Exploring the Intersection of Gender Identity and Eating Behaviours in Gender-Diverse Populations

Background Gender-diverse individuals are at elevated risk for disordered eating, shaped by body dissatisfaction, gender dysphoria, and minority stress. The roles of gender identity and expression, however, remain underexplored in clinical samples. This study examined how self-perceived masculinity, femininity, and gender variance relate to eating behaviours in gender-diverse adults seeking gender-affirming care.Methods Eighty-four adults assigned female (n = 50) or male (n = 34) at birth were recruited from a regional gender incongruence clinic. Participants self-identified as male (n = 44), female (n = 30), or non-binary (n = 10); 36 were receiving gender-affirming hormone therapy (GAHT). They completed the Three-Factor Eating Questionnaire (TFEQ) and the Gender Variance Scale (GVS), assessing masculinity, femininity, and deviation from cisnormative expectations. Regression models tested associations between gender traits and eating behaviours.Results Masculinity was positively associated with cognitive restraint, while femininity correlated with emotional and uncontrolled eating. Gender variance was not significantly related to TFEQ; however, exploratory analyses suggested a modest quadratic trend with dysregulated eating. Eating behaviours did not differ by GAHT status.Conclusions Gender expression, more than gender variance, appears to influence eating behaviours in gender-diverse individuals. Clinicians should consider how masculinity- and femininity-linked eating patterns shape assessment and intervention.