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An Open Letter to Trans Eating Disorder Survivors

It can be really challenging when the people that you love struggle to understand who you are and what you are experiencing. This can contribute to feelings of isolation and depression. Please know that there are people who understand and are willing to help you through this time.

There are many misconceptions about what causes eating disorders and what contributes to one’s gender identity. The most harmful of these misconceptions is that eating disorders and gender identity are choices. Inferring choice leads to blame and shame, discourages communication and help-seeking, and can lead to the deterioration of mental and physical health.

To date, there is strong evidence to show that eating disorders and gender identity have environmental, biologic, and genetic factors that contribute to their development.

Brain structure and function

Research shows there are significant differences in the brain structure and function of individuals with eating disorders. Brain-imaging studies have shown that areas of the brain are smaller (grey matter), the integrity of the white matter that connects these brain areas can be compromised, and messages related to hunger, satiety, anxiety, reward, & motivation are not received in the same way as they are in the brains of those without eating disorders. Additionally, animal and human studies have shown that neurotransmitters involved in mood, reward, and appetite regulation are different in subjects that experienced eating disorder related behaviors and symptoms compared to those that have not. In short, signals from the body are being misinterpreted by the brain.


Although scientists have not yet identified a specific gene that predicts eating disorders, they have identified a number of misspellings in the human DNA sequence, called single nucleotide polymorphisms (or SNPs) that may relate to eating disorder symptoms. Researchers around the world are working together to determine which SNPs are most strongly associated with eating disorders.

Environment and experience

Research has also shown that life experience, stress, trauma, and eating behavior can change the way genes are expressed and alter neurotransmitter function. Taken together, the evidence supports the fact that eating disorders are not a choice, but a perfect storm of biologic, genetic, and environmental influences that result in these devastating disorders.

Similarly, research on gender identity has shown that brain structures and function are different in transgender persons compared to cisgender persons (individuals whose biologic sex matches their gender identity). There is evidence for a genetic basis to gender identity, and data suggests there may be differences in neurotransmitter function in transgender individuals.

Helping your community of support to understand that there is a strong biologic and genetic component to eating disorders and gender identity may help them to realize that you are not choosing to have an eating disorder or choosing to be trans.

It takes an incredible amount of insight and courage to seek help for an eating disorder, and we recognize that it can be particularly challenging to find a trans-affirming provider and/or treatment center. The team at Veritas is always here to support you and can provide you with a list of outpatient resources if you need help identifying providers in your area.

Always remember: You are an amazing force for change and the world is better with you in it.