Nonbinary Hormone Treatment

Nonbinary or androgynous hormone therapy uses hormonal treatments to create a balance of masculine and feminine physical traits. Unlike traditional masculinisation or feminisation therapies that aim for a distinct gender presentation, androgynous hormone therapy is about achieving a more neutral or mixed set of characteristics.

Overview

Hormonal Treatments for Androgyny

Low-Dose Testosterone: For individuals assigned female at birth (AFAB) seeking more masculine traits, low-dose testosterone can be used to achieve subtle changes like a slightly lower voice or minimal facial hair growth.

Low-Dose Oestrogen: For individuals assigned male at birth (AMAB) looking to soften their features without fully feminising, low-dose oestrogen can be used. This can include slight breast development, reduced body hair, and softer skin.

Anti-Androgens or Androgen Blockers: These can be used by AMAB individuals to reduce the effects of testosterone without the significant feminising effects of oestrogen.

The Physical Changes

The physical changes with androgynous hormone therapy can vary significantly based on the individual’s goals, the type of hormones used, and their dosage:

Subtle Masculinization or Feminization: Changes might include a moderate adjustment in body fat distribution, a slight deepening or softening of the voice, and minor alterations in hair growth patterns.

Skin and Hair Changes: Depending on the hormones used, individuals might notice changes in skin texture and body hair.

Muscle Mass and Body Shape: Gradual changes in muscle mass and overall body shape can be expected, aligning more with your desired androgynous appearance.

Emotional and Psychological Impact

Androgynous hormone therapy can have a significant positive impact on mental health and self-perception. It allows you to align your physical appearance more closely with your gender identity, and often leads to improved self-esteem and a sense of inner harmony.

Considerations

Personalised Medical Guidance: Given the unique nature of androgynous hormone therapy, it’s crucial to work closely with healthcare providers knowledgeable in non-binary and transgender health.

Monitoring and Adjusting Dosages: Regular monitoring and dosage adjustments are vital to achieve the desired balance of physical traits while minimising potential side effects.

Fertility and Reproductive Health: Hormone therapy can impact fertility; individuals should discuss these implications when considering treatment.

Psychological Support: Navigating a non-binary identity in a binary world can be challenging. Ongoing psychological support is beneficial in managing societal challenges and mental health.

Specific Treatments

Microdosing hormones

Microdosing is when you take a lower dose of oestrogen or testosterone than you would take for full masculinising or feminising changes.

Microdosing can help you attain more subtle feminising or masculinising changes, which may be your preferred outcome if you are nonbinary (Cocchetti et al., 2020).

Microdosing can allow the effects of oestrogen or testosterone to occur slower than they would in full masculinisation or feminisation. This can give you more control over your transition.

Different bodies can respond differently to hormone treatment. It's impossible to predict how each individual body will respond, so it isn't possible to predict how fast specific changes (such as breast development or voice deepening) will occur.

Antiandrogens and Puberty Blockers

If you have testes, antiandrogens can be used to suppress testosterone production. Antiandrogens include gonadotropin releasing hormone analogues (leuprorelin, triptorelin, nafarelin), 5-alpha-reductase inhibitors (finasteride, dutasteride), spironolactone, and cyproterone acetate.

If you have ovaries, gonadotropin releasing hormone analogues such as leuprorelin, triptorelin, and nafarelin can suppress oestrogen production.

Selective Estrogen Receptor Modifiers (SERMS)

SERMs bind to oestrogen receptors around the body, including the breasts, the skin, and the reproductive organs. This changes the effects of oestrogen in these areas. Different SERMs have different effects because they bind to different oestrogen receptors to different degrees.

People with testes who want partial feminisation but want to minimise breast growth, raloxifene is thought to reduce breast growth. This makes it option for nonbinary people who don't want too much breast growth. However, raloxifene may not completely prevent breast development.

Timescale for androgynous changes

There is no established timescale for androgynous hormone treatment. This is for three reasons:

There has been very little research on androgynous hormone treatment, and so there is no consistent evidence on the rates of bodily changes.
Different people's bodies respond in different ways to hormone treatment, and so it is not possible to predict how any individual person will respond.
The goals for nonbinary people vary, so the desired outcome for one person might not be the desired outcome for another.

There are estimated timescales for full feminising hormone treatment and full masculinising hormone treatment. These may give you an idea of how quickly changes can be expected to happen.

If you're microdosing, these changes can be expected to happen slower. These timescales are averages and vary from person to person.

Feminising hormone treatment

Effect	Onset (months)	Maximum (months)	Details
Skin	3–6	Unknown	Your skin may become softer and drier. Your skin pores may become smaller and produce less oil. You may sweat less and notice that you smell different.
Testicular volume	3–6	24–36	Your testicles are likely to get smaller. Sperm production may decrease (we still recommend using birth control if you're sexually active with someone who can get pregnant).
Breast development	3–6	24–36	Within a few weeks, you may notice small buds developing under your nipples. These may initially be tender, but this is likely to lessen over the following months. Breast development differs from person to person and can vary in size and shape.
Body shape	3–6	24–36	You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat collects more around your hips and thighs. Your eyes and face may look more feminine appearance due to changes in fat distribution under the skin.
Muscle mass	3–6	12–24	Muscle mass may decrease in your arms and legs so that they have a smoother appearance. Regular exercise can help to maintain muscle strength and tone.
Bodily and facial hair	6–12	>36	The hair on your body and face is likely to become thinner and grow more slowly. It may not go away altogether. Remember that many cisgender women and men also pursue hair removal treatments.
Scalp hair	Variable	Variable	Feminising hormone treatment is likely to stop balding on the scalp. It's impossible to predict how much scalp hair will grow back.

This table is adapted from the Endocrine Society (Hembree et al., 2017)

Masculinising hormone treatment

Effect	Onset (months)	Maximum (months)	Details
Skin	1–6	12–24	Your skin may feel thicker and oilier. Your skin pores may become larger and produce more oil. You may sweat more and notice that your smell changes. Some people notice acne, which can usually be managed with skincare practices and treatments.
Stopping periods	1–6	Variable	Your periods may become lighter or shorter, but some people may notice heavier or longer periods for a few cycles before they stop altogether. Ovulation may stop or become less frequent, but the effect is variable. We recommend using birth control if you're sexually active and want to avoid pregnancy.
Changes in genitalia	3–6	12–24	You may notice that your clitoris grows and becomes even larger when you are aroused. Some people notice vaginal atrophy, which is the thinning and drying of the vaginal tissue.
Body shape	1–6	24–60	You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat decreases around your hips and thighs, and increases around your abdomen. Your eyes and face may look more masculine appearance due to changes in fat distribution under the skin.
Muscle mass	6–12	24–60	Muscle mass may increase in your arms and legs, although this depends on other factors such as diet and exercise.
Bodily and facial hair	6–12	48–60	The hair on your body and face is likely to become thicker, darker, and grow more quickly. Facial hair growth varies from person to person, including cis people.
Scalp hair	6–12	Variable	Many people notice thinning of the hair on the scalp. The extent to which scalp balding occurs is influenced by various factors and cannot be predicted. If balding becomes a concern, treatments such as minoxidil and finasteride are available.
Voice deepening	6–12	12–24	Testosterone causes the vocal chords to thicken, which can make your voice deeper. Voice deepening varies from person to person, including cis people.

This table is adapted from the Endocrine Society (Hembree et al., 2017)

References

Cocchetti, C., Ristori, J., Romani, A., Maggi, M., and Fisher, A. D. (2020) “Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals”. Journal of Clinical Medicine, 9 (6): 1609.

Hembree, W. C., Cohen-Kettenis, P., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”. Journal of Clinical Endocrinology and Metabolism, 102 (11): 3869–3903.

Hodax, J. K., and DiVall, S. (2023). “Gender-Affirming Endocrine Care for Youth With a Nonbinary Gender Identity”. Therapeutic Advances in Endocrinology and Metabolism, 14.

Xu, J. Y., O’Connell, M. A., Notini, L., Cheung, A. S., Zwickl, S., and Pang, K. C. (2021). “Selective Estrogen Receptor Modulators: A Potential Option for Non-Binary Gender-Affirming Hormonal Care?” Frontiers in Endocrinology, 12: 701364.