There is paucity in the literature regarding gender-affirming hormone use and surgical interventions in individuals identifying as gender non-binary. Currently, provision of such interventions is predominantly guided by our knowledge of the treatment of trans men and women. The objective of this retrospective study was to characterise the hormonal regimens, surgical interventions, and the medical comorbidities that may be exacerbated by hormone depletion and treatment in a cohort of gender non-binary individuals.
All new referrals for gender dysphoria to an Australian primary care and a specialist endocrine clinic between 2013 and 2017 were analysed. 99 patients identifying as gender non-binary were included in the analysis. Baseline characteristics, medical comorbidities, gender-affirming hormonal and surgical therapies, and history of fertility counselling were recorded.
The median age was 25 years (IQR: 23, 29). Low rates of medical comorbidities were observed, with asthma (19.2%) and hypertension (11.6%) most frequently reported. 51.5% reported hormonal therapy use, which was greater in endocrine specialist clinics compared to in primary care (81.0% versus 43.7%, p = 0.003). A wide variety of hormonal regimens were observed, with 58.8% of patients taking testosterone-based therapies, 37.3% taking estradiol-based therapies, and 3.9% taking an anti-androgen alone. 68.6% of estradiol-based therapies involved the use of estradiol with an anti-androgen (either cyproterone acetate or spironolactone). 86.4% of patients on hormonal therapy had previously received fertility counselling. 14.1% of patients had previously undergone gender affirmation surgery, which included breast mammoplasty or augmentation, orchiectomy, and laryngeal surgery.
Half of all gender non-binary patients reported hormonal therapy use, with most previously receiving fertility counselling. A variety of testosterone-based and estradiol-based therapies were observed, with a large proportion of estradiol-based regimens involving the use of estradiol with an anti-androgen. More prospective studies are required to better guide the prescription of gender-affirming treatments.