Beyond metabolism: towards a Dynamic Endocrine Framework for Eating Behaviour under Gender-Affirming Hormone Therapy

Area of Science:

• Endocrinology
• Behavioral Nutrition
• Transgender Health

Background:

• Existing models of eating behavior overlook intentional endocrine modulation, such as gender-affirming hormone therapy (GAHT).
• GAHT significantly alters sex steroid profiles, affecting metabolic pathways crucial for appetite and energy balance.
• Current research on GAHT primarily focuses on metabolic outcomes, neglecting its impact on eating behavior.

Purpose of the Study:

• To synthesize evidence on eating behavior determinants in transgender and gender-diverse (TGD) populations undergoing GAHT.
• To identify methodological and conceptual limitations in current research.
• To propose a novel theoretical framework for understanding eating behavior in this population.

Main Methods:

• Literature review synthesizing evidence from endocrinology, behavioral nutrition, transgender health, psychology, and food environment research.
• Conceptual analysis to develop a new theoretical framework.
• Identification of limitations in existing studies, including outcome focus and measurement tools.

Main Results:

• Significant gaps exist in understanding the eating behavior of TGD individuals on GAHT, with a predominant focus on metabolic rather than behavioral outcomes.
• Existing measurement tools are often not validated for TGD populations.
• A new Dynamic Endocrine Framework for Eating Behaviour is proposed.

Conclusions:

• Eating behavior in TGD populations on GAHT is an emergent, context-dependent property of a continuously evolving adaptive system.
• The proposed framework integrates endocrine modulation with behavioral, structural, and feedback mechanisms.
• This framework provides a foundation for future research and improved clinical/public health approaches for TGD individuals.