Eating disorder risk in transgender youth and its association with unmet need for gender-affirming hormone therapy in Aotearoa New Zealand: a cross-sectional study.

Aim: This study aimed to estimate rates and factors associated with eating disorder risk in transgender youth, and to explore the association between this risk and unmet need for gender-affirming hormone therapy (GAHT).

Methods: In a national cross-sectional survey of participants aged 14-24 years, the five-item Sick, Control, One stone, Fat, Food (SCOFF) instrument was used to assess eating disorder risk. GAHT demand was self-reported. Modified Poisson regressions were employed to assess risk.

Results: Overall, 1,401 participants were eligible, of whom 1,010 (72.1%) had valid SCOFF scores. Of these, 398 (38.4%) participants met the threshold for eating disorder risk. In adjusted analyses, those aged 14-18 years had an increased prevalence ratio (PR) of eating disorder risk compared with their counterparts aged 19-24 years (PR: 1.26; 95% confidence interval: 1.06-1.50). GAHT demand was reported by 645 participants, with 277 (42.9%) having unmet need. No statistical evidence was found relating unmet GAHT need with eating disorder risk (p=0.29).

Conclusion: Nearly two in five transgender youth are at eating disorder risk, and unmet GAHT need rates appear higher. While it is recognised that eating disorders are a global health concern, they have not received the priority they deserve. In the calls for urgent action, transgender youth deserve particular attention.