Nonbinary individuals, or those who identify outside of the traditional gender binary, are currently present in up to 9% of the general population of youth or up to 55% of gender-diverse youth. Despite the high numbers of nonbinary individuals, this population continues to experience barriers to healthcare due to providers’ inability to see beyond the transgender binary and lack of competence in providing nonbinary care. In this narrative review, we discuss using embodiment goals to individualize care of nonbinary individuals, and review hormonal and nonhormonal treatment options for gender affirmation. Hormonal treatments include those often used in binary transgender individuals, such as testosterone, estradiol, and anti-androgens, but with adjustments to dosing or timeline to best meet a nonbinary individual’s embodiment goals. Less commonly used medications such as selective estrogen receptor antagonists are also discussed. For nonhormonal options, alterations in gender expression such as chest binding, tucking and packing genitalia, and voice training may be beneficial, as well as gender-affirming surgeries. Many of these treatments lack research specific to nonbinary individuals and especially nonbinary youth, and future research is needed to ensure safety and efficacy of gender-affirming care in this population.
Nonbinary is a term that describes someone who identifies outside of the traditional gender binary.1 There are several other terms used, such as genderqueer, genderfluid, agender, two-spirit, often from non-Western societies with centuries-old practice of nonbinary persons being present in their societies.2 For the purposes of this review, we use nonbinary to encompass all identities outside of the binary but recognize that this term may not be accurate for all.
The classic guidance for treatment of nonbinary persons is to individualize the treatment based on the person’s embodiment goals (Figure 1). While this is true of any gender-diverse individual, there are very few studies of effects and safety of gender-affirming hormone therapy at lower doses that may be desired by nonbinary individuals, giving uncertainty to the safety of these treatments. Any outcome data on hormonal replacement for cisgender or transgender adolescents currently inform care for nonbinary persons, but specific research on nonbinary outcomes is needed. Heterogeneity of nonbinary population may preclude these studies, and variability in testosterone and estradiol lab assays also make this challenging. As the prevalence of nonbinary individuals is increasing, we are hopeful that more research will be possible to guide sage and effective care for this population.
Hodax JK, DiVall S. Gender-affirming endocrine care for youth with a nonbinary gender identity. Therapeutic Advances in Endocrinology and Metabolism. 2023;14. https://doi.org/10.1177/20420188231160405
― 30 Mar 2023
PDF: /hodax-divall-2023-gender-affirming-endocrine-care-for-youth-with-a-nonbinary-gender-identity.pdf
