Age-related trends in eating pathology symptoms among transgender and gender-diverse adults

This study examined how eating disorder symptoms, assessed by the Eating Pathology Symptoms Inventory (EPSI), vary across chronological age in a large national (USA) sample of transgender and gender-diverse (TGD) adults.

Participants were 2098 TGD adults-including transgender men (n = 599), transgender women (n = 293), and gender-diverse individuals (n = 1,206, including nonbinary and those who identified with "another gender identity")-enrolled in The PRIDE Study. A multivariate general linear model tested the effects of chronological age, gender group (with gender-diverse as the reference), and their interaction on the eight EPSI scales.

Multivariate analyses showed significant main effects of age (V = .045, p < .001) and gender group (V = .098, p < .001), but no significant age-by-group interaction. Older age was associated with greater Cognitive Restraint (β = .22, p < .001), Negative Attitudes toward Obesity (β = .22, p < .001), and Excessive Exercise (β = .12, p = .001). Compared to gender-diverse individuals, transgender men exhibited higher Muscle Building, Cognitive Restraint, and Excessive Exercise scores, whereas transgender women reported higher Binge Eating, Purging, Cognitive Restraint, and Negative Attitudes toward Obesity, but lower Muscle Building. A single significant interaction indicated that transgender women showed stronger age-related differences in Purging.

These findings contribute to growing evidence that disordered eating symptoms may not simply resolve with age among TGD individuals and necessitate lifespan-sensitive approaches to eating disorder care. These patterns likely capture a mix of aging processes and cohort-specific exposures to weight-normative and cis-normative ideals. Level of evidence Level V: based on descriptive studies.