Physical activity, body (dis)satisfaction and mental health in the transgender population

BACKGROUND AND AIMS. Prior to gender affirming medical interventions, transgender people often experience high levels of body dissatisfaction and poor mental health in comparison to the cisgender (i.e., non-transgender) population. Body dissatisfaction and poor mental health have been associated with eating disorder psychopathology within the cisgender population. Transgender people are therefore an important group to target for intervention development. Participating in physical activity and/or sport within the cisgender population has been associated with body satisfaction and mental well-being. The overarching aim for the research reported on in this thesis was therefore to explore the role of body (dis)satisfaction, mental health and medical transition on physical (in)activity and eating disorder symptoms within the transgender population. Studies that have evaluated gender affirming medical interventions have been limited by the outcome tools used and therefore this thesis also aimed to develop and validate a new measure to assess intervention and treatment outcomes. PARTICIPANTS. Treatment seeking transgender people were invited to take part in all of the empirical studies reported on in this thesis. For some studies, transgender people from the community and/or cisgender participants were also recruited. MAIN FINDINGS. Despite being motivated, many transgender people reported having negative experiences engaging in physical activity and/or sport due to numerous internal and external barriers. Many of these barriers are directly or indirectly related to body dissatisfaction. Cross-sex hormones appeared to increase physical activity participation, possibly by alleviating body dissatisfaction and increasing mental well-being. It was also found that body dissatisfaction played a key role in the existence of eating disorder symptoms. Transgender people who had taken cross-sex hormones reported lower levels of eating disorder symptoms, possibly due to an increase in body satisfaction. Finally, this thesis successfully developed a new outcome measure in collaboration with transgender people and experts working in transgender healthcare. This measure was named the Gender Congruence and Life Satisfaction Scale (GCLS) and was found to be valid and reliable. IMPLICATIONS. Spreading awareness of the barriers that transgender people face in relation to physical activity and sport engagement may help this population to become more active. Being more active is important for transgender people as it may have body image and mental health benefits. Cross-sex hormones appear to be crucial in reducing body dissatisfaction and increasing mental well-being. Possibly because of this, physical activity levels are higher among people who have taken cross-sex hormones. Additionally, cross-sex hormones also appear to reduce eating disorder symptoms. However, the research in this thesis is cross-sectional. Future research should adopt a longitudinal research design, particularly now that a new tool to evaluate intervention and treatment outcomes (the GCLS) has been developed. This tool is likely to make important advances in research which will contribute towards increasing the well-being of the transgender population.