Body Image Therapy for LGBTQ People: A Guide to Self Trust.

Body image has always been a challenge, but it hits different for queer and trans people. As a queer therapist with advanced training in gender affirming care, I've witnessed firsthand how gender identity and minority stress can play a role in how safe people feel in their bodies. 

The relationship between body image and identity is deeply personal and layered. Body image stress is partially about appearance but also goes deeper into feelings of worthiness. It can bring up thoughts of not being enough and feeling un-loveable. Body shaming in our society can feel especially dehumanizing for queer people, who might turn to disordered eating to cope.

The dominant messaging from our society constantly reinforces that only thin, white, cis bodies are acceptable and deserving of respect. With the rise of GLP-1s and skinny culture, I’m feeling it too. Queer people in larger bodies don’t have to just make peace with their own biases, but they must learn how to navigate a world that is constantly telling them they are wrong. As a queer therapist, I am passionate about helping queer and trans people find neutrality towards their bodies and connect with the parts of themselves beyond their shape.

Understanding Body Image in LGBTQ Communities

 Body image is so much more than what we see in the mirror. It includes our thoughts, feelings, and perceptions about our physical selves, as well as how we believe others perceive us. Structural oppression can put queer people on high alert, with an over-emphasis on appearance and how other people perceive them.

The impact of minority stress cannot be understated when discussing body image for queer and trans people. Minority stress refers to the chronic stress experienced by individuals from stigmatized minority groups, resulting from experiences of prejudice, discrimination, and rejection. This stress can manifest in various ways, including negative body image, disordered eating, and chronic health issues.

For transgender individuals specifically, body image concerns might center around gender dysphoria and identity. This can create a complex relationship with the body, where certain physical characteristics may feel incongruent with one's identity. However, it's crucial to understand that not all transgender individuals experience dysphoria, and experiences vary widely from person to person.

Unique Challenges Faced by LGBTQ Individuals

The body image challenges experienced by LGBTQ+ individuals are often compounded by societal pressures that center thin, white, cisgender standards of beauty. The same expectations that impact cis, straight people affect queer people, but even harder. There can be a feeling of having to overcompensate for an internal sense of feeling “wrong”.

Common Body Image Issues in Trans Men

Trans men are at risk for the same pressures that affect cis men, but the impact is larger and different. Trans men may try to shrink their bodies to minimize curves and achieve more masculine features.  Some trans masculine individuals may focus on wanting a lean, muscular body to the point that they over-exercise or spend hours at the gym. While going to the gym can be a positive, gender-affirming experience, it can turn into compulsive exercise for some people. I always urge my clients to evaluate their relationship with exercise to discern whether it’s healthy or disordered. If you’re trans masc, here are some helpful questions to ask yourself?

How many days do I spend at the gym? Are there any rest days? (Remember, even professional athletes need rest days!)

How do you feel if you take a day off from exercise?

If you’re feeling sick or under the weather, do you push yourself to exercise?

Are you able to flexible with your workout schedule to accommodate other plans?

Trans Femmes and Passing

Wanting to pass as cisgender is a common pressure among the transgender community. While passing impacts trans people of all genders, it can have unique implications for trans women and femmes. Like trans men, trans women are affected by the same standards that impact cis women. Women are socialized that their worth is tied to their youth, body size, and attractiveness. These standards reduce women to the interests of cis men and their desires. Many trans femmes want to pass to feel feminine and worthy in our society. It can feel protective to ensure people are using the correct pronouns and to feel safer using a public bathroom. The problem is not the gender expression, but the cis-normative, binary standards that shape our society. Passing as cis can be a way to feel safer moving through the world.

The desire to pass can also relate to one’s gender identity. Some trans women aim to pass in order to alleviate gender dysphoria. This can bring up the question of what’s within one’s control and what resources are available in regard to gender expression. Gender affirming procedures like breast augmentation, facial feminization surgery, and vaginoplasty all cost money and are not an option for every trans person. Gatekeeping and transphobia in healthcare provide a lot of barriers to accessing these  resources.

Body Image concerns for Lesbians

The lesbian clients I’ve worked with often come to therapy with a lot of self-awareness and values rooted in social justice. So, when they find themselves wanting to be smaller, there can be a lot of shame and judgement towards their own struggles with body image. I hear a lot of “I shouldn’t care about this,” and “I know this is problematic,” while also struggling to let go of the fear of getting bigger. Body comparison in sapphic relationships is another common theme.

Subcultural Standards

Queer and trans people face unique pressures in their own communities, often centering thin, white, Eurocentric ideals. The thin, white androgynous aesthetic is often the only representation non-binary people get in the media. The reality is non-binary people come in all shapes and sizes, and gender expression can lean more masculine or feminine in presentation.

Non-binary and gender fluid people may be at risk of not feeling “trans enough” which can impact how they feel in their bodies. Gatekeeping in LGBTQ communities is very real, with bisexual people and gender expansive people feeling excluded for not being “queer enough.” Online spaces can be especially negative with judgement between members of the community.

It can be common for BIPOC queer people to feel alienated in white queer spaces. Even within LGBTQ+ communities, there can be pressures to look a certain way or conform to specific aesthetic standards. This might include pressure to appear more masculine or feminine, to "pass" as cisgender, or to fit certain cultural ideals within specific subcommunities.

Healthcare Discrimination

Queer and trans people may have to navigate hospital systems that aren’t gender affirming. The reality is that you’re not just interacting with the doctor, but also the nurses, reception, and health techs. Many of my clients have had great relationships with their doctors but have had negative experiences with other providers they’ve interacted with at the clinic. Charts that don’t include the correct names and pronouns lead to trans people getting misgendered in the waiting room.

Weight Stigma

Fat phobia continues to be an issue in our society with unique challenges surrounding the rise of GLP-1s. Queer people in larger bodies may also be carrying trauma from being judged in healthcare spaces, which can lead to health issues getting misdiagnosed or dismissed. Queer people in larger bodies may avoid the doctor altogether to protect themselves from feeling shamed and judged.

Building Body Neutrality and Acceptance

While body positivity movements have brought valuable awareness to body image issues, many individuals find the expectation to "love" their body feels unrealistic or invalidating of their experience. Body neutrality can feel more accessible where there is a focus on what your body can do, rather than loving your body.

In body image therapy for LGBTQ people, body neutrality can be particularly relevant. Rather than focusing on loving every aspect of one's physical appearance, the goal becomes developing a functional, respectful relationship with the body that allows for authentic self-expression and engagement with life. Body image therapy for LGBTQ people can be space to strengthen body respect.

Low Barrier Options for Gender Affirmation

When body image stress is triggered by gender dysphoria, I help my clients separate what they can change about their appearance and what they can’t. The aspects we can change, we explore whether that can be done safely. Hair, clothes, and make-up can help people feel better in their gender and can feel more accessible. I help people focus on finding clothes that feel comfortable and fit their current bodies while aiding in self-expression.

Grieving What Can’t Be Changed

Some aspects of the body can’t be changed, like height and body. While weight can be changed in short term, research shows that most people gain it back and more. Intentional weight loss also puts people at risk for eating disorders. As a relational therapist, I hold space for my client to process the feelings they have about what they can’t change.

Holding Oppressive Systems Accountable

I ask my clients how they would feel about their bodies if we lived in a world that celebrated size diversity and gender fluidity. What if transphobia, racism, and homophobia didn’t exist? What if our world was fat positive, and larger bodies were considered desirable?  Most people agree that while it wouldn’t solve all their problems, they would feel a lot better in their bodies. Societal messaging and conditioning impacts how we feel about ourselves and what we view as attractive. While these structures aren’t going anywhere, you can direct your anger towards them, rather than yourself. .  

The Importance of Community and Connection

Human connection is more important than ever, as AI continues to rise in alarming ways. Hanging out in queer spaces and cultivating friendships can help you connect with your true self. Game night, drawing class, or book are great ways to explore hobbies in queer spaces. What brings you joy can remind you that you’re more than your body. .

Surrounding yourself with people who have a healthy relationship with food and who practice body neutrality can have a major impact. With skinny culture and looksmaxxing, there is a lot of noise out there right now. Listening to voices that are challenging diet culture and fat phobia can help you feel less alone. Podcasts, social media influences and You Tube can be great resources for this. Following fashion bloggers of queer and trans people in larger bodies can challenge the narrative that you need to be thin to be desirable. I truly believe that we have been condition to find certain things attractive, and that we can unlearn that.

Discrepancy between Values and Diet Culture

I help clients explore and connect with aspects of their true self. Gender identity can relate to physical appearance, but it also goes deeper. My approach is to help trans clients explore the parts of their gender that go beyond their body size. The values my clients have at their core often don’t align with the societal expectations that are imposed on them. I help people separate their values from the societal messaging they’ve internalized

Therapeutic Approaches to Body Image Therapy for LGBTQ People

As a queer licensed therapist with over 15 years of experience, I use creative and somatic approaches to help people explore their body image.

Internal Family Systems (IFS) is a compassionate framework that views our inner world as parts. You might have a part that wants to be smaller while another part feels that diet culture is problematic. Together, we identify your parts and explore the roles they have in your life. All parts have good intentions, even the ones deemed problematic. They are like workaholics who are working overtime to protect you from feeling pain. IFS helps you build acceptance towards all of your parts so they can finally relax. This allows you to get to the root of your past trauma and heal it. IFS is truly client-centered and doesn’t require you to share details of the past.

Art Therapy provides a unique avenue for exploring body image that bypasses our logical brains and helps us connect with our feelings. Through creative expression, you can explore your relationship with your body in a way that feels safer and more manageable than direct verbal discussion.

Art therapy techniques might include creating self-portraits that represent how one feels internally versus externally or using clay to explore physical sensations in the body. Collage is a great icebreaker for people who don’t like to draw and can help you access your inner world more quickly than talking. The creative process can reveal thoughts and feelings that you weren’t consciously aware of. By putting things on paper, you can gain some distance and perspective on what your body image struggles.

 For transgender clients, art therapy can be particularly valuable in exploring gender expression and identity. Creating images of one's ideal self, exploring color and form as expressions of gender, or documenting the transition journey through art can all be powerful therapeutic tools. Interested in art therapy? Click here to learn more about art therapy.

Moving Forward with Hope and Intention

Healing body image concerns isn’t linear, and it isn’t perfect. I never pressure people to love their bodies, nor do I impose my vision of recovery. I hold a neutral space and guide people towards their goals. Through therapeutic work, you can develop a relationship with your body that supports rather than hinders your ability to live fully and authentically.

 The path toward body image healing isn't always easy, but the journey is worth it. You can live life on your own terms, even in our problematic society. I'm here to walk alongside you on that journey, whenever you’re ready.

Are you queer and interested in body image therapy? You learn more about Body Image Therapyand LGBTQ Affirming Care through my website. Ready to get started? You can book a free 20 minute phone or video consultation through my website.