Gender-affirming hormone therapy (GAHT, sometimes called HRT) is considered one of the pillars of transgender healthcare. Hormones are an important aspect of transition for many transgender people. Some nonbinary people identify as transgender and some choose to take hormones (these may or may not be the same people!). Estrogen, testosterone, and other medications change the way your body looks and feels. These medications are safe and commonly used by all kinds of people. This blog is for nonbinary people who are considering GAHT as part of their gender-affirming care plan.
Hormones can help you align with your gender identity. It is common for nonbinary people, agender people, gender non-conforming people, or folks who don’t want to pass as cisgender to question whether GAHT is right for them. If a nonbinary person doesn’t identify as transmasculine, transfeminine, or with any binary sex, they may be concerned that GAHT either won’t help or will in fact worsen feelings of gender dysphoria.
Gender expression is a beautiful, individual, deeply personal aspect of your identity. GAHT is supposed to work with your body to help you see yourself and feel comfortable in your own skin. While hormones will create changes in your appearance, there is no one-size-fits-all effect of any hormone treatment. Everyone’s body is different. Talking with your healthcare provider will help you move toward your transition goals. At Plume, we recognize everyone has different goals for their transition, and we are here to support whatever journey you choose.
Gender-affirming hormone therapy (GAHT) is a life-saving treatment for transgender people. However, it is more complex than just taking a pill or injection. Hormones work with your body’s natural chemistry to help align your appearance with your gender identity. But what about nonbinary people? When someone is nonbinary, agender, anti-gender, genderfluid or has a type of gender expression that falls outside the gender binary, they might wonder if hormones are right for them.
While estrogen is often considered a feminizing hormone and testosterone is often considered a masculinizing hormone, no hormone is inherently gendered. All bodies produce different amounts of each type of hormone. Our culture traditionally associates certain physical qualities, such as soft skin or broad shoulders, with one of the binary genders. There are plenty of exceptions to these cultural rules—such as women with mustaches, men who chestfeed their babies, and people who embrace a genderbending aesthetic that defies rigid gender norms. Some of us naturally produce higher amounts of the hormone that is not associated with our assigned sex at birth, such as Olympian athlete Caster Semenya. There is a broad spectrum of hormonal diversity that varies from person to person, and it isn’t always possible to guess someone’s hormonal makeup just by looking at them.
A person’s gender identity can be very different from their gender expression or the way they look on the outside. Those of us whose identities are beyond the binary redefine “masculine” and “feminine” and other gender qualities for ourselves. Everyone’s body and transition goals are different. Some nonbinary people don’t use GAHT at all, while others find it is essential to their sense of well-being. Even people who share gender identities don’t always take the same medications or the same dose of GAHT.
Gender-affirming medications can be prescribed in different amounts, depending on your transition goals, personal preferences, natural hormone levels, and other factors. Some people “microdose” hormones, which means take a smaller amount. Others use the highest recommended dose. Your healthcare provider will work with you to create a care plan that honors your gender identity and keeps you healthy and well. You deserve to feel your best as you explore your gender identity and find what makes sense for you.
What are my dosage options for gender-affirming medications?
Plume prescribes hormones, blockers, and other medications to support your gender transition. Here are some common dosage amounts of gender-affirming medications. (Microdosing may mean taking a smaller amount than the recommended dosages listed here.) The medications are divided into testosterone and estrogen/E+ medications. There are different types of medications, including gel, cream, patch, and injections. Your healthcare provider can help you decide which type of medication is best for you.
The most common initial gender-affirming hormone regimens for masculinizing (i.e., for transgender men, transmasculine people, female to male transgender people, FTM, nonbinary people who want more masculine features, and other transgender and/or nonbinary people who want to try testosterone hormone therapy) include:
| Injectable (intramuscular or subcutaneous) | Dosage |
|---|---|
| Testosterone enanthate or cypionate | 20-100mg/week |
| Transdermal | Dosage |
|---|---|
| Testosterone 1% and 1.62% gel | approximately 12.5-100 mg/day |
| Testosterone patch | 1-8 mg/day |
| Oral estrogen (pills) | Dosage |
|---|---|
| Oral 17-beta-estradiol | 2-8mg/day |
| Injectable estrogen (intramuscular most commonly) | Dosage |
|---|---|
| Estradiol valerate | 2-15mg IM /week |
| Estradiol cypionate | 1-5mg IM./week |
| Transdermal estrogen (patches) | Dosage |
|---|---|
| Estradiol patch | 0.1-0.4mg, changing patches 1-2X week |
| Anti-androgen (also known as T-blockers) | Dosage |
|---|---|
| Spironolactone | 100-200 mg/day (up to 400 mg) |
| Finasteride | 1-5 mg/day |
| Dutasteride | 0.5 mg daily |
If you want to learn more, please visit our FAQs to read about estrogen and E+ medications and testosterone GAHT. (Not a member yet? You can get started here!)
How does taking hormones work for nonbinary people?
Every person’s body naturally produces different amounts of hormones, including estrogen and testosterone. Taking GAHT will change that balance. Over time, the new levels of hormones will create changes in your physical appearance and emotions. This change is known as the “expression” of the hormone. For example, someone who is taking estrogen/E+ as GAHT should observe the full expression of the medication within three years. That means they will likely notice breast buds, softer skin and hair, a more curvy body shape, and a newfound emotional sensitivity. People who take testosterone will likely notice a lower voice, coarse or dark facial hair, mood changes, and changing body proportions as fat is redistributed.
Everyone’s gender journey is unique, but over time most GAHT patients find that they experience similar or comparable results from their hormone therapy. For people who are microdosing, these changes may come on more slowly or subtly. There is no way to take GAHT, especially for an extended period of time, without experiencing the full expression of that medication. Hormonal changes affect every system of the body, from the way that your skin feels to your fertility. It is impossible to cherry-pick certain desirable outcomes and avoid others that are less desirable. For example, if you choose to take testosterone, you will notice vocal changes and changes to your menstrual cycle—likely within the first year. Some hormonal changes go away or reduce if you stop the medications (for example, your menstrual cycle can resume if you stop taking testosterone), but others are permanent (for example, a lower voice).
While a lower dose of GAHT might slow the onset of these changes, they are a natural result of this type of GAHT. If you are concerned that certain hormonal changes might create gender dysphoria, talk to your healthcare provider about your options. Plume also offers peer support groups where you can talk through your feelings before, during, and after you use GAHT.
Hormonal treatment is complex and it can take time to find the right GAHT dosage that makes sense for you. You deserve to love your body and feel the joy of gender euphoria. As you explore and play with your gender expression, learn more about yourself, and get comfortable with your identity, you might find that GAHT is an important part of your care plan—or not! There are no right or wrong answers—just the wonderful person you are.
