Midlife Without the Binary: LGBTQIA+ Health Beyond the Hype

By Lane Edwards, Accredited Practising Dietitian

We've talked about perimenopause and manopause. Now it's time to talk about midlife health beyond the binary.

Midlife is often framed as a time of reckoning — a period of reflection, transition, and renewal. For LGBTQIA+ people, this life stage can be uniquely complex, shaped by a lifetime of navigating identity, systemic barriers, and evolving health needs. Yet nutrition care at midlife offers a powerful opportunity: not just to support physical wellbeing, but to affirm identity, reduce stigma, and foster healing.

Why This Matters: The Health Gap

LGBTQIA+ Australians experience significant health disparities:

• Around 4.5% of Australians aged 16+ identify as LGBTI+, including 0.9% as trans or gender-diverse (ABS, 2023).

• LGBTQIA+ adults are twice as likely to experience high or very high psychological distress compared to the general population (AIHW, 2025).

• One in five LGBTQIA+ people avoid healthcare due to fear of discrimination or past negative experiences (AIHW, 2025).

• Older LGBTQIA+ adults are more likely to live alone and less likely to have family support, increasing the risk of social isolation (Fredriksen-Goldsen et al., 2015).

These realities shape how — and whether — people access nutrition and health support. As dietitians, we must meet people where they are, with care that affirms identity and acknowledges lived experience.

Identity, Hormones and Aging: What Changes in Midlife

Midlife hormonal shifts aren't just about menopause or testosterone decline. For many trans and nonbinary people, gender-affirming hormone therapy plays a central role in health and identity — and its effects evolve with age. Estrogen therapy may impact bone density and fat distribution, while testosterone can influence cardiovascular markers and mood (Irwig, 2017; Getahun et al., 2018). These changes intersect with aging physiology, creating unique nutritional needs.

Cisgender lesbian, gay, and bisexual people also experience midlife differently. Historical trauma, minority stress, and reduced access to preventive care can shape how menopause, andropause, and chronic disease risk unfold (Fredriksen-Goldsen et al., 2015).

Barriers in the Clinic: Why LGBTQIA+ People Avoid Dietetic Care

Despite growing awareness, many LGBTQIA+ people still hesitate to seek nutrition support. Studies show that fear of discrimination, lack of provider knowledge, and previous negative experiences are common deterrents (Czapla & Dissen, 2025). These barriers are compounded by systemic gaps in training: many clinicians aren’t equipped to provide gender-affirming care or understand LGBTQIA+ aging (Dubin et al., 2018).

Medical mistrust, social isolation, and elevated rates of disordered eating further complicate access. LGBTQIA+ individuals — especially trans and nonbinary people — are at higher risk of body image concerns and restrictive eating patterns (Watson et al., 2017). Nutrition care must be trauma-informed, inclusive, and affirming to be truly effective.

What Dietitians Can Do: Affirming, Evidence-Based Support

Nutrition care can be transformative — when it's delivered with cultural humility and clinical insight. Here's how dietitians can support LGBTQIA+ clients in midlife:

• Bone Health: Support calcium, vitamin D, and weight-bearing exercise, especially for clients on estrogen therapy (Wierckx et al., 2017).

• Heart Health: Monitor lipid profiles and blood pressure in clients on testosterone, and promote omega-3s, fibre, and plant-based fats (Irwig, 2017).

• Muscle Maintenance: Encourage protein intake (1.2-1.6 g/kg/day) and resistance training to preserve strength and metabolic health (Coelho-Junior et al., 2022).

• Mental Health Nutrition: Prioritise B vitamins, magnesium, and regular meals to support emotional regulation and reduce anxiety (Fredriksen-Goldsen et al., 2015; AIHW, 2025).

• Disordered Eating: Recognise elevated risks among trans and nonbinary clients, and offer flexible, non-restrictive approaches (Watson et al., 2017).

Healing Through Food: Beyond Nutrients

Nutrition isn't just about biochemistry — it's about dignity, access, and feeling seen. Affirming care means asking about pronouns, understanding hormone therapy, and recognising the impact of stigma on eating patterns. It means creating space for clients to explore nourishment without judgement, and without needing to fit a binary.

As dietitians, we have the tools to support physical health — but also to foster resilience, autonomy, and joy. Midlife is not a crisis. For LGBTQIA+ people, it can be a time to reclaim strength, deepen relationships, and shape legacies. Nutrition care, when done well, can help make that possible.

What I Tell My LGBTQIA+ Clients

• Your body deserves nourishment, not judgment.

• Hormonal change is real — whether it’s from therapy, aging, or both.

• You don’t need to fit a binary to deserve support.

• Nutrition can be a tool for healing, strength, and self-affirmation.

Final Word

Midlife isn’t one-size-fits-all. It’s shaped by hormones, history, and identity. LGBTQIA+ people deserve health guidance that reflects that — without the hype and assumptions.

If you missed my articles on perimenopause or manopause, this piece completes the trilogy. Because midlife health belongs to everyone.

References

Australian Bureau of Statistics. (2023). Estimates and characteristics of LGBTI populations in Australia. https://www.abs.gov.au/statistics/people/people-and-communities/estimates-and-characteristics-lgbti-populations-australia

Australian Institute of Health and Welfare. (2025). LGBTQIA+ people: Health snapshot. https://www.aihw.gov.au/reports/lgbtiq-health-and-wellbeing/lgbtiq-people-health-snapshot

Coelho-Junior, H. J., Calvani, R., Gonçalves, I. O., Rodrigues, B., & Marzetti, E. (2022). Protein intake and sarcopenia in older adults: A systematic review. International Journal of Environmental Research and Public Health, 19(14), 8718. https://doi.org/10.3390/ijerph19148718

Czapla, M., & Dissen, A. (2025). Inclusive nutrition care for LGBT+ patients: Challenges and opportunities for dietitians. Nutrients, 17(20), 3276. https://doi.org/10.3390/nu17203276

Dubin, S. N., Nolan, I. T., Streed, C. G., Greene, R. E., Radix, A. E., & Morrison, S. D. (2018). Transgender health care: Improving medical students’ and residents’ training and awareness. Advances in Medical Education and Practice, 9, 377–391. https://doi.org/10.2147/AMEP.S147183

Fredriksen-Goldsen, K. I., Kim, H. J., Shiu, C., Goldsen, J., & Emlet, C. A. (2015). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. The Gerontologist, 55(1), 154–168. https://doi.org/10.1093/geront/gnu081

Getahun, D., Nash, R., Flanders, W. D., Baird, T. C., Becerra-Culqui, T. A., Cromwell, L., ... & Goodman, M. (2018). Cross-sex hormones and acute cardiovascular events in transgender persons: A cohort study. Annals of Internal Medicine, 169(4), 205–213. https://doi.org/10.7326/M17-2785

Irwig, M. S. (2017). Cardiovascular health in transgender people. Reviews in Endocrine and Metabolic Disorders, 19(3), 243–251. https://doi.org/10.1007/s11154-017-9441-3

T’Sjoen, G. (2017). Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the European Network for the Investigation of Gender Incongruence. The Journal of Sexual Medicine, 14(5), 624–634. https://doi.org/10.1016/j.jsxm.2017.02.001

Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50(5), 515–522. https://doi.org/10.1002/eat.22627

Wierckx, K., Van Caenegem, E., Schreiner, T., Haraldsen, I., Fisher, A. D., Toye, K., ... & T’Sjoen, G. (2017). Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: Results from the European Network for the Investigation of Gender Incongruence. The Journal of Sexual Medicine, 14(5), 624–634. https://doi.org/10.1016/j.jsxm.2017.02.001