National Eating Disorders Association

Gender Outside the Binary: Eating Disorder Recovery and My Transgender Identity

Ryan K. Sallans, MA

Part One of a Three Part Series

I started outpatient treatment for my eating disorder prior to coming out as transgender. This included almost six years of weekly therapy and support group sessions, meetings with a nutritionist, psychiatrist and physician, and participation in the peer education group on campus. During this time, I continued to severely struggle with my eating disorder and other self-harming behaviors, and found it difficult to fully connect with the other people in treatment and members of the student group. I felt like an outsider because of the way that I dressed, my interests, and something I felt inside, but couldn’t quite identify. When I was able to identify these feelings, first by coming out as lesbian, and then eight months later as a transgender man, I felt even further disconnected from my peers. Coming out is one of the hardest things to do, after spending a lifetime rejecting yourself, the fear of further rejection from others, including those working with you in your recovery, is defeating. 

A recent research article in the Journal of Adolescent Health titled Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students, studied eating disorders on college campuses. Data from surveys conducted from 2008 to 2011 found that the highest rates of reported eating disorders were among transgender respondents. While this is just one study, it is reflective of the narratives I have heard from many people in the transgender community, including myself. 

I have found that two questions people working with eating disorders and transgender clients often have are: How are transgender people accessing recovery and treatment programs? And does a transition alleviate the disorder? While more research is needed to address these questions, below is a retelling of the moment I came out as transgender, and my eating disorder recovery ten-years after transition. Part two of this series will focus on transgender identities, and the unique issues to consider when providing treatment.


 “Where did you go?”

“I don’t know,” my pat answer every time I heard my therapist ask me that question. I couldn’t give her more; words were always stuck, either lodged in my throat or swirling in my mind.

“I see you brought a folder in with you today,” she gestured toward the binder sitting next to me on the couch. “Is there something in there you wanted to share?”

I looked down at the folder and contemplated if sharing was still a good idea, and if now was the right time. In the past, self-doubt and embarrassment would cause me to change my mind or “forget” to bring up my journal.

Today, it was time to share my biggest secret.

It was time to pull out the words around my self-discovery, even if they were to be read from paper. I cleared my throat and began to read my scribbles. My voice cracked, my hands shook, and sweat seeped from my body. 

“All my life, I’ve felt like my outside has not reflected my inside. All my life I’ve struggled to fit into a gender that I didn’t feel was my place. I feel my disorder was an attempt to find gender…to get the gendered body inside my head…”

As I finished, I lowered the paper and looked up at my therapist, only to look quickly back down again. At that moment I didn’t want to be in that space with her. I was fearful of rejection from the one person I trusted the most with my secret.  

 “So, you are telling me that you want to be a boy,” my therapist said.

I nodded my head. 

I was scared. She was inexperienced with people like me, people who are transgender, but we were in this space together, sharing a moment of transition, not only in our therapeutic relationship, but in my life.


I am ten years behavior free from my eating disorder and ten years into my transition. I am classified as “post-op” meaning I have completed the surgeries and other medical transition options needed to align my physical body with my internal sense of identity. I ended therapy shortly after coming out, not because I wanted too, but because I had graduated from college. This left my recovery in my hands, along with my transition. 

I noticed that when I began exploring sexuality, my disordered behaviors around food decreased, after coming out as transgender these behaviors stopped. While my behaviors have ceased and aspects of my negative body image have changed, the negativity that I feel, and the distortion that I view, have NOT gone away. What has helped me when I struggle with my body image, or when my eating disorder thoughts start to creep into my mind, is to remind myself that what I am feeling is influenced by insecurities, and what I have idolized regarding physical bodies is something either unattainable or is not sustainable. 

In my opinion, a tie that binds us all, who have or are struggling with eating disorders, is the fear of not being loved or accepted and also letting down those that we love. What is unique for transgender people is the extra layer of dysphoria we may have with a body that is not aligned with a gender identity. If we look at treatment, while working with the dysphoria is needed, another important factor is to explore identity and break down the beliefs formed from binary views, in order to move us all beyond gender. I look forward to sharing more with you, around this concept, in part two of this series. Part three will focus on the narratives we have predominantly seen around men with eating disorders, and the narratives that have been left in the shadows. 

About the author:

Ryan K. Sallans, MA is a public speaker, diversity trainer, consultant, publisher and author of the book Second Son. Ryan specializes in healthcare and workplace issues surrounding the LGBTQIA community, with an emphasis in transgender healthcare. For the past five years he has served as the Lead Subject Matter Expert, for Affiliate Risk Management Services Inc, in the development of e-learning courses for healthcare professionals seeking CMEs in LGBTQ healthcare and cultural competency. These courses have been added to the Human Rights Campaign – Healthcare Equality Index. Ryan also works with organizations and universities on LGBTQ social issues, creating transgender-inclusive environments, and media literacy related to eating disorders, body image and gender. His educational background includes a Bachelor of Arts in English and anthropology, Masters of Art in English, and a Masters of Art in educational psychology. Learn more about Ryan’s work and his book on his website:

Diemer, Elizabeth W. et al. (2015). Gender Identity, Sexual Orientation, and Eating Related Pathology in a National Sample of College Students. Journal of Adolescent Health.