In this blog, we’ll be talking about health care for nonbinary folks. A quick word on terminology before we jump in – we recognize that not all nonbinary people identify as trans, and that there are many gender identities that lie on the spectrum outside of exclusively male or female. Here, we’ll be using “nonbinary” to refer broadly to gender identities that are not binary male or female, but we want to acknowledge that this term might not recognize or identify everyone in the community. With that being said, let’s talk about health care for genderqueer, genderfae, and otherwise nonbinary folks. For those of us whose gender identity is not exclusively male or female, interactions with the health care system can be extremely difficult and present unique challenges when compared with care for binary transgender members of our community.
For example, a recent survey of nonbinary people about their experiences with health care found that nearly all participants reported encountering health care providers who did not provide gender-affirming or inclusive care ((Lykens, J. E., LeBlanc, A. J., and Bockting, W. O. (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT Health 5, 191–196. doi: 10.1089/lgbt.2017.0215 Available at https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6016091&blobtype=pdf)).
Other research has unsurprisingly shown that nonbinary people face specific challenges compared to binary transgender peers when accessing health care, such as being misunderstood by providers who approach care from a binary concept of identity ((Scandurra C, Mezza F, Maldonato NM, et al. Health of Non-binary and Genderqueer People: A Systematic Review. Front Psychol. 2019;10:1453. Published 2019 Jun 25. doi:10.3389/fpsyg.2019.01453 Available at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01453/full))
One particular challenge in accessing care can be the harmful misconception that nonbinary people do not need to access health care services to affirm their identity. This myth isn’t just wrong because it unfairly singles out nonbinary folks as undeserving of care. Besides being discriminatory, it’s also contradicted by best practices and international standards set by the World Professional Association of Transgender Health, which affirm that nonbinary people require equal access to health care services that are a part of their gender affirmation ((Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., . . . Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165–232. Available at: >https://doi.org/10.1080/15532739.2011.700873))
While not all nonbinary folks find that medical interventions are part of their gender journey, research shows that many nonbinary people do desire and need hormonal or surgical treatments to align their body with their gender identity ((Beckwith, N., Reisner, S. L., Zaslow, S., Mayer, K. H., and Keuroghlian, A. S. (2017). Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend. Health 2, 156–164. doi: 10.1089/trgh.2017.0028 Available at: https://www.liebertpub.com/doi/10.1089/trgh.2017.0028)) .
Yet likely due to this innacurate and harmful stereotype, fewer nonbinary folks who wish to access hormones are able to access them when combared to binary transgender members of our community . In fact, as many as 69% of nonbinary and gender-expansive individuals are without gender-specific healthcare ((Kachen, A and Pharr, J. (2020). Health Care Access and Utilization by Transgender Populations: A United States Transgender Survey Study. Transgender Health. 10.1089/trgh.2020.0017. Available at: https://www.liebertpub.com/doi/10.1089/trgh.2020.0017))
Yet people with gender non-conforming and genderqueer identities make up a third or more of the broader trans community – and an even larger proportion of our community for younger age groups ((James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., and Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. Available at: https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF))
Clearly, there is an urgent need for gender affirming care for nonbinary folks. At Plume, we are committed to delivering gender-affirming care for our nonbinary community. As we have noted previously, gender-affirming care means that your health care provider works with you on your own, unique gender journey, and helps to facilitate any medical interventions necessary for your transition. It recognizes that while there are many medical interventions that some folks need to affirm their gender, other folks may not desire or pursue these types of treatments. This holds true no matter if your gender identity is binary or not – your ability to access gender-affirming care does not depend on where your gender identity lands today, or in the future. For nonbinary people who find that medical care is part of their gender journey, there are a wide range of options available to affirm you in your gender. Some nonbinary people find that hormone therapy, or GAHT, can help align your physical body with your gender identity. It is critical to note that there’s no one “right dose” of hormones for trans and nonbinary people. Lower than typical doses of GAHT therapies like testosterone, estrogen, or an androgen (testosterone) blocker, or GAHT at lower or higher doses for shorter periods of time, are all possibilities in exploring the care that best affirms your gender ((Hastings, J. (2016) Approach to genderqueer, gender non-conforming, and gender nonbinary people. UCSF Transgender Care & Treatment Guidelines. San Francisco, CA. Available at: https://transcare.ucsf.edu/guidelines/gender-nonconforming))
Some people may have heard of this principle as “microdosing,” which is a term some in the community use to talk about taking less than what may be considered typical doses of hormones. Additionally, nonbinary folks may also find that surgical interventions are necessary to align your physical body with your identified gender. It is vital that nonbinary folks are provided equal access to gender-affirming care, with an individualized approach that allows you to travel safely on your own, unique gender journey at the speed that’s right for you. At Plume, we affirm and celebrate nonbinary gender identities, and are here to provide the best in gender-affirming care by trans and nonbinary people, for trans and nonbinary people.
