Non-Binary Hormone Replacement Therapy 

Transgender hormone therapy is a form of hormone replacement therapy (HRT) in which sex hormones or other hormonal medications are prescribed for the purpose of getting the patient’s secondary sexual characters to align with their gender identity. Secondary sex characteristics are features that surface during puberty. For example, secondary sex characteristics can show up in the following ways: 

  • For those who underwent an estrogenic puberty, the estrogen broadens the pelvis and expands the measure of muscle to fat ratio in the in the hips, thighs, buttock and breastsEstrogen likewise incites development of the uterus, expansion of the endometrium, and menses. 
  • For those who underwent an androgenic puberty, the testosterone specifically expands the size and mass of muscles, vocal cords, and bones, a deeper voice, and shape change of the face and skeleton. It also quickens the development of facial and body hair.  

Much like non-binary top surgery it’s hard to speak to the specificity of what would constitute as a non-binary HRT treatment plan. What we can do is talk about HRT for testosterone and some information on the ‘usual dosage’ and a ‘lower dosage’ that some non-binary patients may (or may not be) interested inNot all trans and non-binary people chose to start hormones or get top surgery and any decision is valid. 

Accessibility to Hormone Treatment 

Historically a ‘referral letter’ from a mental health professional was required in order to receive hormone therapy. However, experienced providers or larger volume trans healthcare clinics may use the ‘informed consent’ model to initiate hormones (therefore a referral may not be necessary). WPATH Standards of Care 7 indicates either is acceptable.  However many insurance companies will require you to obtain a referral letter in order for them to cover your hormones. A wide range of medical providers (primary care physicians, endocrinologists, physician assistants, advanced practice nurses etc.) have the ability to prescribe gender affirming hormones. Despite the ability for a variety of medical providers to prescribe hormones, some may not due to lack of knowledge about the positive benefits of hormone treatment.   

Testosterone Dosage 

The goal of masculinizing hormone therapy is the development of male secondary sex characteristics, and suppression/minimization of female secondary sex characteristics. General effects may include a redistribution of body fat, increased body hair, facial hair, deepening of voice etc. The dose that most providers will start you on varies by the method of delivery (injection, oral, topical). In the United States, most prescribers follow a dosage guideline that has been designed for cisgender men with low androgen levels. Cypionate Testosterone is often prescribed as it is more widely covered by insurance and is readily available in most areas of the U.S. The method of delivery for Cypionate Testosterone is usually injection (intramuscular or subcutaneous). The initial dose (all done weekly) is usually 20 mg (which is considered a ‘low dose’), the initial typical dose goes up to 50 mg and the maximum typical dose is 100 mg. There is no ‘regular dose’ just a majority average and dosage varies greatly from person to person.  

 Testosterone effects everyone differently and you can’t pick and choose which changes you get when taking hormones (deeper voice, facial hair, fat re-distribution). This means you should weigh out the reversible and irreversible changes that come with being on T in order to make an informed decision. As you can tell from the wide range of dosing there is a great deal of flexibility as far as what your typical weekly dose could look like. It’s important to have a discussion with your provider regarding the goals you have around starting T so they can assist with individualizing your dosage.  

Effects of Low Dose Testosterone 

The lower the dose the slower and more gradual the changes are, the higher the dose the faster and more drastic changes are. Some personal accounts from non-binary folks on a very low dose of T reported that the changes were gradual enough that they felt like they had room to explore the physical changes they wanted out of their alignment without their physical characteristics changing too quickly. If you want to start T but your goals are ambiguous then a low dose affords you time to think while experiencing gradual changes along the way.  

Starting and Stopping Testosterone 

Making the choice to start testosterone doesn’t mean you have to continue to take testosterone indefinitely. If you aren’t liking some of the effects of testosterone it’s best to contact your provider to discuss what your options and if you decide you want to stop all together they will be able to assist you with that. Reversible changes once you’ve stopped taking T are acne, body odor, oily/coarse/thick skin and muscle-fat redistribution (mostly around the hips, thighs and stomach). Irreversible changes after going off T are: Genital growth, voice drop, male-pattern baldness, and facial/ body hair. 

Non-Binary Hormone Treatment in Conclusion 

More information on testosterone can be found here, but to sum up what we’ve discussed today:  

  • What looks and feels like a non-binary presentation varies from person to person Although it’s more common for non-binary folks to be on a low dose of T there’s no ‘one’ dose or way for someone to align/transition 
  • Referral letters to start testosterone are usually necessary due to insurance policies but are not always required if the provider uses the informed consent model 
  • Since the prescribing dosage varies widely and testosterone effects everyone differently it can be helpful to come in with an exploratory mindset v.s set expectations  
  • You can stop taking testosterone but you should have a discussion with your healthcare provider prior to doing so