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Personalized Non-Binary Transition Options

Written by Sammie Westelman.

Non-Binary Experiences and Representation

If you asked me about my transition – the steps I take to affirm my gender identity – I’d tell you about the ways in which I’ve adjusted my presentation, my pronouns, and my body. While I’ve identified as non-binary (NBi, sometimes written out as NB) for a long time, my transition ‘officially’ began in 2021 when I changed my pronouns on Instagram. I cut my hair into a shaggy, androgynous mullet soon after. Then, that summer, I had top surgery to reduce the size of my chest. I’d also tell you, though, that there’s plenty I haven’t changed during my transition. My legal name and birth-assigned gender remain on my driver’s license, and I’ll never give up my platform shoes or signature graphic eyeliner. The main thing I’d want to get across to you, though, is that this is just what my transition looked like. 

Every NBi person has their own relationship with gender, and so every NBi transition is unique. Some of us want hormone replacement therapy (HRT), and some of us don’t. There are NBi people who use pronouns like ‘she’ and ‘he,’ while there are others who only go by ‘they’ (or other gender-neutral pronouns). I always say there are as many NBi genders as there are NBi people. By extension, there are just as many ways that NBi people can transition!

Key Terms Related to Non-Binary Identities and Gender Diversity

In general, NBi people identify with genders that fall outside of, in between, and beyond the traditional Western notions of ‘man’ and ‘woman.’ While some people describe their specific identities with the word ‘non-binary,’ it’s also an umbrella term that encompasses a multitude of genders (some of which I’ll explore in the next section). Transgender (trans) people are those whose gender identities transcend the one they were assigned at birth. Lots of NBi people consider themselves part of the trans community for this reason. Cisgender (cis) people’s gender identities align with the one they were assigned at birth; certain NBi people feel some connection with their birth-assigned gender, so they may still consider themselves cis (Wilson & Meyer, 2021). However, many of us NBi folks fall somewhere in between cis and trans. Just as NBi people disrupt the man-woman binary, we also disrupt the cis-trans binary!

Lastly, the term ‘gender non-conforming’ (GNC) is one often associated with NBi people. A GNC person is anyone who defies or resists society’s gender norms, especially through their gender presentation. Because of their gender expansiveness, trans and NBi people can be described as GNC. However, cisgender people can also be GNC: Billy Porter, a cis man actor, often wears dresses on red carpets; Rachel Maddow, a cis woman journalist, is known for her butch presentation. Despite the terminology we now have, it can be difficult to perfectly or completely capture the nuances of NBi and GNC identities. This is because ‘trans,’ ‘NBi,’ and ‘GNC’ are umbrella terms, and because every NBi person has a unique relationship to gender and personally identifies with a different set of terms. 

Understanding Non-Binary Identity and Gender Diversity

Today, NBi people are often defined by what we are not – not men, and not women. A lot of us find it harder to define ourselves by what we are, because NBi identities are complex, fluid, and incredibly personal. Some bigender people identify with two genders at once. In contrast, agender people don’t identify with a specific gender identity at all. Genderfluid NBi people identify with different gender identities at different times in their lives. Some people’s NBi identities are specific to their racial/ethnic group, such as Two-Spirit and hijra people. These are just a few examples of the ever-expanding and ever-shifting list of NBi gender identities: as more folks learn about gender-expansiveness and investigate their own experiences with gender, we are likely to learn about even more.

Am I Non-Binary Enough?

Importantly, there is no one way to ‘be NBi’ or to ‘be NBi enough.’ NBi people present in a wide variety of ways, and you don’t have to appear ‘androgynous’ to ‘qualify’ as or validate your gender identity as an NBi person. You are valid as an NBi person if your gender identity transcends the binary – that’s the only real ‘requirement’! You don’t need to experience gender dysphoria to identify as NBi and/or trans, and you don’t need to have your exact, micro-labeled gender identity ‘decided’ to know you’re NBi. What being NBi means to you is your choice, along with what types of transition will help you feel aligned with that.

Transitioning as a Non-Binary Person

Transition refers to the steps that trans and/or NBi people take to affirm their gender identity. The most important thing to remember about transitioning is that it is different for everyone: some people feel that their transition is a lifelong process, whereas others consider their transition complete after a certain point. A transition can begin at any time in someone’s life, whether they are a young child or an older adult. Some NBi people don’t even use the term ‘transition’ to describe how they live in alignment with their gender identity, and that’s okay too.

Transition comes in three major forms: social, legal, and medical. 

• ‘Coming out,’ using new names and pronouns in social settings (work, school, community events, etc.), and changing one’s gender presentation (clothing, hair, body modifications) are all examples of social transition. 
• Legal transition involves name or gender marker changes on government documentation, such as driver’s licences, birth certificates, and passports. 
• Lastly, medical transition includes any medical care that helps people live in alignment with their gender. For example, gender-affirming care like hormone therapy, surgeries, and voice training can be part of a medical transition. 

Regardless of which steps you choose to take (or not take!), remember that you get to decide what transition means for you. No single process is necessary to ‘make’ you NBi, and you don’t have to feel guilty or ‘too binary’ if you want to transition in a way that other people might deem ‘masculine’ or ‘feminine.’ 

Common Experiences in Non-Binary Transitions

Every transition is unique, but there are some common experiences NBi people go through during their transitions. 

Confidently finding language that resonates with you 

This process involves a lot of introspection and self-discovery – many of us feel pressure to put words to a gender-expansive experience that can be difficult to understand for ourselves, to describe to others, and to find reliable information about. Some of us – myself included – didn’t identify as NBi sooner because we didn’t have the words to describe the feelings of gender dysphoria and/or incongruence that we went through as younger people. It can be especially difficult when you experience gender dysphoria, but don’t identify completely with the ‘other’ binary gender. That’s a normal experience that a lot of us NBi folks share.

No time limits on coming out: 

Some people don’t outwardly identify as NBi until later in life than they might have liked. For example, many of my friends identified as trans men or trans women before discovering their NBi identities. Coming out could be a one-time event or an ongoing process of getting to know yourself in different stages of life, and having new truths about yourself reveal themselves when you’re ready to accept and have the language to describe them. Life is not a race to figure out who you ‘truly are.’ Take pride in the time you take to come out. This is your transition, and you get to decide what timeline you’re on. If you don’t even want to come out, you can choose that too! 

NBi Gender-Affirming Care

Transitioning can be a complex process; it can bring immense joy, but it can also come with some challenges. NBi people might experience gender dysphoria, the discomfort and distress that come from a misalignment between someone’s birth-assigned gender and their gender identity. The challenges that dysphoria presents, which can have lasting effects on our overall wellness, underscore the importance of gender-affirming care tailored to our specific needs as NBi people. That being said, not all NBi people who medically transition experience gender dysphoria, and their transition care needs are just as valid as those who do.

What treatments are best for me?

There isn’t just one way to be NBi, so there isn’t a one-size-fits-all set of treatments that will work for everyone. It’s up to you to decide what kinds of gender-affirming care you want to pursue. To begin, I’d encourage you to think about what would most minimize your gender dysphoria, and what would bring you the most gender euphoria. Then, you can talk over those transition goals with a medical provider who can help you make more informed choices about which treatments are best for you.

Hormone Replacement Therapy (HRT)

One form of gender-affirming care is HRT, also called gender-affirming hormone therapy (GAHT). Like many of our transmasculine and transfeminine counterparts, NBi people can be prescribed hormones that encourage changes to the body, in terms of hair growth patterns, body fat redistribution, and more.

• NBi people might be prescribed testosterone, estrogen, androgen blockers, or other hormones – the ones you’d take would depend on which kinds of bodily changes you’re interested in. 
• NBi people also have the option of microdosing testosterone or microdosing ‘feminizing’ hormones, if you’re interested in slower or more subtle results. 
• Not all NBi people take HRT, but most insurance companies require someone to be on continuous HRT for at least 12 months to get coverage for certain gender-affirming surgeries (facial surgery, body contouring, breast augmentation, and bottom surgery). However, HRT usually isn’t a requirement to qualify for these surgeries, only to get them covered by insurance. Likewise, most insurance companies do not require HRT for chest reconstruction top surgery.

Top Surgery

Top surgery refers to a gender-affirming surgery on the chest. Some NBi people wish to surgically reduce or remove volume from their chests. For these folks, there are a few things to consider:

• Whether the chest will be completely flat, reduced, or have a different non-flat appearance
• Whether nipples are present or not
• Where the nipples are placed, and what size they will be 
• You may even have the option to undergo a nerve reconstruction double incision surgery to preserve as much nipple sensation as possible.

Other NBi people want top surgery to surgically increase the volume of their chest. These patients often choose breast augmentation.

• If augmentation seems right for you, you may want to consider taking ‘feminizing’ HRT for a year or two beforehand: the natural breast tissue growth can help with your final augmentation results.
• Some people wish for a larger, but more ‘masculine’ appearance to their chest instead. These patients may opt for implants that look like prominent pectoral muscles.

Facial Surgery

Some NBi people want to give facial structure a different appearance, beyond the soft-tissue changes that HRT can produce. At the GCC, NBi people can choose from several ‘feminizing’ procedures (softening facial features) and ‘masculinizing’ procedures (augmentations or making features more angular). You can even choose a combination of ‘feminizing’ and ‘masculinizing’ surgeries. These procedures target features like the forehead, nose, lips, jaw, Adam’s Apple, and more – you’ll find a complete list of the gender-affirming facial surgeries available at the GCC here.

Body Contouring

Body contouring is available to NBi patients who want to feel more gender congruent with the shape of their body. Contouring the body may take the form of liposuction (to remove unwanted fat), skin excision (to tighten unwanted loose skin), or fat grafting (to augment the buttocks and/or hips). These procedures, similar to facial surgeries, are often categorized as either ‘masculinizing’ or ‘feminizing’ – but these procedures aren’t inherently gendered and can be part of an NBi transition. If you’re a good candidate for body contouring, you will work with your surgeon to figure out which kinds of surgery will feel the most gender-affirming for you.

Bottom Surgery for Assigned Female at Birth Patients

Some NBi people who are assigned female at birth (AFAB) want ‘masculinizing’ bottom surgery, to feel more alignment between their gender identity and the appearance of their genitals. These procedures include metoidioplasty (meta) and phalloplasty (phallo). Both create a penis, but the final results from these techniques vary in aesthetics, sensitivity, and function. Metas use the natal erectile tissue (sometimes called a clitoris) to create the penis, whereas phallos create a penis using donor skin from another part of the patient’s body. To determine which procedure is right for you, you’ll need to consider what your transition goals include. For example, would you like to urinate standing up? Or, how much erotic sensitivity would you like to preserve? You could also consider which natal organs (like the labia majora and vaginal canal) you’d like to preserve post-surgery. To learn more about how metas and phallos differ and which one is right for you, visit this article.

Bottom Surgery for Assigned Male at Birth Patients

Assigned male at birth (AMAB) NBi people can get ‘feminizing’ bottom surgery if they wish to. There are several surgical options for these patients. Some NBi people want an orchiectomy, a removal of the testicles, with an optional scrotectomy (removal of the scrotum). Others want vaginoplasties or vulvoplasties, which create vulvas with and without vaginal canals, respectively. If you’re not sure which procedures will be right for you, it might help to consider what your transition goals are regarding genital sensation, which body parts you would like to have (vaginal canal, clitoris, clitoral hood, labia minora, preserved penis, etc.), and whether you would like to receive vaginal penetration. If you’re still unsure if you want a vaginoplasty/vulvoplasty, many patients report that after getting an orchiectomy, they have greater clarity around what they desire afterwards. Don’t worry – an orchiectomy is the first step before a vaginoplasty, so getting one won’t preclude you from a vaginoplasty/vulvoplasty later.

Frequently Asked Questions About Non-Binary Identity and Transition

Is being non-binary a phase?

No, NBi genders are real, and NBi people are valid. There are plenty of people who identify as NBi for their whole lives! Certainly, some people only identify as NBi for a short period of their transition. Whether they come to align with their birth gender or another one, these people are still deserving of the right to self-identify and to transition how they want.

Is being non-binary a new trend?

Quite the opposite! All over the world, and all throughout history, GNC people have been instrumental parts of society (Towle & Morgan, 2013). Today, we might understand these people as counterparts to the modern trans, NBi, and GNC communities.

What is misgendering? How should I handle accidentally misgendering someone?

Referring to someone using the incorrect pronouns is misgendering them. Striving to get someone’s pronouns right is an absolute necessity to respect them and to affirm their gender identity. Getting misgendered, even unintentionally, can trigger dysphoria or cause harm to an NBi person. If you accidentally misgender someone, apologize briefly and correct yourself as soon as possible. Take care not to over-correct: continuing to escalate the situation may further alienate your NBi loved one. It might make them feel pressured to comfort you or to completely excuse your mistake. If you find yourself misgendering someone often, take some alone time to practice using their pronouns out loud, (ex: “Sammie and their friends are coming by,” or “Sammie isn’t here yet, could somebody text them?”).