As always, some definitions up front.

Non-binary is a space that lives somewhere outside of male and female, or occupies both genders in varying degrees simultaneously. 

For most folks, non binary falls under the identity umbrella of transgender, but as always, this is not universal.

Some sibling terms: gender queer or gender nonconforming

Why discuss non-binary care on its own?

We know that non-binary communities have a unique set of healthcare disparities and health care experiences.

We also know that non-binary individuals have different health outcomes, healthcare needs, and healthcare experiences when examed separately from the binary transgender umbrella. 

Gender is a social construct. This matters to medicine because it impacts how we see non binary individuals and impacts their ability to navigate health care spaces

Non-pharmaceutical gender affirming steps

Stuffing: often rolled socks or a phallic shaped object in one's pants to present the image of a fuller package

Tucking - people with penises to tuck their testes into their groin and often tape their phallus to create a flatter appearance in their crotch 

Check out some health tips at Callen Lorde’s Safer Tucking pamphlet

Binding - Wearing a special garment, cloth or other material to flatten chest tissue or contour one’s body

Some tips, consolidated from Callen Lorde’s Safer Binding pamphlet:

Max out your daily binder wearing around 8 to 12 hours a day

Avoid duct tape and ace bandages as these can cut into skin

Use undershirts or body powder to minimize the effects of sweating, like rashes and chafing

Hormones (specifically microdosing)

On the “micro” in microdosing: 

It implies a binary as the “standard” size. We don’t love that implication, but it’s the word we heard from the community. 

Other similar words we like more: “low dose”. 

Our (improved) slogan: same hormones, different dosing

Misconceptions: 

You can control the changes you going to get with a smaller dose

The effect size will be smaller (i.e. proportional to the dose)

Small doses mean non-permanent effects

General approach from a provider standpoint:

Go slowly and monitor effects

Expect a time frame of months to years to fully realize any changes

Constantly re-assess

Informed consent and microdosing. 

The lack of studies on microdosing makes this difficult. Know that taking hormones at these doses leaves some of the risks and benefits that are known at other doses up in the air. 

What to know about testosterone hormone therapy: here.

What to know about estrogen hormone therapy: here.

Surgery, briefly.

It’s a la carte. 

Any gender affirming surgery can be part of someone’s non binary affirming care.

Something we don’t love: to get a surgery approved by insurance, non-binary folks often have to resort to the binary - for example, someone may have to state they claim a male gender identity in order to receive the coverage for top surgery

Primary care for a non binary individual

Good gender-affirming care is grounded in good primary care! 

Regardless of someone’s need for medically regulated medications (hormones) or procedure (surgeries) high quality primary care will include discussion of anatomy, gender identity, and sexual orientation. 

For non binary folks, the binary expectations of a clinical space can be a barrier. From the paperwork to the social understanding of binary gender that health care workers bring with them to the clinical space - the reality of anticipated or experienced stigma is real. 

Providers who are skilled in LGB health or transgender health may have shortcomings when it comes to understanding the goals and lived experience of non binary health care consumers.