National Eating Disorders Association

Gender Outside the Binary: Part Two

Ryan K. Sallans, MA

Eating Disorder Recovery and Transgender Identities
Part Two of a Three Part Series

As I mentioned in part one of this series, one of the biggest fears I had when I first realized that I was transgender was whether my feelings were real or due to my body image distortion and eating disorder. 

Two questions that I immediately raised were:

  • What if I transition and I still feel the same way? 
  • And will my therapist validate my transgender identity, or will she also relate it back to my body image distortion and eating disorder? 

Ten years after my transition, I can say that the dysphoria I had due to my assigned gender and body was a factor in my eating disorder, but separate from my body image distortion. 

How does dysphoria differ from body image distortion? 

When talking about dysphoria and transgender identities, I am referring to the combination of fear, discomfort, anxiety, anger, and sadness a person feels toward the gender they were assigned, their gendered body, and/or how they are treated by society. This goes beyond body image distortion, and beyond the surface of a person’s skin. It dives down into the confusion that is created when you feel your very core is something different from what everyone sees, or expects from you, based on your assigned gender. It intensifies when you express your feelings, only to be rejected or disregarded by family, friends, therapist or teachers. 

We live in a society that predominantly assigns identity based on biological sex. This creates hurdles for all of us, but has an even higher impact on transgender people. For example, when a person is pregnant and they learn the sex of the fetus, or when a child is born and the doctor says, “It’s a boy!” or “It’s a girl!” what thoughts and assumptions are formed about the child, including, interests, clothing preferences and physical capabilities? Are they treated differently? If a child expresses themselves differently from what you assumed, how do you react and feel? 

We are trained to look at gender as black and white, this isn’t how gender works, and so we need to continually challenge this way of thinking, including the way we research eating disorders and gender. For example, some research suggests that a transition helps to alleviate the disorder. This is misleading, as a transgender identity does not necessarily equate a transition, or a person identifying within male or female categories.

Transgender is an umbrella term that relates to a person's gender identity being different from the sex they were assigned at birth, and/or a person's gender expression being outside of traditional societal norms. It is important for us to recognize that when we talk about transgender identities, we are talking about identities and forms of expression that move between or outside of male and female.

The impact of binary views leaves many transgender identities silenced and left in the shadows. This is exacerbated by what we see projected by mainstream media. For example, let’s take a look at media coverage around the transgender community. Who do we see as forms of representation? Most typically, we see highly feminine transgender women or highly masculine transgender men. While I am of the standpoint that any visibility and any person’s story adds value to the transgender movement, the one barrier this creates for many is the idea that the word “transgender” means that a person is going to be transitioning from one gender to the other, and in so doing, expressing forms of what is essentially hyper-femininity or hyper-masculinity.

So, what are tangible steps we can take in our homes, in our friendships, or in our facilities to help transgender people explore feelings that go beyond the binary? 

  • Do not assume that when a person identifies as transgender, it means they want to transition.
  • Do not assume you know what a transition means and looks like. All transitions can look different. 
  • For people that identify as transgender, respectfully ask them what their identity means to them at this time. 
  • Talk about how their transgender identity relates, or doesn’t, to other parts of their identity, such as: race, ethnicity, religion, politics, and other aspects of their sexuality.
  • Use requested name and/or pronoun, and if you call someone by the wrong name or use the wrong pronoun, acknowledge your mistake and apologize. 
  • Be flexible - allow space for a person that identifies as transgender to move around or outside of an identity. For example, some people may ask that you use a name or pronoun, and then later request you either revert back to their previous name or pronoun, or use something different. 
  • Be patient and respect individual requests.

People need space and time to explore and understand what feels right for them. When personal information is shared with you, you are being trusted to ride along with them in this journey; a journey that hopefully includes recovery from an eating disorder.

To learn about other terminology within the transgender community, consider reading an interview that I did on the Huffington Post. To close this series, the next article will look at how binary views and mainstream media have left the voices and experiences of men who are impacted by eating disorders 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: