"Hello, these people exist": Examining dietitians' perspectives, approaches, and experiences in transgender and gender diverse health.

AIM: The lack of research and guidelines on transgender and gender diverse health, including nutrition considerations, contributes to negative health outcomes for transgender and gender diverse people. This study sought to examine dietitians' perspectives, knowledge, and experiences regarding transgender and gender diverse health dietetic practice. METHODS: This critical inquiry study recruited dietitians globally. Data collection involved online surveys and interviews. At survey completion, consenting dietitians were invited to participate in an individual interview or focus group. Quantitative data were analysed using descriptive statistics. Qualitative analysis was conducted through reflexive, team-based thematic analysis. RESULTS: Seventy-eight participants across seven countries completed the survey. Twenty-three dietitians participated in interviews. There was diversity in dietitians' gender, sexuality, disability, chronic illness, and neurodivergence. Many (74%) of dietitians had experience working with transgender and gender diverse people, and 79% reported their comfort to engage with transgender and gender diverse people as high or very high. Six themes were conceptualised: (1) diversity and intersectionality of dietitians; (2) disappointment in the profession; (3) recognition and support for transgender and gender diverse people in dietetic practice; (4) fostering safe, respectful, and inclusive dietetic practice; (5) desire to change; and (6) dissonance and tensions in the transgender and gender diverse space. CONCLUSIONS: Study findings suggest that most dietitians are prepared to support transgender and gender diverse people. The data indicate that some dietitians are disappointed in dietetics as a profession and desire radical change regarding transgender and gender diverse health, with concerns about current practices harming transgender and gender diverse people.