starkel nutrition seattle nutritionist trans awareness month gender affirming

November is Trans Awareness Month! We want to celebrate the transgender community by providing nutrition information regarding gender-affirming care for individuals. The following is nutritional implications for clients undergoing hormone therapy of estrogen and testosterone, spironolactone, and/or surgery support. 

Starkel Nutrition seeks to promote the health of all clients, regardless of gender identity. Transitioning can involve gender-affirming hormone therapy, gender-affirming surgery, both, or neither. Gender-affirming hormone treatment is used to reduce the characteristics associated with one’s sex assigned at birth and induce those of their gender identity. Gender-affirming surgery and hormone therapy can be extremely beneficial for transgender individuals’ physical and mental health. 

Though research on the nutritional implications of gender-affirming hormone therapy is limited, there are known metabolic side effects that can benefit from nutritional intervention. These side effects include challenges to bone health, cardiovascular health, cholesterol, and gut health. In addition to support in these areas, proactive nutritional support for individuals choosing gender-affirming surgery is also recommended. 

Bone Support

Sex hormones are important in regulating the growth of the skeleton, remodeling bones, and maintaining bone strength throughout each stage of life. Individuals who undergo gender-affirming Estrogen or Testosterone (T) hormone therapy could be at risk for a decrease in bone density because of fluctuations in hormone levels. 

Luckily, there is a remedy that supports bone health! Getting regular bone-density exams, increasing weight-bearing exercises, and consuming a calcium-rich diet (foods like yogurt, collard greens and tofu) supplemented with vitamin D (fatty fish and vitamin D fortified foods such as orange juice) can be helpful in maintaining adequate bone density.

Gut Support

Sex hormones can also change the diversity of our gut microflora which can lead to dysbiosis, which is an imbalance of good and bad bacteria (Org et al, 2016). A diet high in digestives (prebiotics and probiotics) will help keep gut flora diverse and healthy. 

Prebiotics feed the good bacteria in our gut. They can be found in fruits and veggies like asparagus, garlic and whole grains.

Probiotics add good bacteria to the gut population. They can be found in yogurt, kefir and kombucha.

Cholesterol Support

Research on T and estrogen hormone therapy’s effects on cholesterol has produced mixed results. A meta-analysis of transgender patients on hormone therapy published in 2017 displayed hormone effects on patients’ cardiovascular health (Maraka et al, 2017). 

Here at Starkel, we can help guide you toward keeping lipid levels within healthy ranges, including increasing the right kinds of foods in your diet as well as finding enjoyable movement to increase your HDL levels (“good cholesterol”) and lowering your LDL levels (“bad cholesterol”). 

Cardiovascular Support

While the effects of sex hormones on cardiovascular health are not completely understood, there is some evidence that they can impact the cardiovascular risk profile of some (Maraka et al, 2017).

Many cardiovascular diseases are inflammation driven, so we can tailor your diet to increase anti-inflammatory foods, herbs, spices and teas. Using common household herbs and spices can help reduce inflammation, while adding more color to your plate can increase your phytonutrient intake. Here is a great quick recipe to make a powerful anti-inflammatory tea. 

Anti-inflammatory Golden Milk (Aka Turmeric Tea)
Heat 2 cups milk of choice (almond, coconut)
Add ½ inch peeled, minced fresh ginger
Add 2 Tablespoons chai tea spice mix (should contain cinnamon, cardamom, cloves & dried ginger)
1-2 tsp turmeric
3-4 whole black peppercorns
Simmer 10 minutes.  Strain.  Sweeten to taste.

Muscle Support

Testosterone hormone therapy can increase muscle mass, which will require an increase in protein needs. A good rule of thumb for making sure you are getting enough protein throughout the day is to include a source at each meal and snack. Working with a nutritional counselor can help you determine your specific protein needs. 

Surgery Support

Any individual undergoing surgery and subsequent recovery has more nutritional needs than they would in everyday life. Surgery creates a hypermetabolic state, resulting in increased protein and energy requirements. Post-surgery nutrition support can include the following:increased protein intake, vitamin C, zin and fiber intake. We would love to help you with wound healing support and optimal nutrition for surgery recovery. 

Nutritional Implications of Antiandrogens (Spironolactone)

Spironolactone is a common anti-androgen used to suppress endogenous testosterone (Unger, 2016). The highest nutrition-related risk with this medication is high potassium levels (hyperkalemia). Having too much potassium could affect the way your heart’s muscles work. Spironolactone is widely used to treat hypertension, or high blood pressure. In a person with normal blood pressure, this diuretic could cause low blood pressure (hypotension). Our nutritionists can go over which things needs to be considered nutritionally while being on spironolactone. 

Nourishment Support

The pressure to pass, gender/body dysphoria, expensive/inaccessible gender-affirming surgery or HRT, and anti-fat weight limits for surgery are all factors that can contribute to disordered eating and eating disorders. 

If you struggle with disordered eating and would like to receive support, getting a trans-competent and Health at Every Size (HAES) treatment team consisting of a nutritionist, therapist, and primary care provider will be essential. We would be honored to be your nutritional counselors and can help refer you to wonderful therapists and primary care providers that we trust.

Reach out to us and schedule an appointment to help support you, whichever journey you are on. 

Aster Galloway

Written by Aster Galloway, MS, RDN 

Aster’s nutritional approach is guided by a Health at Every Size (HAES) philosophy and that it is not our size that determines our health but our lifestyle. She also practices Intuitive Eating principles which encourages clients to eat in a flexible manner that honors internal hunger cues. Aster’s end goal with every client is creating peace with food and body.



  1. Breeding, Zachari. “Nutrition Considerations for the Transgender Community | Food & Nutrition | January February 2018.” Food & Nutrition Magazine, 12 Dec. 2017,
  2. Elbers, JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, et al. Effects of Sex Steroids on Components of the Insulin Resistance Syndrome in Transsexual Subjects. Clin Endocrinol. 2003;58(5): 562-71.
  3. Maraka, Spyridoula, et al. “Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis.” The Journal of Clinical Endocrinology & Metabolism, vol. 102, no. 11, 2017, pp. 3914–3923., doi:10.1210/jc.2017-01643.
  4. Pronsky, Zaneta M, et al. Food Medication Interactions. 18th ed., 2015.
  5. Radix, Asa, and Madeline B. Deutsch. “Bone Health and Osteoporosis .” Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Transgender Patients and the Physical Examination, Center for Excellence for Transgender Health, 2018,
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  7. Wierckx, Katrien, et al. “Long Term Evaluation of Cross Sex Hormone Treatment in Transsexual Persons.” The Journal of Sexual Medicine, vol. 9, no. 10, 2012, pp. 2641–2651.