This is a follow-up post to my post, “Nutritional Guidelines for Transgender Patients.” See the original post here. This article is an excerpt from my research paper, “Nutritional Guidelines for Transgender Patients,” which was written for practitioners of TCM who can use this information as part of a holistic diet tailored to client’s constitutions. It is not intended to function as medical advice. Because every body can respond differently, before beginning or changing your diet always consult a healthcare provider. I have included a few gems in here for practitioners, if you don’t have an understanding of TCM theory you may skip over the italicized portions.
To start, proper general nutrition is important, including plenty of healthy fats, avoiding animal products raised with hormones and processed or refined foods, and adding more fresh fruits, vegetables, and high quality protein.
As long as there are not contraindications based on your underlying constitution, a testosterone supportive diet should be high fiber, low carb and include a lot of vegetables and a moderate amount of protein.
This diet along with herbs and acupuncture can cause a slight elevation in testosterone levels in some people. However, please note that these diets alone will not have a significant effect.
Table 2: Trans-masculine Dietary Suggestions
A mildly yang nourishing diet is generally safe for most people however care should be taken in following this diet long term if yang deficiency is not present. It is important to note that trans men who have just begun taking testosterone often have some degree of yin deficiency, and this diet would be inappropriate in that case. Always talk to your healthcare provider when making dietary changes.
A yang tonifying diet includes more warming, sweet, pungent foods (Pitchford, p. 54), and avoiding raw and cold temperature foods (Pitchford, p. 95). Meat, especially poultry, lamb, wild game, tuna, lobster, salmon, and shrimp are especially good, but if the client experiences side effects from the testosterone, especially high red blood cell counts, meat should be cut down. Once taking testosterone, a yang tonifying diet would have to be greatly modified and monitored by a TCM practitioner or discontinued since testosterone tends to create more yin deficiency and blood heat rather than yang deficiency.
A high fiber diet can decrease blood estrogen levels by removing estrogen from the body before it can be reabsorbed in the bowel (Griffith, p. 158). Carbohydrates and especially starches should be limited as well because high blood sugar and associated high insulin levels can in turn raise estrogen levels. In addition, trans men should always avoid animal products raised on hormones (Cole and Han, p.75), since these hormones are estrogenic.
Anyone taking hormones should include sulfurous foods like garlic, dark leafy greens, and egg yolks, as well as lemons and limes, shiitake, reishi, dark leafy greens and cruciferous vegetables (cooked only if taking estrogens), to detox the body. Sulfur gives the liver the ability to get rid of toxins such as synthetic hormones (Duvall), tonifies the kidneys, warms yang, and benefits the skin (Caruso-Radin). Cruciferous vegetables, except for brussels sprouts and broccoli, stimulate testosterone production and flush out estrogen (Prodragonist), and celery has androgen like properties (Midnight). Lignans in sesame and whole grains -also in flax but that has an estrogenic effect- (Petersen), interfere with the enzymes that are involved with the production of estrogen (Duvall). Methionine, which aids estrogen breakdown (Marz, p.85), is found in many animal products; especially tuna, cheese, salmon, wild game, and shrimp, and also nuts, especially walnuts (Marz, p. 86), so protein should come especially from these sources. It is also important to balance excess methionine with glycine from bone broths (Caruso-Radin).
White button mushrooms also prevent testosterone to estrogen conversion (Prodragonist), and bee pollen and royal jelly may increase testosterone levels (Balch, p. 457). Acidophilus in lactofermented foods breaks down metabolites of estrogen (Balch, p. 588), as well as soothing the digestive tract which can be irritated by hormones. DHEA -via combining wild yam and cholesterol as described above is known to cause acne, hair loss, facial hair, and deepening voice in female assigned people (Griffith, p. 158-159), reminiscent of many of the effects of testosterone, and these “side effects” could be used to the client’s benefit. However, as DHEA can be converted to either estrogen or testosterone, it is important to monitor your hormone levels with a doctor when using this method.
Countering Side Effects:
Side effects from testosterone include high blood pressure, high red blood cell count, and high cholesterol. High blood pressure may be prevented somewhat by following a low salt, sugar, and caffeine diet, including avoiding foods with preservatives, aged meat, anchovies, avocado, fava beans, and pickled herring (Balch, p. 438). High blood pressure, if it occurs, can also be eased by selenium (Balch, p. 437), which is found in brewer’s yeast, brazil nuts, pork, eggs, liver, lamb, beef, tuna, and lobster (USDA). Selenium astringes yin, anchors yang, and calms shen (Caruso-Radin), allowing it to calm liver yang rising causing hypertension. High cholesterol, another potential side effect of testosterone use, can be helped with apples, cold water fish, dried beans, garlic, olive oil, carrot juice, and limiting sugars and oils to only unrefined cold or expeller pressed oils and naturally sweet foods like fruit (Balch, p. 442).
Vitamin C in citrus and brightly colored fruits and vegetables boosts testosterone levels, clears heat, stops bleeding, resolves toxins, and calms the shen (Caruso-Radin), potentially helping to stop the menses, prevent toxicity from hormone use, and ease initial mood swings as well as heat side effects, such as hypertension, hives, hot flashes, and acne. Vitamin E can also help reduce hot flashes common with starting testosterone (Balch, p. 512). Vitamin E is found in green vegetables, milk, liver, and nuts, and nourishes the blood and yang from a TCM perspective (Caruso-Radin), potentially countering liver yang rising due to deficient heat. Vitamin A, such as that in grass-fed whole dairy, bright orange and yellow fruits and vegetables and dark leafy greens (Caruso-Radin), is somewhat depleted by testosterone use (Gaby, p.175), so these foods should be increased in the diet.
Overall, a simple high fiber, low carb, moderate protein diet with plenty of vegetables should be followed for trans men. Good proteins to include are tuna, cheese, salmon, wild game, shrimp, lamb, and raw unsalted walnuts, peanuts, and almonds. White button mushrooms, bee pollen, royal jelly, brightly colored fruits and vegetables, lactoferments, beans, cruciferous vegetables, celery, sesame seeds, tomatoes, pears, and apples are great additional foods. If taking testosterone, clients should follow a low salt diet and add brazil nuts and garlic.
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