Resolution of Severe Anorexia Nervosa Associated with Gender Dysphoria (Dysphorexia) by Testosterone Therapy in Two Male Transgender Youth

Abstract

Anorexia nervosa is a severe and potentially lethal eating disorder. In transgender youth with severe gender dysphoria, a severe eating disorder (proposed name: dysphorexia), coherent with anorexia nervosa may be triggered by the desire to avoid the cisgender pubertal transition. In these patients, gender-affirming hormone therapy can be extremely effective. We report hereby the cases of two female-to-male transsexual patients with severe gender dysphoria whose anorexia nervosa was related to their pubertal development and who promptly recovered when they started gender-affirming hormone therapy with testosterone, after very limited success with standard psychotherapy and pharmacotherapy for anorexia nervosa. Our patients could not access pubertal suppression due to lack of parental consent in one case and failure to express the conflict in the other. We postulate that avoiding the cisgender pubertal transition with GnRH agonist treatment might also be able to prevent the development of dysphorexia.