/06/13 · “Non-binary” is a term that refers to transgender people who do not identify within the gender binary. Despite the fact that they do not identify as either male or female, many non-binary transmasculine and transfeminine people pursue hormone therapy just like transgender men and women. While some non-binary individuals opt for a full hormonal transition similarly to most binary-identified . The following are regimens that could potentially be applied to non-binary transition. Experimental regimen: bicalutamide and raloxifene: Potential regimen allowing for feminization without breast growth. Sex hormones include estrogen (aka oestrogen), progesterone and testosterone. Blockers include antigonadotropins such as danazol. Many nonbinary, genderqueer or gender variant people opt not to undergo hormone therapy, or to follow a full hormone therapy regime equivalent to binary transition. However these are not the only options.
Experimental non-binary HRT - Mad Gender Science!
Non binary hormone options Aly W. First published June non binary hormone options, Last modified December 14, Despite the fact that they do not identify as either male or female, many non-binary transmasculine and transfeminine people pursue hormone therapy just like transgender men and women.
While some non-binary individuals opt for a full hormonal transition similarly to most binary-identified transgender people, many non-binary people would prefer only a partial hormonal transition. This could be to achieve an intermediate area between masculine and feminine characteristicsto achieve a more sexually neutral appearanceor to induce some but not all aspects of masculinization or feminization. Communities of these individuals exist on sites like Reddit e, non binary hormone options.
Feminization-inclined non binary hormone options people who pursue hormonal transition often have similar preferences as transfeminine non-binary people—one of the most common of which is feminization without breast development. Sometimes these initially cisgender-identified hormonally transitioning individuals end up progressing to a transgender identity with time.
Partial approaches to hormonal transition and even widespread identification as non-binary are fairly recent developments, non binary hormone options. There is very little written on non-conventional approaches to hormone therapy of this sort in the published literature. Moreover, there are no available standards or guidelines for such therapy at this time. A number of recent reviews have started to discuss non binary hormone options for non-binary hormone therapy however Richards et al.
There is currently a discordance between the number of people who desire non-conventional hormonal transition and the clinical establishment of such therapy. Consequently, an exploration of the possibilities from a theoretical standpoint would be of value and is the aim of this review.
As a disclaimer, the ideas in this article are experimental and preliminary. No studies with the goal of partial hormonal transition in transgender people have been conducted as of present and there is no data or evidence in non-binary people to inform the use of such approaches.
Instead, we can only extrapolate from theory and research in other groups of people at this time. Examples of these other groups in the case of transfeminine non-binary hormone therapy include cisgender men undergoing hormone therapy for prostate cancer, cisgender men going through treatment for gynecomastia male breast developmentand transgender women undergoing hormone therapy.
For these reasons, the present discussion is exploratory and should not be taken as therapeutic recommendations. The goal of therapy in conventional hormone therapy for transgender women is to produce the maximum degrees of demasculinization and feminization—including breast development—that are possible. This is achieved by suppressing testosterone levels and increasing estradiol levels such that they are non binary hormone options within normal adult female ranges.
Alternatively, the actions of testosterone can be blocked instead of full suppression of testosterone levels. Estrogens produce feminization, including breast development, while testosterone suppression causes demasculinization—as well as disinhibits feminization. Estrogens, progestogens, and antiandrogens can all contribute to testosterone suppression. The specific medications used in conventional transfeminine hormone therapy include estradiol and estradiol esters such as estradiol valerate ; antiandrogens like spironolactonebicalutamideand gonadotropin-releasing hormone GnRH agonists and antagonists ; and progestogens such as progesterone and cyproterone acetate CPA.
They have limited tissue-selective antiandrogenic effects, for instance in skin and hair follicles. The therapeutic goals of a subset of non-binary transfeminine people are equivalent to those of transgender women and hence are compatible with the effects of conventional transfeminine hormone therapy. That is, the maximum possible feminization, including breast development, and demasculinization are the aims of therapy.
Non-binary transfeminine people with these preferences can simply use conventional transfeminine hormone therapy for their hormonal transition as opposed to more experimental and non-conventional partial approaches. For a comprehensive introduction to conventional transfeminine hormone therapy, see this article:. The above article is intended to provide everything one needs to know to achieve a basic understanding of the subject. If you are new to the topic of transgender hormone therapy, it is highly recommended reading prior to continuing in the current article.
The introduction covers the sex hormones, their effects, specific hormonal medications used, routes, and dosages for this type of hormone therapy. Much of this information is also applicable to non-conventional transfeminine hormone therapy. Depending on the specific aims, this can be more complicated and require more thought non binary hormone options conventional transfeminine hormone therapy.
The following goals of partial transfeminine hormone therapy may be encountered:, non binary hormone options. The first option non binary hormone options fairly straightforward in that it can entail what is essentially conventional transfeminine hormone therapy using lower medication doses. This will result in partial testosterone suppression non binary hormone options a mixture of both androgens and estrogens as major active sex hormones.
The second option involves deprivation of both androgens and estrogens. While possible, this can have negative consequences as sex hormones are important for maintaining certain aspects of health and well-being. There are ways to avoid or mitigate such consequences however. The third and fourth options are also possible but are more difficult to achieve and require specialized and potentially complex hormonal approaches.
If the goal of non-binary transfeminine hormone therapy is simply to achieve an androgynous appearance with minimal or no feminization, this can be achieved via deprivation of testosterone without concomitant administration of an estrogen. There are multiple ways to achieve androgen deprivation or testosterone suppression in people assigned male at birth. For these purposes, low-dose cyproterone acetate e.
As an alternative to cyproterone acetate, high doses of other progestogens, such as just about any other progestin, or alternatively rectal progesterone Aly W. GnRH agonists and antagonists are another option for testosterone suppression. However, GnRH agonists and antagonists are very expensive, non binary hormone options, although there may be some viable options for obtaining them more cheaply e.
Gonadectomy, or surgical removal of the gonads, can be performed as a more permanent alternative to GnRH agonists and antagonists.
However, this procedure is expensive a few thousand dollars USDrequires minor surgery, and can be more difficult to obtain. Most surgeons require letters from gender therapists and real-life experience ; informed-consent surgeons do exist however. Gonadectomy is also irreversible, notably resulting in permanent loss of testes and sterility. In any case, gonadectomy is far less expensive and more convenient than GnRH agonists and antagonists in the long run.
Androgen receptor antagonists like bicalutamide and spironolactone act by directly binding to the androgen receptor and displacing androgens like testosterone and DHT from the recetor, thereby preventing its activation by these androgens.
This is in contrast to therapies that act by suppressing androgen production and levels. High-dose bicalutamide monotherapy e. However, bicalutamide monotherapy increases testosterone and hence estradiol levels.
The testosterone will be blocked by bicalutamide and will not have effects, but estradiol is increased to a concentration range that allows for marked or full feminization, including breast development. In addition, bicalutamide alone, even at very high doses, might not be enough to completely block male-range testosterone Aly W. With these considerations, if the goal is full demasculinization with no feminization or breast development, bicalutamide monotherapy is not something that, at least alone, can achieve this.
High-dose bicalutamide is expensive and potentially cost-prohibitive. Concomitant partial suppression of testosterone and estrogen levels via additional use of a progestogen e. Some potentially major advantages of high-dose bicalutamide monotherapy are that in contrast to marked or full suppression of testosterone levels, bicalutamide monotherapy largely preserves sexual desire and erectile function and likely does not result in infertility.
Another option is only partial demasculinization, which can be achieved essentially by using lower dosages of the medications discussed above e. This AAS will help to suppress and replace testosterone levels. Nandrolone decanoate might also have the benefit of helping to maintain sexual desire and function. However, nandrolone decanoate was recently discontinued in the United States. Oxandrolone is another, similar AAS, but has been associated with liver toxicity.
While androgen deprivation therapy is effective for achieving the desired changes—specifically demasculinization without feminization—it is not recommended by itself. This is because estradiol is produced from testosterone and hence androgen deprivation results in estrogen deficiency as well.
Estrogens are essential for maintaining bone density in both men and women, and without them, a person will quickly lose bone mass, eventually develop osteoporosisand be at a high risk for bone fractures. Skeletal and postural disfigurement may non binary hormone options eventually occur Figure ; Figure. In addition, the person is likely to experience other menopause -like symptoms, non binary hormone options, such as hot flashesmood and sleep problems, sexual dysfunction e.
An increased risk of weight gain, type 2 diabetes, cardiovascular disease, and dementia may be associated with sex hormone deficiency as well. As such, extended deprivation of both androgens and estrogens with no estrogenic supplementation is not advisable. With that said, a couple of clarifications should be made. Due to preservation of estradiol levels, high-dose bicalutamide monotherapy has minimal to no risk of bone density loss or most other menopausal symptoms.
In addition, the low-dose cyproterone acetate plus low-dose bicalutamide option may have less of a risk of menopausal symptoms and possibly osteoporosis as well. Instead of only androgen and estrogen deprivation, the inclusion of selective estrogen receptor modulators SERMsso-called partial estrogens, can be employed.
These medications are partial agonists of the estrogen receptor, and have mixed estrogenic and antiestrogenic effects depending on the tissue. For example, the SERM raloxifene has estrogenic effects in bone, fat tissue, and the liver, but antiestrogenic effects in the breasts. In general, SERMs reduce bone density loss and osteoporosis risk while not causing breast development and actually blocking it. A full list of SERMs can be found here. However, practically speaking, only raloxifene Evistanon binary hormone options, tamoxifen Nolvadexand toremifene Fareston are available, inexpensive, and commonly used.
For non binary hormone options overview of the estrogenic and antiestrogenic effects of the different SERMs in different tissues, see here.
In general, SERMs have a fairly similar pattern of effects. Although we have some idea of the differential tissue effects of SERMs, in many cases we do not know how they behave in specific tissues. For example, only a single clinical study has shown that a SERM, specifically raloxifene, has estrogenic effects in fat tissue Francucci et al. SERMs also have various side effects. For instance, SERMs commonly produce hot flashes as non binary hormone options adverse effect.
It is still on-patent and hence is expensive however. In any case, SERMs are also likely to produce other menopause-like symptoms. Additionally, SERMs have estrogenic effects in the liver and therefore influence production of coagulation factors and decrease production of insulin-like growth factor-1 IGF-1among other potentially undesirable changes. Due to the increase in coagulation with SERMs, they have a notable risk of blood clots and cardiovascular complications like stroke Non binary hormone options W.
Some SERMs, like tamoxifen, also have unique off-target actions and risks, non binary hormone options, for instance rare liver toxicity. Raloxifene is a more selective and probably safer SERM than non binary hormone options. SERMs are effective for maintaining bone density. However, they are, unfortunately, only partially estrogenic in bone and hence are submaximally effective for such purposes—they are significantly more effective than no treatment at all but are not as effective as estrogens Dane et al.
Indeed, SERMs have actually been found to significantly antagonize the effects of estradiol on bone, for instance on bone density in premenopausal women Powles et al.
Can I Transition if I'm Non-Binary or Genderfluid?
, time: 9:58Episode Non-Binary Pronouns & Hormone Therapy Options
And so under that umbrella of non-binary are very common terms, and some of those include Gender Fluid, gender ambiguous, Pangender, Neutrois, Gender Bender, Gender Blender, Gender Expansive, Genderqueer is one too, and androgynous. Androgynous was . The following are regimens that could potentially be applied to non-binary transition. Experimental regimen: bicalutamide and raloxifene: Potential regimen allowing for feminization without breast growth. /06/13 · “Non-binary” is a term that refers to transgender people who do not identify within the gender binary. Despite the fact that they do not identify as either male or female, many non-binary transmasculine and transfeminine people pursue hormone therapy just like transgender men and women. While some non-binary individuals opt for a full hormonal transition similarly to most binary-identified .
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