title: Disordered Weight Management Behaviors, Nonprescription Steroid Use, and Weight Perception in Transgender Youth.
abstract: Disordered weight management behaviors are prevalent among youth; recent case reports suggested that these behaviors might also be common in transgender youth. We studied associations of gender identity with disordered weight management behaviors, nonprescription steroid use, and weight perception among transgender and cisgender (nontransgender) high-school students in Massachusetts.
  
  
  
  Data were analyzed from the 2013 Massachusetts Youth Health Survey, an anonymous survey in a random sample of Massachusetts public high schools. Respondents were divided into three groups: transgender (n = 67), cisgender male (n = 1,117), and cisgender female (n = 1,289). Fisher's exact tests and multivariable logistic regression models were used to examine unhealthy weight management behaviors in the past 30 days: fasting >24 hours, vomiting, diet pill use, and laxative use; nonprescription steroid use; and self-perceived weight status. Analyses controlled for age, race/ethnicity, and body mass index.
  
  
  
  Compared with cisgender males, transgender adolescents had higher odds of fasting >24 hours (adjusted odds ratio [AOR] = 2.9, confidence interval [CI] = 1.1-7.8), using diet pills (AOR = 8.9, 95% CI = 2.3-35.2) and taking laxatives (AOR = 7.2, 95% CI = 1.4-38.4). Transgender youth had higher odds of lifetime use of steroids without a prescription than male cisgender respondents (AOR = 26.6, 95% CI = 3.5-200.1). Compared with cisgender females, transgender respondents had higher odds of perceiving themselves as healthy weight/underweight when they were overweight/obese (AOR = 2.4, 95% CI = 1.5-4.1).
  
  
  
  Transgender youth disproportionately self-reported unsafe weight management behaviors and nonprescription steroid use compared with cisgender youth. Clinicians should be aware of this increased risk among transgender youth. Research is needed to further understand these disparities and to inform future interventions.
authors.affiliation: Department of Medicine, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts. Electronic address: carly.guss@childrens.harvard.edu.
authors.forename: Carly E
authors.initials: CE
authors.lastname: Guss
authors.affiliation: Department of Medicine, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David N
authors.initials: DN
authors.lastname: Williams
authors.affiliation: Division of Adolescent/Young Adult Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: Department of Medicine, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.affiliation: Department of Medicine, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sabra L
authors.initials: SL
authors.lastname: Katz-Wise
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001828:Body Image / Q000523:psychology*; D000076064:Drug Misuse / Q000523:psychology / Q000706:statistics & numerical data*; D005215:Fasting / Q000523:psychology; D005260:Female; D006801:Humans; D054368:Laxatives; D008297:Male; D008404:Massachusetts; D009765:Obesity / Q000517:prevention & control* / Q000523:psychology; D012309:Risk-Taking; D045165:Testosterone Congeners; D063106:Transgender Persons / Q000523:psychology* / Q000706:statistics & numerical data; D014839:Vomiting / Q000523:psychology
chemical_list: D054368:Laxatives; D045165:Testosterone Congeners
keywords: Adolescent; Eating disorder; Steroid; Transgender