This is a follow-up post to my post, “Nutritional Guidelines for Transgender Patients.” See the original post here. This article is an excerpt from my research paper, “Nutritional Guidelines for Transgender Patients,” which was written for practitioners of TCM to create holistic diets tailored to clients’ constitutions. It is not intended to function as medical advice. There are a few jewels tucked into this article for practitioners, if you don’t have an understanding of TCM theory you can skip over the italicized parts.
To start, proper general nutrition is important, including plenty of healthy fats, avoiding animal products raised with hormones and processed or refined foods, and adding more fresh fruits, vegetables, and high quality protein.
As long as there are not contraindications or food allergies, an estrogen and progesterone supportive diet (i.e. does not actually produce/mimic estrogen and progesterone but can help to support those hormones in your body) should be focused on ancient grains and cooked dark vegetables, and include cooked berries, eggs, dark legumes, micro-algaes, nuts and seeds, garlic, shiitake, and reishi.
This diet along with herbs and acupuncture can cause a slight elevation in estrogen levels and breast enlargement in some people. However, please understand that these diets alone will not have a significant effect. Since each individual has different goals, this diet can be adapted based on changes that each person wishes to make and any underlying conditions.
Estrogen & Progesterone Supportive Diet Suggestions
Increase starchy vegetables, millet, barley, seaweed, micro-algaes, dark legumes, beets, kudzu, persimmon, cooked berries, bananas, watermelon, mollusks (limit mollusks when taking progesterone), pickled and fermented foods, eggs, and coconut milk.
Grass-fed hormone-free organic milk and fermented/cultured dairy products are also a great addition.
Limit meat to small amounts of duck, beef, pork, goose, rabbit, and organ meats.
If not taking hormones, add raw dark fruits (blackberries, purple plums, blueberries, etc.), raw dark greens, raw bell peppers, and small amounts of real black licorice (avoid with high blood pressure, when taking spironolactone, or with hot flash or night sweat symptoms).
If taking estrogen, add garlic, lemons and limes (avoid if taking progesterone), shiitake, and reishi. AVOID eating grapefruit or taking GSE with estrogen.
If taking spironolactone, AVOID buchu, cleavers, dandelion, gravel root, horsetail, juniper, uva ursi, molasses, and radishes.
Many, though by no means all, trans women taking estrogen and spironolactone have some degree of yin deficiency, and this diet can help to counteract this issue while still supporting transition goals. This is a generally mild and healthy diet safe for most people, however care should be taken in following this diet exclusively long term if yin deficiency is not present. Always talk to your healthcare provider when making dietary changes.
A yin nourishing diet should be based on millet, barley, teff, quinoa, amaranth, and other ancient grains (Pitchford, p. 65). Other appropriate yin foods that could be added to the diet include seaweed, micro-algaes, black beans, kidney beans, mung beans, sprouts, beets, string beans, kudzu (not with damp signs), persimmon, grapes, cooked berries, bananas, watermelon, dairy, eggs, clams, abalone, oysters (avoid mollusks when taking progesterone and with damp signs), and sardines (Pitchford, p. 65). Reduce meat -which is a more yang tonifying food- except for small amounts of yin and blood nourishing duck, beef, pork, goose, rabbit, and kidney (Pitchford, p. 65). Sour foods are beneficial because they tonify yin and move the blood (Caruso-Radin), which could be helpful to prevent blood clots, a common side effect of estrogen use,. Spices should mainly include milder white pepper, cilantro, and marjoram, which are yin spices (Pitchford, p. 62), rather than stronger yang spices like cayenne. When these foods are made into soups, stews, and congees they become even more yin tonifying.
In designing a feminizing diet, it is necessary to think about not only the energetic and hormonal properties of foods, but also their safety for long term use. For example, eating mainly carbohydrates, starches, coffee, and soy can raise estrogen levels and lower testosterone levels (Duvall), but this can also potentially cause diabetes, hormone dependent cancers, heart palpitations, and other serious health consequences.
I would generally recommend that for those looking for natural sources of estrogen, there are many safer options than soy. For example, “flax contains substances called lignans, which have been shown to have estrogen-like qualities” (Wright & Morgenthaler). A few foods have small amounts of identical-to-human hormones [about 1-2% potency of human hormones] (Wright & Morgenthaler), including: Rice, apples, date palm, pomegranate (estrone); and French bean seedlings (estradiol). Note that eating these foods alone will generally not be enough to noticeably increase estrogen levels.
For trans women not taking hormones, licorice could be added to the diet to increase estrogen, however it should not be taken with diuretics (such as spironolactone), by an individual with high blood pressure (Griffith, p. 345), or with symptoms of hot flashes and night sweats. The ipriflavone in soy, alfalfa, and propolis is additive when taken with estrogen (Gale Group), and should not be combined with estrogens (Gaby, p. 110), but may be useful for those not taking hormones, though only fermented soy such as tempeh should be consumed (to avoid the other detrimental effects of soy).
Pregnenolone derived from diosgenin in wild yams is extracted in the body when combined with cholesterol heavy foods such as eggs, and is converted to either DHEA or progesterone (Bennett), which can balance high estrogen levels. This is known to cause breast enlargement in male assigned people (Griffith, p. 174-175), but because DHEA and progesterone can convert to either estrogen or testosterone in the body, they should not be used with synthetic hormones or without medical supervision.
Synthetic Estrogen and Food Interactions:
Trans women taking hormones should be aware that they can interact with nutrients in certain foods. Estrogen for example, has adverse interactions with the quercetin in grapefruit, which is also to a lesser extent in capers; onions; raw dark fruits like cranberries, black plums, blueberries, currants, and cherries; and raw kale, lettuce, asparagus, spinach, broccoli, and peppers (Kerns, 2014). These foods should be limited when taking estrogen and not eaten at the time of medication.
In addition to having adverse reactions with quercetin, synthetic estrogens deplete B6, which can be replaced by eating organ meats, brewer’s yeast, garlic, and whole potatoes (USDA). B6 smooths liver qi stagnation, clears heat, harmonizes wood and earth, and clears heat from the stomach and damp-heat from the gall bladder (Caruso-Radin), which can help ease negative effects of estrogen on the digestive system and emotional health.
Countering Estrogen Side Effects:
Estrogen can cause several side effects, such as circulation problems, blood clotting, and sometimes increased blood levels of cholesterol, all of which may be prevented with nutrition. Circulatory problems can be combated with the chlorophyll in dark leafy greens and micro-algaes (Balch, p.129). This can be further aided by the CoQ10 and B5 (converted to coenzyme-a, which works along with CoQ10) in organ meats, eggs, brewer’s yeast, avocado, and seeds, which together improve tissue oxygenation (Coffman). According to TCM, CoQ10 and coenzyme-a relieve liver qi stagnation, clear heat, and tonify the spleen (Caruso-Radin), perhaps allowing the spleen to create qi and the liver to move qi to prevent stagnation that could lead to blood clots and other circulatory problems.
Shiitake and reishi prevent hypertension, heart disease, and cholesterol problems (Midnight). The Vitamin C and other antioxidants in a diet full of fermented foods and a variety of fruits and vegetables prevents blood clotting (Midnight), and also clears heat, resolves toxins, and calms the shen (Caruso-Radin), potentially minimizing the toxicity of synthetic hormones and easing emotional imbalances caused by introducing new hormones to the system. Nuts and seeds, especially coconut milk, walnuts and sunflower seeds which contain both essential fatty acids and vitamin E (USDA), should also be consumed to help the body to manufacture hormones like estrogen (Balch, p. 454), and to replenish vitamin E that is depleted by synthetic estrogen (Pitchford, p. 397).
Anyone taking estrogen should include lemons or limes (avoid with progesterone), spinach, and other leafy greens to detox the liver (Duvall). Brussels sprouts and broccoli in particular also contain phyto-estrogens (Duvall), so are an especially good choice. Monitor your hormone levels with a doctor when doing a liver detox to ensure that you are maintaining the appropriate amounts for your body.
Countering Spironolactone Side Effects:
Spironolactone is the most commonly used androgen blocker in the United States. It was originally developed as a potassium sparing diuretic and therefore should not be combined with diuretic herbs like buchu, cleavers, dandelion, gravel root, horsetail, or juniper; or with foods with a lot of magnesium and potassium (Gaby, p. 243), like molasses, kelp, chocolate, bananas, or radishes (USDA), since those minerals are not excreted as easily with spironolactone use.
(Providers: Magnesium astringes yin, suppresses yang, and calms shen (Caruso-Radin), so the fact that spironolactone causes the body to retain magnesium may explain why spironolactone has a yin tonifying anti-androgenic effect. Potassium tonifies the spleen, drains damp, and clears heat (Caruso-Radin), accounting for the diuretic effects of spironolactone.)
Anyone taking spironolactone should supplement with organ meats, spinach, or asparagus which provides the folate that can be depleted from spironolactone use (Gaby, p. 243). Folate nourishes the blood, harmonizes the liver, and calms the shen (Caruso-Radin), which could potentially ease some of the emotional side effects of hormones.
Salt is also depleted and should be supplemented via cheese and pickled or fermented vegetables (UCSF). Salt tonifies the liver and kidney and astringes jing (Caruso-Radin), which can all be damaged by longer-term synthetic hormone use. A low-salt diet combined with spironolactone can cause low blood pressure. Blood pressure should be monitored frequently while taking spironolactone to ensure it is not too low, especially if you tend to experience low blood pressure.
Countering Progesterone Side Effects:
Progesterone, when taken internally, increases vitamin A. From a TCM standpoint, vitamin A tonifies the blood and jing and clears deficiency heat and stagnation, accounting for progesterone’s ability to nourish yin to counterbalance estrogen.
Progesterone also increases folate, zinc, and magnesium (Gaby), so these items should not be supplemented, however, this most likely does not apply to foods containing those nutrients. This does mean that the folate depleted by spironolactone would be balanced by progesterone and magnesium would be even more increased so should definitely not be supplemented when taking both of these medications.
Overall, a diet for trans women could focus on ancient grains, especially millet and barley, and cooked Brussels sprouts, broccoli, and other dark greens. It should also include micro-algaes, dark legumes, cooked berries, eggs, coconut milk, grass-fed organic hormone-free dairy, walnuts, sunflower seeds, garlic, shiitake, and reishi.