affirming medical care (GAMC), and five attributed their improvements in disordered eating exclusively to GAMC. Study quality ranged from 0.7 to 1.Discussion ED treatment may reduce ED symptoms in trans people, but other mental health disparities can persist. Findings support the need for integrated, gender-affirming ED care that maintains or integrates GAMC and directly addresses gender dysphoria and minority stressors within formulation and treatment planning.