Evaluation of the Sex-Specific Nature of Nutrition Assessment Within the Nutrition Care Process: Case Study Vignettes of Transgender and Gender Diverse Patients

OBJECTIVES: Certain aspects of nutrition assessment within the Nutrition Care Process (NCP) are sex-specific, meaning they require nutrition professionals to select a male or female sex (i.e., growth charts, body fat percentage, and the normal ranges for certain biochemical markers). This presents a unique question for nutrition professionals working with transgender and gender diverse (TGGD) patients who may be medically transitioning or identify as non-binary. METHODS: LB is a 17 year-old, white individual who was assigned male at birth, identifies as non-binary, and uses they/their pronouns. They wear both masculine and feminine clothing and are not interested in pursuing medical interventions. LB is 5’5” and weighs 120 lbs. Which growth chart would be appropriate to assess LB's weight status? JY is a 50 year-old African American individual who assigned female at birth, identifies as transgender male, and uses he/his or they/their pronouns. JY's past medical history indicates he medically transitioned in his mid-20s, has been on masculinizing HT for the past 25 years, and is amenorrheic. Given JY's past medical history, which reference values would be most appropriate to assess hemoglobin and hematocrit? Hemoglobin - 12 g/dl Hematocrit - 37% RBCs - 5.0 ml Platelet count - 250,000 WBC - 6,000 cells/ml MR is a 30 year-old, Hispanic individual who was assigned male at birth, identifies as transgender female, and uses she/her pronouns. She started feminizing HT one month ago, is 5’8” tall and weighs 180 lbs; she would prefer a smaller physique and expressed that she would like to lose about 30 lbs. MR walks her dog for 30 minutes daily. Using the Estimated Energy Requirement (EER) equation, what are MR's energy needs to maintain her current weight? What energy requirement would support MR's weight loss goal? RESULTS: The cases of LB, JY and MR illustrate the potential strategies that nutrition professionals can utilize. 1. Use reference values consistent with sex assigned at birth for patients who have not medically transitioned (LB). 2. Individualize nutrition assessment to align with the client's medical transition (JY). 3. Express data as a range between the female-male reference values (MR). CONCLUSIONS: Nutrition professionals can apply specific strategies and clinical reasoning to address sex-specific aspects of nutrition assessment when caring for TGGD patients. FUNDING SOURCES: None.