Transgender Nutrition Education Program

In partnership with Ingersoll Gender Center - Seattle, WA

Grant Funder: Pride Foundation

Proposed Start & End Dates: August 2016 - August 2018
Funds Requested: $10,000
Awarding Organization: Ingersoll Gender Center
Grant proposal created by: M. Barris, K. Dickson, N. Harris, K. Galloway, A.
McKee, C. Simcoe

II. Executive Summary

The transgender community experiences limited support within the Washington State healthcare
system. Currently, there is no nutrition education available to support gender-affirming hormone
therapy or gender transition. As a Seattle-based, mutual support and education organization for

transgender individuals, Ingersoll Gender Center aims to use The Pride Foundation grant to
address the unmet need of trans-competent nutrition and wellness services.
Grant funds will be allocated to create a variety of education opportunities that emphasize
transgender nutritional needs and competent care practices. Within one year of receiving funds,
200 nutrition professional and students will be exposed to transgender care information through a
keynote speaker presentation at the Washington State Academy of Nutrition and Dietetics
(WSAND) annual conference and a speaker roadshow series that will present at three
Washington-based universities. A contracted project coordinator will arrange the speakers for
both events and will design pre- and post-surveys to evaluate the effectiveness of this education
plan. A budget of $10,000 for the first year of operations will compensate the project manager,
fund equipment needs, and provide travel costs and honorariums for speakers.
Future funds will support a long-term plan to implement additional curricula pertaining to
medical nutrition therapy for transgender health into the didactic program in dietetics (DPD).
The project coordinator will work with trans-competent healthcare professionals to create the
curriculum by the next update of accreditation standards (as governed by the Accreditation
Council for Education in Nutrition and Dietetics, or ACEND).

III. Needs Statement

In the current healthcare arena, there is a profound need for nutrition care for transgender
patients. Transgender individuals undergoing hormone replacement therapy (HRT) experience a
variety of metabolic and physiological changes that could result in negative health outcomes.
Currently, there is no consistent nutrition education to support gender transition, and many of the
metabolic side effects that people experience with gender-affirming HRT could benefit from
nutritional intervention. Additionally, nutritional support for patients choosing gender-affirming
surgery should also be considered (Overview of perioperative nutritional support, 2014). The
following table briefly outlines some of the health challenges that could result from transgenderrelated medical interventions and the potential nutrition support that could be employed to
mitigate these challenges.

Table 1: Health challenges of transgender care and their nutrition-related interventions

Possible Risks

Potential Nutrition
Intervention(s)

Source

Bone
health

Trans men and women who undergo

gender-affirming hormone therapy
are at risk for osteoporosis because of
fluctuations in hormone levels.

Increase weight-bearing
exercise; Consume a
calcium-rich diet; Take an
additional calcium and
vitamin D supplement if
necessary.

Transsexual people
and osteoporosis,
2016

Lipid
Profiles

For trans men, high-dose testosterone

resulted in lower HDL-cholesterol
levels, elevated triglyceride levels,
smaller LDL-particles and an
increased ratio between visceral and
subcutaneous abdominal fat.

Balance caloric intake and

physical activity to
achieve or maintain a
healthy body weight;
Increase fiber and fluids;
Limit intake of saturated
fat (<5-6% kcal), transfats (1% of kcal) and
cholesterol.

Elbers, 2003

Cancer

Cancer of the reproductive organs is

still a concern for transgender
individuals who have not had genderaffirming surgery. Especially in the
case of trans men who have not had a
total hysterectomy, studies have
shown a 10-fold increase of
inadequate Paps as compared to nontransgender females (Inadequate tests
are of clinical relevance because it
has been shown that women with
inadequate Paps are more likely to
develop cancer).

Provide education on
modifiable nutrition- and
physical activity-related
cancer risks; Maintain a
healthy body weight, diet
rich in antioxidants, and
consistent physical
activity regimen.

Peitzmeier, 2014

Weight

Transgender college students were

more likely to be either underweight
or obese, and less physically active
as compared to non-transgender
students.

Balance caloric intake and

physical activity to
achieve or maintain a
healthy body weight

Vankim, 2014

Body
Image

Trans men who have not had breastremoval surgery may be more likely
to carry extra weight to mask their
upper body appearance, while trans

Nutrition counseling to
navigate changes in body
composition and address
body ideal assumptions.

General prevention
and screening, 2016.

women may intentionally restrict

calories and protein to maintain a
thinner, less muscular build.
Surgery
Support

Surgery creates a hypermetabolic

state, resulting in increased protein
and energy requirements.

Provide pre-, peri-, and

post- operative nutrition
education to
avoid/manage negative
consequences of
malnutrition including:
increased risk of infection
and poor wound healing

Overview of
perioperative
nutritional support,
2014

As outlined above, nutrition interventions can help improve these outcomes and potentially
reduce the burden on an already-taxed healthcare system. The focus of the proposed project is to
provide educational training opportunities for both current and prospective registered dietitian
nutritionists (RDNs) and certified nutritionists (CNs) in the greater Seattle area so that they may
be better equipped to provide compassionate and informed nutrition care for members in the
Seattle transgender community.
This approach is corroborated by a 2009 needs assessment of transgender people in Philadelphia
that found that ensuring that medical staff are culturally competent and sensitive to transgender
patients is essential to improving healthcare access (Carson, 2009). This elucidates the need for
additional training of healthcare providers as well as insurance companies, so that procedures
and coverage for those procedures can be better understood, explained, and treated with the
proper sensitivity. Similar findings arose in a national survey, the National Transgender
Discrimination Survey: 50% of transgender respondents reported having to teach their medical
providers about transgender care and 40% indicated that they felt their health care provider
needs more education/awareness about the healthcare needs of the LGBTQ population (Boog,
2011).
In addition to disparities within healthcare and the metabolic health risks from HRT, the
transgender population faces an exceptional minority stress and is more vulnerable to
developing depression and suicidal thoughts than other minorities (Dhejne, 2011). Offering
educational opportunities for healthcare professionals to learn about the physical and
psychosocial stresses of the transgender community will increase expertise among providers by
providing information on a population with whom they may not have had previous experience.
Better-educated healthcare providers, in turn, can create a safe and welcoming environment for
transgender patients, allowing them to take advantage of preventative health information,
resulting in overall improvements in wellbeing.

IV. Project Description

A. Mission, Goals, and Objectives
Mission: Our mission is to support the health and well-being of the Seattle transgender
community by creating a sustainable dietetic curriculum that educates on transgender-specific
health concerns, informs on gender disparities within the healthcare system, and ensures that
Washington-based dietitians are equipped to provide culturally competent and compassionate
nutritional care.
Goal 1: To provide education opportunities for Washington-based RDNs and CNs that expand
the current knowledge base regarding nutrition support for transgender health needs.
Objective 1.1: Within one year, facilitate the creation of a continuing education
presentation at the WSAND annual education conference that is attended by at
least 100 credentialed nutrition professionals.
Objective 1.2: Within two years, increase the proportion of Washington-based
dietitians able to identify the top nutritional needs of the transgender community
by 25%.
Goal 2: To educate Seattle-based dietetic students on the unique metabolic processes that
transgender patients face during hormone therapy and gender-affirming surgery, as well as the
challenges they experience within the healthcare system.
Objective 2.1: Within one year, arrange a speaker roadshow that will visit at
least three local universities and be attended by a total of at least 100 nutrition
students, connecting them with experts in transgender health.
Objective 2.2: By the next update of curriculum accreditation standards (as
governed by ACEND), implement an addition to the DPD curriculum that
includes medical nutrition therapy for transgender health concerns and broadens
cultural competency coursework to address transgender health issues.

B. Methods/Approach
This project seeks to support the health and wellbeing of the Seattle transgender community
through impactful changes within the healthcare system. Specifically, this project will provide
education on trans health and expand nutritional care provided by RDNs and CNs to include the
needs of transgender patients. Transgender people are in need of healthcare providers to

acknowledge the unique physical, social, and psychological challenges they face and would
benefit from innovative ways to address their healthcare needs to create a healthier population.
Specific health concerns include a variety of metabolic and physiological changes that can
potentially result in altered metabolic profiles, type 2 diabetes, osteoporosis, and other
undesirable health outcomes after beginning hormone therapy (American Cancer Society, 2012;
Elbers, 2003; Overview of perioperative nutritional support, 2014; Peitzmeier, 2014; Transsexual
people and osteoporosis, 2016; Vankim, 2014). As discussed previously, the health challenges
faced by the transgender community have clear nutritional ties for intervention and this project
will improve upon the ability of nutrition professionals to confidently treat transgender
individuals as they navigate their unique healthcare needs.
In order to address the first goal (to provide education opportunities for Washington-based RDNs
and certified CNs that expand the current knowledge base regarding nutrition support for
transgender health needs), a contracted project coordinator will identify and contact healthcare
professionals knowledgeable about nutrition support for transgender needs. At least one of these
healthcare professionals will then be put in contact with the organizer of the WSAND annual
education conference. They may submit a proposal for a keynote presentation at WSAND that
will be attended by at least 100 credentialed nutrition professionals. The project coordinator will
facilitate ongoing communication with future conference organizers in order to include a
presentation on transgender nutritional needs and support.
Objective 1.1 (to facilitate a speaker on transgender health at the WSAND conference) provides
continuing education opportunities for RDNs and CNs within Washington State and acts to
directly influence the practitioners who may be providing care to transgender individuals. A
continuing education presentation at the Washington annual conference of dietitians will
effectively address and implement this educational goal.
After the presentation, the credentialed nutrition professionals in attendance should be able to:
Identify nutritional needs of the transgender community through different stages of transition
Communicate effectively and sensitively with transgender patients, taking a respectful approach
to sensitive issues
Take a comprehensive health history of transgender patients taking into account social, sexual,
and transition-related health care history
Develop appropriate transition stage-specific nutrition recommendations and demonstrate
effective counseling skills for transgender patients
Start to be able to apply the knowledge of common gender identity terminology, health
disparities, health screenings, surgical and hormonal treatment options, mental health
manifestations, barriers to healthcare, and policy/insurance issues affecting transgender patients
in their practice

Surveys will be used to monitor the proportion of Washington-based dietitians knowledgeable in

transgender nutrition needs (and meet Objective 1.2, to increase the proportion of Washingtonbased dietitians able to identify the top nutritional needs of the transgender community by 25%).
A pre-survey will evaluate base-line knowledge and a post-survey will show the change in
number of dietitians able to identify the top transgender nutritional needs.
Goal 2 (to educate Seattle-based dietetic students on the unique metabolic processes that
transgender patients face, as well as the challenges they experience within the healthcare system)
will educate dietetic students within Washington State on the unique healthcare needs and
treatment protocols of transgender patients, therefore influencing all future RDs and CNs within
the state. A speaker roadshow that will visit local universities and a change to the DPD
curriculum will address and implement this educational goal.
The healthcare professionals contacted in Goal 1 will be used again to find those to participate in
the university roadshow on transgender nutritional needs. All Seattle-area universities will be
contacted to find at least three that will facilitate a presentation attended by at least 100 nutrition
students total (across all three universities). The project coordinator will organize dates, times,
and locations of presentations as well as which healthcare professionals will be presenting.
The project coordinator will facilitate the collaboration of dietitians and healthcare professionals
knowledgeable on transgender nutritional needs to design a DPD curriculum that includes
medical nutrition therapy for transgender health concerns and broadens cultural competency
coursework to address transgender health issues; this addresses Objective 2.2 (to implement a
curriculum update that includes medical nutrition therapy for transgender health). ACEND will
be contacted in order to present the curriculum design and discuss inclusion into curriculum
education standards. Please see Appendix A for a complete timeline.
As outlined above, Goals 1 and 2 will take place in Washington State, focusing on Washingtonbased dietitians, healthcare professionals, nutrition students, and Seattle-based universities.
Objective 2.2 will reach out to a national level when contacting ACEND and affecting a nationwide curriculum change.
A list of potential speakers who can facilitate the goals above has been. The list includes
individuals within healthcare that have extensive experience working with the transgender
community. See Appendix B for detailed descriptions of potential participants. Recruiting efforts
will take place through in-person or virtual meetings via Skype, Google Hangout, or
GoToMeeting. Continued access to participants will be achieved via email and phone, or
conference calls. If individuals decline or are unable to participate, they will be asked for
additional speaker recommendations.
Evidence-Based Intervention

The transgender population has a collection of unmet needs that are just starting to be discussed
in a larger, national conversation. These needs include: a basic acknowledgment of the
transgender community; an understanding by healthcare providers and policy makers of the
unique physical, social, and psychological challenges faced by transgender people; and new
ways of addressing their health care needs to create a healthier population. These topics are on
the national agenda, as demonstrated by the United States Office of Disease Prevention and
Health Promotion Healthy People 2020 objective: To improve the health, safety, and wellbeing
of lesbian, gay, and bisexual, and transgender individuals (Lesbian, Gay, Bisexual and
Transgender Health, 2016).
It is also clear that the desire for services from the community itself is strong. For example,
Fenway Healtha Boston-based healthcare center whose mission is to enhance the wellbeing
of the lesbian, gay, bisexual and transgender communityhas grown exponentially from serving
5,000 patients per year in 1975 to 140,600 patients per year in 2015. While this encompasses all
services for the greater LGBT community, Fenway launched its Transgender Health Program in
2004, focused on this underserved segment of the LGBT population and, as of 2015, more than
1,600 transgender patients currently receive care at Fenway Institute. Furthermore, the Fenway
Institute was awarded $813,000 in funding to study the health of female-to-male (FTM)
transgender people (Fenway Health, 2016), demonstrating an interest in understanding the
distinct factions within the transgender population. These are all indicators that the transgender
population is seeking support in its endeavors towards health and wellbeing, and that some forms
of support are beginning to take form. Through provider education and nutrition-specific
interventions tailored for the unique needs of transgender individuals, RDNs and CNs can be part
of the support system caring for this community and contributing to its overall health.
As previously discussed, the metabolic and physiological changes experienced by transgender
individuals undergoing HRT can have undesirable health outcomes, most of which can be
mitigated by nutritional interventions. Nutrition education and counseling has been a proven
method for affecting change in individuals; it has been demonstrated to improve weight loss,
blood glucose levels for persons with type 2 diabetes, and cardiovascular disease risk factors
(Spahn, 2010; Mahdavi, 2016). In a study of individuals with type 2 diabetes who received six to
12 months of cognitive behavioral therapy-based nutrition counseling, the research group
reported highly significant improvements in fasting blood sugar, HbA1C values, and weight as
compared to controls (Look Ahead, 2007). Follow-up at one year showed that participants
maintained improvements in biomarkers of metabolic syndrome. Because nutritionists could
apply similar intervention methods to those in the transgender community, they are well
positioned to promote healthy changes in a community that has been generally overlooked by
nutrition professionals in the past.

Increasing transgender health knowledge among healthcare providers will improve access to care
and outcomes for the transgender community. A 2015 study assessed the impact of integrating a
lecture on gender identity and hormonal treatment regimens into the educational curriculum for
medical residents. The addition of the lecture significantly improved resident knowledge and
willingness to assist with hormonal therapy for transgender patients (Thomas, 2015). This
supports Objectives 1.1, 1.2, and 2.1: the creation of a continuing education presentation,
increasing Washington-based dietitians knowledge of transgender nutritional needs, and
organizing a speaker roadshow. Lectures designed to educate nutrition professionals and
students will help to create a new generation of transgender-literate nutrition professionals. Such
lectures will not only aim to provide specialized training for dietitians but will also instruct on
culturally competent care to ensure transgender patients feel safe and accepted when seeking
health services.
The objective of implementing an addition to the DPD curriculum that includes medical nutrition
therapy for transgender health concerns (Objective 2.2) works to promote a long-term,
sustainable solution for educating the nutrition professionals of the future. As was demonstrated
at the Boston University School of Medicine, an addition of transgender curriculum content to
the endocrinology section of a mandatory course resulted in a substantial change in future
provider attitudes. Prior to the curriculum, 38% of students reported anticipated discomfort with
providing care to transgender patients; after learning the curriculum, there was a 67% drop in
discomfort with providing care and no student felt that the treatment would fall outside of
conventional care (Safer, 2013).
The transgender community is a dramatically underserved population in the current healthcare
system. While medical care for transgender individuals is beginning to be addressed, there are
very few resources available that provide nutritional support for the metabolic changes that occur
during HRT. Dietitians that are knowledgeable in medical nutritional therapy to support HRT and
other transgender health concerns will contribute to a multi-dimensional support system of
healthcare professionals able to care for transgender patients and improve health outcomes of
this community. Furthermore, offering educational opportunities in transgender nutrition will
create a more culturally competent, safe and welcoming healthcare network for the transgender
community in the Seattle area.
Potential Problems/Limitations
Goal 1 (to facilitate a speaker on transgender health at the WSAND conference): A possible
limitation would be finding dietitians who are both knowledgeable in this subject matter and
interested in participating. Information on transgender nutritional needs is limited and this area of
focus is very new and on the rise. For this reason, acquiring speakers who are dietitians may
prove difficult initially. To address this limitation, the search scope will be expanded to all
healthcare providers with a general knowledge of transgender needs, including a familiarity with

specific nutritional needs. The budget is also prepared to provide monetary compensation
through a speaker fee, paying for travel/accommodations, etc. in order to secure a qualified
speaker.
The current president of the WSAND was contacted and ensured no problem with securing a
presentation spot at the annual education conference. Potential limitations will be assuring that
100 credentialed nutrition professionals attend. Working collaboratively with the conference
organizer will help to secure a presentation time that has historically experienced high
attendance. Furthermore, a transgender health ad will be printed in the conference program to
facilitate interest in the topic and presenter prior to the event.
Goal 2: All universities in the Seattle-area may not have nutrition programs and, even if they do,
may not be able to assure attendance of 100 nutrition students. Although the goal is three
universities and 100 nutrition students in the audience across the three universities, flexibility
will be key even if it means settling for less or in expanding the criteria to students in the
healthcare field and community/technical colleges.
In trying to update the curriculum for ACEND there are several barriers that could be faced.
These include finding qualified dietitians to work on the curriculum, having the curriculum
approved by ACEND, and meeting the five-year cut-off for accreditation updates. These
obstacles will be addressed by making adjustments in the criteria of participating healthcare
consultants (by including other types of healthcare professionals), allowing adequate time to
begin working on the project to meet the deadline, and allotting time for alterations in order to be
approved by ACEND.
C. Program/Intervention Staffing & Administration
Paid Staff:
Project Coordinator Consultant (1): 1099 part-time contract position that could be a current staff
member of Ingersoll or an outside hire. This employee will help facilitate communications with
and between speakers, conference coordinators, universities, and ACEND. Pay would be $1821/hour. Qualifications for this position are a Bachelors or Masters degree with previous
experience working as a project facilitator. Good communication, organization, and networking
skills required.
Nutrition Consultants (1-3): 1099 part-time contract position. Speakers at conference and
roadshow will be reimbursed for travel and accommodation and receive a $500 honorarium.
Consultants working on curriculum will be paid a pre-agreed upon lump sum. These individuals
should have a Bachelors or Masters degree in Nutrition, and preferably be an RDN with
experience in public speaking. The most important qualification will be their knowledge,
expertise and experience working with the transgender community in addressing their nutritional
needs. Consultants working on the curriculum will have prior experience creating curriculums or
coursework.

 Healthcare Professional Consultants (1-3): 1099 part-time contract position. Speakers at

conference and roadshow will be reimbursed for travel and accommodation and receive a $500
honorarium. Consultants working on curriculum will be paid a pre-agreed upon lump sum. These
individuals should have a Bachelors or Masters degree in a healthcare field, and preferably are
currently in health practice and have experience in public speaking. The most important
qualification will be their knowledge, expertise and experience working with the transgender
community in addressing health issues and nutritional needs. Consultants working on the
curriculum will have prior experience designing and writing curriculums or coursework.
See Appendix B for potential nutrition and healthcare participants.
Volunteers:
Ingersoll Liaison (1): This liaison will be in contact with the project coordinator in order to stay
aligned with Ingersolls program goals. They will ensure these grant projects are on track to best
serve the transgender community and can provide ongoing advice, direction, and community
connections.

D. Evaluation Plan
To assure the program objectives are met, the program coordinator will oversee the evaluation
process by collecting information and providing progress reports throughout the program period.
Findings will be directed to the grant funder and board members in order to limit bias. Data from
electronic surveys will be analyzed statistically using data analysis software.
The evaluation design includes outcome and impact evaluation as well as process evaluation to:
1.
2.
3.
4.

Determine the effectiveness of the program

Determine whether and to what extent a program achieved its stated goals
Assess the specific effect of program activities on the target population
Assess long-term effectiveness of program goals
The board members will use the information gathered to interpret, report findings, and
recommend modification for improving the program.

Process Evaluations:
To evaluate the successful completion of the program, the process evaluation will be used to
gather information about the success of the strategies used by the Transgender Nutrition

Education Program. The process evaluation will provide both quantitative and qualitative data.
This data will describe whether the people it reached were in the target audience and what
proportion of the target audience was reached. The process evaluation data will focus on:
Goal 1, Objective 1.1
Conference Registration / Attendance Records In collaboration with WSAND, the program
coordinator will track the number of Washington-based RDNs and CNs that registered for and
attended the annual WSAND conference.
Goal 2, Objective 2.1
Roadshow RSVP / Attendance Log In collaboration with the designated Seattle-area
universities, the program coordinator will track the number of students who RSVPd and
attended the roadshow presentation at each individual university.
Goal 1 & 2
Program Meetings The program coordinator and board members will evaluate the programs
implementation on a quarterly basis. Meetings will focus on the project's progress as well as
discuss necessary modification needed to ensure success.
Impact Evaluation:
To evaluate the overall effectiveness of the program, the impact evaluation will focus on
assessing the immediate effectiveness of our program by evaluating the knowledge gained by our
target audience.
Goals 1 & 2, Objectives 1.2 & 2.2
Pre- / Post-survey In collaborations with WSAND and the roadshow universities, the program
coordinator will obtain registration and RSVP data including name, email address and other
contact information in order to develop a listserv. Using this listserv, the pre-survey will be sent
out to all participants starting two months before the scheduled event. Within five days of event
completion, a post-survey will be sent using the same listserv.
E. Sustainability
The Transgender Nutrition Education Program exhibits several characteristics necessary for
long-term financial viability. Firstly, the potential impact this program can have compared with
the relatively low proposed budgetary costs ($10,000, explained in more detail below) makes it
an appealing project for funders interested in the wellbeing of the transgender community.
Although Ingersoll Gender Center itself is completely volunteer-run and donation-based, and
therefore may seem financially unstable, its long legacy and deep roots make it a reliable

nonprofit for this program to be associated with. The main traits that this program has to prove
its viability is the ability to build capacity in contributing to the future self-sufficiency of
transgender nutrition programs and to make these efforts attractive to other future donors.
As stated in the program objectives, this program will lay the groundwork necessary to have
continuing education materials available for years beyond the funded period. It will do this by
not only increasing the number of educated dietitians and nutrition students able to share their
knowledge, but create written materials available through new curriculum education standards
with a certified organization (ACEND). By building strong foundations through an initial twoyear funding period that can show concrete successes in increasing the number of educated
dietitians on transgender needs and impact on the state of transgender health care as a whole,
other funders will be much more inclined to back future transgender nutrition education
programs.

V. Proposed Budget
Proposed Budget Justification:
Total budget for the first year of the program is $10,000. The program budget includes personnel,
fringe benefits, and office supplies and equipment. Each category of the budgeted expenses is
briefly described below.
A. Personnel:
Project Coordinator Consultant (1): $2400 ($20/hr for approximately 3 months)
The project coordinator consultant will have a part-time position and will help facilitate
communications with and between speakers, conference coordinators, universities, and ACEND.
Nutrition Consultant (2) $2000: ($500 per consultant + $500 each for travel and accommodation)
One nutrition consultant will be the speaker at the WSAND conference and the other nutrition
consultant will hold the university roadshow. Both will be reimbursed for travel and
accommodation and receive a $500 honorarium.
Healthcare Professional Consultants (2) $2000: ($500 per consultant + $500 each for travel and
accommodation)
The healthcare professional consultants will be the speakers at the conference and roadshow and
will be reimbursed for travel and accommodation and receive a $500 honorarium.

B. Fringe Benefits:
As career service employees, the above staff is entitled to fringe benefits under the terms of their
employment. This project will pay 25% of annual salary for each position.
C. Supplies and Equipment:
Throughout the course of two years, this project will require various supplies and equipment. All
consultants will need common office supplies to perform their individual tasks. The nutrition
consultant and the healthcare professional will need presentation equipment for the WSAND
conference and the roadshow. Budget is allocated in the event that the hosting organizations do
not have all needed equipment and supplies. The data analysis software for the electronic survey
that will be created to assess the knowledge base regarding nutrition support for transgender
health needs will require $400.
Proposed Budget: See Appendix C for detailed descriptions of proposed budget.

VI. Organizational/Agency Information and Qualifications

Ingersoll Gender Center is an all-volunteer organization that focuses on direct peer support,
community building, education and advocacy within the transgender, gender variant, and
genderqueer community.
The mission of Ingersoll Gender Center is to support transgender people in their growth and
wellbeing. They provide support, education, advocacy, and a wide array of resources for people
interested in gender identity issues. They support and respect service providers, employers,
families and friends as well, in order to promote understanding, awareness and acceptance of
gender diversity.
Ingersoll is composed of a 10-person board including the Founder and Co-chair Marsha Botzer.
A volunteer, to be selected from the current board, will act as the liaison between Ingersoll and
project staff.
Ingersoll Gender Center has been active for over 40 years, making it the longest running
transgender support group in the country. In addition to the weekly support group, Ingersoll also
facilitates a physicians consult group that empowers area providers to discuss the unique
challenges and needs of this community from a clinical perspective. The ability of Ingersoll to
bridge the gap between community support and medical/clinical education makes Ingersoll an
excellent fit for the purpose of this project proposal.

VII. Conclusion
The Transgender Nutrition Education Program is an innovative project, intending to highlight
and challenge the current barriers in todays healthcare system. Providing competent and pointed
nutritional care can yield positive health outcomes and subsequently allow transgender patients
to succeed in other parts of life. In order to accomplish these goals, comprehensive education
platforms for current and future dietitians need to be established to address the unique metabolic
processes of transgender people through different stages of transition.
By receiving full funding to accomplish this project, the Transgender Nutrition Education
Program can succeed in implementing these goals and objectives. This program will positively
impact not only the standard of care for the health care system as a whole, but allow the
transgender population to finally receive the care they have always deserved.

VIII. References
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention. American Cancer
Society Web site. http://www.cancer.org/healthy/eathealthygetactive/
acsguidelinesonnutritionphysicalactivityforcancerprevention/acs-guidelines-on-nutrition-and-physical-activity-forcancer-prevention-intro Published January 11, 2012. Updated February 5, 2016. Accessed February 29, 2016.
Boog D, Cridland L, Villanueva M, Jurez-Daz E, Ballezza J. Seattle LGBT Commission Report of Needs
Assessment Survey 2010. Snapshot Seattle. http://www.seattle.gov/Documents/Departments/SeattleLGBT
Commission/documents/Rpt_SnapShotSEATTLE.pdf. Published June 2011. Accessed February 15, 2016.
Carson L. Physical and Emotional Health Needs of Transgender Individuals in Philadelphia: Summary of Key
Findings. 2009.
Dhejne C, Lichtenstein P, Boman M, Johansson AL, Lngstrm N, Landn M. Long-term follow-up of transsexual
persons undergoing sex reassignment surgery: cohort study in Sweden. PloS One. 2011;6(2):e16885.
Elbers, JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, et al. Effects of Sex Steroids on
Components of the Insulin Resistance Syndrome in Transsexual Subjects. Clin Endocrinol. 2003;58(5): 562-71.
Fenway Health. www.fenwayhealth.org. Updated 2015. Accessed May 4, 2016.
General Prevention and Screening. UCSF Center of Excellence for Transgender Health Web site.
http://transhealth.ucsf.edu/trans?page=protocol-screening#S4X.Updated 2016. Accessed February 20, 2016.
The Look AHEAD Research Group. Reduction in weight and cardiovascular disease risk factors in individuals with
type 2 diabetes. Diabetes Care. 2007;30:1374-1383.
Lesbian, Gay, Bisexual and Transgender Health. Office of Disease Prevention and Health Promotion.
www.healthypeople.gov. Updated March 11 2016. Accessed March 13, 2016.
Mahdavi R, Ghannadiasl F, Jafarabadi M. Effect of a balanced low-calorie diet with or without nutrition education
on weight loss and processes of behavioral change among healthy obese women: a randomized clinical trial. Iranian
Red Crescent Medical Journal. 2016;18(3): 2074-1804.

Overview of perioperative nutritional support. UpToDate Web site. http://www.uptodate.com/contents/overview-ofperioperative-nutritional-supportUpdated February 18, 2014. Accessed February 29, 2016.
Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory
paps compared to non-transgender females: Implications for cervical cancer screening. J Gen Intern Med.
2014;29(5):778-84.
Safer JD, Pearce EN. A simple curriculum content change increased medical student comfort with transgender
medicine. Endocrine Practice. 2013;19(4):633-637.
Spahn J, Reeves R, Keim K, Laquatra I, et al. State of the evidence regarding behavior change theories and
strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc. 2010;110:879-891.
Thomas D, Safer J. A simple intervention raised resident-physician willingness to assist transgender patients seeking
hormone therapy. Endocr Pract. 2015;21(10):1134-1142.
Transsexual people and osteoporosis. National Osteoporosis Society Web site.
https://www.nos.org.uk/document.doc?id=1369. Updated October 2014. Accessed February 24, 2016.
Vankim NA, Darin JE, Eisenberg ME, Lust K, Simon Rosser BR, Laska MN. Weight-related Disparities for
Transgender College Students. Health Behav Policy Rev. 2014;1(2):161-71. Web.

Appendix A
Program Timeline:

Appendix B
Potential Participants:
Center of Excellence for Transgender Health, San Francisco, CA
Edward Michael Reyes, MD, MPH
Since 1989, Edward Michael Reyes, has held major leadership roles with both the Pacific AIDS Education and
Training Center (PAETC), and its predecessor, the Western AIDS Education and Training Center. As a Principal
Investigator, he has developed a variety of innovative HIV clinical training programs for health care providers
throughout the United States.
Maddie Deutsch, MD
As an Assistant Clinical Professor in the department of Family and Community Medicine and the Clinical Lead for
the Center of Excellence for Transgender Health, Dr. Deutsch is well versed at providing transgender-inclusive

primary care as well as hormone therapy. She sits on the editorial boards for the International Journal of
Transgenderism and the Journal of LGBT Health and areas of research include effects of hormones on lipids and
metabolism as well as cervical cancer risk in transgender men. She chairs the Medical Advisory Board which
develops guidelines for the UCSF Primary Care Protocols for Transgender Care.
Fenway Health, Boston, MA
Harvey J. Makadon, MD, FACP
As the Director of Education and Training Programs at The Fenway Institute and a Professor of Medicine at Harvard
Medical School. Dr. Makadon is on a mission to improve the health care of LGBT people in community health
centers. He actively provides education on how to improve access to quality care for LGBT in healthcare settings
around the country. Some of his many responsibilities include directing the National LGBT Health Education Center
as well as the National Center for Innovation in HIV Care, both of which strive to improve health care services
nationally. Most notable, he served on the Advisory Committee to the Institute of Medicine of the U.S. National
Academy of Sciences in the preparation of The Health of Lesbian, Gay, Bisexual, and Transgender People: Building
a Foundation for Better Understanding published in March, 2011.
Ingersoll Gender Center, Seattle, WA
Marsha Botzer
As founder of the Ingersoll Gender Center, Marsha Botzer has served the LGBT and progressive communities in
many roles for over 35 years. Marsha was a founding member of Equality Washington, and served as a board
member for Pride Foundation, Safe Schools Coalition, Lambert House, and Seattle Counseling Service. As a
consequence of her leadership roles within the Seattle LGBT community, Marsha provides unique insight.
Circle Healthcare Clinic: Scopes, Portland, OR
Suzanne Scopes, ND
Dr. Scopes runs a full-time general naturopathic practice in Portland, Oregon. Her treatment modalities include diet
and nutrition. Volunteering at Outside Ins transgender clinic Dr. Scopes has a particular interest in transgender
health care and natural hormones.
Additional Persons of Interest
Theresa Garnero, APRN, BC-ADM, MSN, CDE
Theresa has written an article titled Advice for RDs with Transgender Patients in the Food & Nutrition magazine
published by the Academy of Nutrition and Dietetics, the world's largest organization of food and nutrition
professionals. She is also quoted in the Todays Dietitian magazine in the article titled Providing Optimal Diabetes
Care and Education to the LGBT. Additional work includes a publication in the Diabetes Spectrum journal entitled
Providing Culturally Sensitive Diabetes Care and Education for the Lesbian, Gay, Bisexual, and Transgender
(LGBT) Community. She is skilled in curriculum development and education.
Brooke Stepp, MSN CHP
Brooke completed her graduate training in counseling and nutrition in 2015 at Bastyr University. She is a Licensed
Mental Health Counselor Associate and Certified Nutritionist in Washington state. She has a strong commitment to
social justice and cultural responsiveness. She runs a private practice, Have Heart Wellness, where she provides
gender affirming health care to the community.

Sally Terbeck, MSN CHP

Sally holds dual Masters degrees in Nutrition and Clinical Psychology from Bastyr University. She is a Certified
Nutritionist and Licensed Mental Health Counselor Associate. Among her many clinical interests, Sally works with
the LGBTQIA community to promote health and empowerment.
Jennifer Creson, MA, LMHCA
Jennifer completed her training as a clinical Clinical Mental Health Counselor from Antioch University in Seattle.
She is a Licensed Mental Health Counselor Associate in Washington State. Professionally, she is a member of the
American Counseling Association, and the Association for Lesbian, Gay, Bisexual and Transgender Issues in
Counseling.

Appendix C
Proposed Budget:
A. Personnel
Project Coordinator Consultant

$2400

Nutrition Consultant

$2000

Healthcare Professional
Consultants

$2000
Total: $6400

B. Fringe Benefits
Project Coordinator Consultant

($2400 x 0.25)

$600

Nutrition Consultant

($2000 x 0.25)

$500

Healthcare Professional
($2000 x 0.25)
Consultant
C. Supplies and Equipment

$500
Total: $1600
$500

General office supplies and equipment

Presentation equipment

$350

Data analysis software for electronic survey

$400

Other

$500
Total: $1750

Summary of Program Budget:

Income:
Grant funds
Expenses:

$10,000

Personnel
Total personnel expenses

$6400

Total Fringe Benefits

$1600

Total non-personnel expenses

$2000

Total program expenses

$10,000