Partial Gender-Affirming Hormone Treatment in Non-Binary Transgender Individuals in a Referral Center Cohort

Abstract

Abstract Context: Hormone treatment (HT) is a cornerstone of gender-affirming therapy in transgender and gender non-conforming people. Non-binary and genderqueer (NBGQ) people, individuals identifying in between or outside the male to female binary, are increasingly recognized. Not all trans people and NBGQ binary individuals seek full HT. Current guidelines for HT of transgender and gender non-conforming people do not include specific regimens for people who seek partial treatment. Objective: To compare HT prescribed to NBGQ and binary trans people. Design: Retrospective study. Setting: Referral clinic for gender dysphoria. Participants: 602 applicants for gender care in 2013-2015. Intervention: GenderQueer Identity questionnaires at entry were used to categorize people as NBGQ or binary transgender. Medical records were assessed until the end of 2019. Main Outcome Measures: prescribed HT, serum estradiol and testosterone concentrations. Results: 113 individuals identified as non-binary and 489 as binary transgender. NBGQ persons were more likely to receive partial HT than binary transgender people (11% versus 4.7%, p=0.02). None of the NBGQ individuals who received partial HT had undergone gonadectomy, hypogonadism did not occur. NBGQ individuals assigned male at birth using only estradiol had similar estradiol and higher testosterone serum concentrations compared with individuals using conventional HT. Conclusions: NBGQ individuals are more likely to receive partial HT compared with binary transgender people. In the future, tailored endocrine counseling may further shape partial HT regimens for NBGQ individuals.