Tailored Gender-Affirming Hormone Treatment in Nonbinary Transgender Individuals: A Retrospective Study in a Referral Center Cohort

Abstract

Purpose: Hormone treatment (HT) is a cornerstone of gender-affirming therapy in transgender and gender nonconforming people. Nonbinary and genderqueer (NBGQ) people, individuals identifying outside the male to female binary, are increasingly recognized. Not all trans people and NBGQ individuals seek full HT. Current guidelines for HT of transgender and gender nonconforming people do not include specific regimens for NBGQ people who seek tailored treatment. We aimed to compare HT prescribed to NBGQ and binary trans people.

Methods: We performed a retrospective study in 602 applicants for gender care in 2013-2015 at a referral clinic for gender dysphoria. GenderQueer Identity questionnaires at entry were used to categorize people as NBGQ or binary transgender (BT). Medical records were assessed until the end of 2019 with regard to HT.

Results: A total of 113 individuals identified as nonbinary and 489 as BT before the start of HT. NBGQ persons were less likely to receive conventional HT (82% vs. 92%, p=0.004) and more likely to be prescribed tailored HT than BT people (11% vs. 4.7%, p=0.02). None of the NBGQ individuals who received tailored HT had undergone gonadectomy. A subgroup of NBGQ individuals assigned male at birth using exclusively estradiol had similar estradiol and higher testosterone serum concentrations compared with NBGQ individuals using conventional HT.

Conclusion: NBGQ individuals more often receive tailored HT compared with BT people. In the future, individualized endocrine counseling may further shape customized HT regimens for NBGQ individuals. For these purposes, qualitative and prospective studies are needed.

Keywords: genderqueer; hormone treatment; nonbinary; transgender.

FIG. 1.

Number of people receiving conventional HT or nonconventional HT, stratified for BT and NBGQ gender identity. p-Value from chi-square test. BT, binary transgender; HT, hormone treatment; NBGQ, nonbinary and genderqueer.

FIG. 2.

Box plots displaying medians and interquartile ranges of serum concentrations and p-values using Student's t-testing (*Denotes Mann–Whitney U test) for comparisons of (A) estradiol and testosterone concentrations in BT (N=254) versus NBGQ (N=56) individuals AMAB and testosterone concentrations in BT (N=206) versus NBGQ (N=45) individuals AFAB using HT. (B) Estradiol and testosterone concentrations in AMAB nonbinary individuals receiving tailored HT (N=9) or conventional HT (N=48). AFAB, assigned female at birth; AMAB, assigned male at birth.