Which is probably why you’ll find bulimia, anorexia, and cutting at higher rates among trans men then their cisgender brethren, if anyone cared to study that. Ryan K. Sallans (pictured below), who wrote about his body image, eating disorder, and transition in last year’s memoir, Second Son: Transitioning Toward My Destiny, Love and Life, knows eating disorders well. He’s written and spoken extensively and done trainings around eating disorders and body image, using his own experience as a transgender man who was anorexic, as a jumping off point.
Years ago, after nine months of being sick, Sallans looked at an online check list for anorexia. “I felt a rock in my stomach as I looked back over the check list and realized I fit every single criteria,” he recalls. “It took me another three months before I finally went to a therapist and sought help. My health and spirits were rapidly declining and my life was empty. Eating disorders are not glamorous, they punish you and those that love you, and the recovery takes a lot of work. Work that will continue throughout your life.”
But he does know he’s seeing an increase in trans men who can be diagnosed with eating disorders. “This may seem more than other men because the trans community is much smaller, but it has me concerned,” he admits. “What makes me even more concerned is that treatment facilities aren’t yet prepared or trained on how to work with transgender clients. They are currently struggling with how to even serve men, let alone trans men.”
The numbers are telling: eating disorders in men are up, in some areas they’ve risen 40%. Though most men never seek treatment, about 10-15% of people with anorexia or bulimia are male, according to the National Association of Anorexia Nervosa and Associated Disorders. Of gay men, nearly 14% appeared to suffer from bulimia and over 20% appeared to be anorexic. Trans men aren’t studied as a group, but some activist believe their numbers are even higher.
It’s not a surprise considering trans men are often raised and enculturated as girls regardless of what their mind feels, living in a gender discordant body, often trying hard to match up to media images of men like Vin Diesel and G.I. Joe. Jake tells other guys that no matter how much you want gender reassignment surgery, it isn’t a magic bullet. It won’t solve all your problems. It won’t make you look like Vin Diesel.
Sallans agrees: “Every time I conduct a training or speak with other trans men I always say, ‘You can’t put all of your eggs into the surgery basket.’ You first have to work on your emotional and internal self before looking toward physical changes. I know several guys who move forward with surgeries thinking that they will no longer feel uncomfortable after their surgery is completed, only to find out that their emotions are still the same. For example, they could come out with a great looking penis, but still feel unsatisfied in life. Our emotions run deeper than our exterior skin. When working with guys that already have severe body image disturbance or an eating disorder, there is an extra layer of emotional work that they’ll need to do."
No slouch in the looks department, Sallans says that he’s “completed every surgery and have genetics that many say are attractive, but I still struggle with my body image. I have found that I struggle more during times where I feel unsettled, whether it be financially, in my romantic relationship, or with my family. When I feel insecure and vulnerable I always turn to my body and start shaming the parts of me that I don’t think are ‘perfect.’ Fortunately, I am aware of this now, so when my mind starts attacking my physicality, I stop myself and say, ‘Okay, Ryan, what is really going on here? What are you really feeling?’ This has helped me a lot, but I still have my struggles. That is the tricky thing about eating disorders, they are a mental illness; one can’t cure a mental illness.”
I ask Sallans how trans men survive in a culture where size matters? “Being in a culture where physical appearance is focused on more than intelligence, where sexuality is splashed all over magazines, billboards and the internet, it is hard to move past thinking about appearance and comparing what attributes we have compared to all the air-brushed images on our screens and pages,” he admits. “What really matters isn’t our size, it is our relationships with ourselves and those around us, which includes how we respect ourselves and those around us. I know that I have moments where I wish my penis were bigger but then I laugh because I’m just like any other guy, always wanting something bigger than the other guys. After I laugh it off, I realize I need to be happy with what I have, and I need to put my energy into more important things like being present, helpful and loving.”
Croft says that being the opposite gender of one's body is a "mind prison — a person has to either escape, be freed, or become institutionalized. Escaping means, to me, suicide, alcoholism, drug addiction, or a combination, etc. Becoming institutionalized means, to me, living in the cage and following the regimental framework of society’s role for you. Being freed, to me, means to pick yourself up, walking through the gates and into the world with no one but yourself to rely on. The choice is ours which way to go.” He says he was public with his surgery, and with living out his trans life in small town America onscreen, not just to help himself but to help others like him who don’t realize he options they have. “They have not been shown examples of all of the alternatives. I am open about myself to allow others to understand their options.”
Still, all these men agree that finding peace with your body is a process every trans man goes through. Jake covered himself with a towel quickly the other day when I walked into his shower. Is he just shy? (Could be familial: I didn’t see his parents show any PDA until we had been married 15 years.) Or was he plagued with body issues that day? He pokes at his belly, muscles his arms, then generally crashes on the sofa in a heap with me, happy in knowing he’ll never be a muscle man. He’s a very hot geeky guy and I love him. But, he has issues. Many guys do, even if they aren't allowed to give voice to them.
Sallans still gets those thoughts: If only my abs were more defined, if my stomach were tighter, if my arms were stronger. These are a variation of the “what ifs” women have had for decades, the ones men seem to have more and more these days thanks to everything from internet porn to Diet Coke ads.
“I remind myself that what we see every day in media is not reality,” Sallans says. “Unless reality is having millions of dollars, a trainer, personal chef, plastic surgeons, and hours upon hours of allotted time by a producer, manager, or director to spend in the gym. When I start to attack myself, I think of what really matters in life and also that I shouldn’t take my current abilities for granted. I have found the importance of moderation and balance, and feel like I am in a better place because of it. I can say because I spent six intensive years in therapy that my chest surgery, hysterectomy, and metoidoplasty procedures have definitely helped my external self feel whole. I love what surgery has done for me and when I am in museums where they have a sculpture of David or Greek gods I say, ‘Hey, look at that, my penis looks just like theirs.’”
DIANE ANDERSON-MINSHALL is the editor in chief of HIV Plus magazine and the Advocate's editor at large.