Am I Non-Binary? Ultimate Guide to Help with Gender Identity!
There has been an increase in gender-affirming medical care for nonbinary individuals in the US, with more gender-affirming doctors offering their expertise and training in gender-affirming medicine.
The prevalence of gender-affirming medical care has led to advancements in plastic and reconstructive surgery, paving the way for various options.
Today, more nonbinary individuals seek medical and surgical services to align their physical characteristics with their gender identity.
With increased options and differences in surgical techniques, it can be challenging to make an informed decision in making the best choice.
As a gender specialist with 15+ years of experience, I have written extensively on gender-affirming care and the latest surgical advancements. To aid you in the decision-making process, I bring ALL of that together in this post to give you the essential guide for figuring out if you are nonbinary and on deciding which medical and surgical interventions are suitable for you.
NONBINARY GENDER IDENTITY
1. What is a nonbinary identity?
Nonbinary identity is an umbrella term covering gender identities that don’t fit within the gender categories of male and female. It is also a gender identity in its own right.
People often describe nonbinary identity in three ways or a combination of the three.
A person who is between male and female.
A person closer to one gender than another but not entirely male or female.
A person who is outside of the binary system altogether.
Some of the ways nonbinary people define themselves are:
“I identify with both male and female binary of genders. Sometimes I feel more masculine and other times more feminine.”
“I don’t feel connected to either of the binaries. I see myself more as a combo of the two but not one or the other."
“My gender often feels fluid between male and female, and it varies from day to day.”
“There is more dimension to my gender identity as simply male or female.”
It is impossible to coin nonbinary identity into a simple definition because everyone experiences and perceives their nonbinary identity differently.
There are, however, many nonbinary identities that resonate with many, and I have covered the five most common ones in Do You Know These 5 Common Non-Binary Identities?
Nonbinary individuals vary in the ways they define themselves and the ways they choose to present their gender expression.
Remember, gender expression is an extension of your gender identity and is often seen as a way you like to show up in the world.
Some of the nonbinary presentations and expressions are:
gender conforming
gender non conforming
feminine
masculine
androgynous
fluid
Finding a gender presentation that resonates with how you see yourself is a personal quest and can change from time to time.
2. How does a nonbinary identity differ from a genderqueer identity?
Nonbinary gender identity and genderqueer often get confused. Some even debate each as a stand-alone identity.
And while the two may share similarities, there are historical differences.
It wasn't until the later 90s that the word genderqueer began to take on a much more established and solid meaning to describe someone who felt their gender outside of the binary or between male and female or towards one specific binary identity, but not quite totally identifying.
People today who identify as genderqueer feel an inner experience and a conscious expression of a non-male and non-female identity. Not really exactly male or female.
It is important to know that historically the word genderqueer has also been associated with the political stance against gender, but today it is much more readily used as an umbrella term to identify any kind of gender identity outside of male and female.
Genderqueer was the first word that entered gender diverse landscape even before nonbinary was introduced. It wasn’t until about a decade after the genderqueer existence that the term nonbinary started to appear.
The difference between the two terms has been widely debated, but to many people, the two often mean similar things.
Outside of academia, some view genderqueer as more than just an identity, but also as a statement against the gender system.
Whereas in contrast, nonbinary identities have been described as apolitical in nature and more as a statement of identity, often linked more with those who identify as trans.
Today, I see both nonbinary and genderqueer used as umbrella terms, with identities such as gender fluid, gender flux, or poly gender and other identities falling under the umbrella term.
There's also a personal and subjective understanding of what this words mean to each individual.
In short, nonbinary and genderqueer identities share more similarities than differences and fall in the scope of gender-diverse identity. So they're really much more similar in scope.
3. Questions to ask yourself to help you figure out your nonbinary gender identity.
Gender identity is complex and it can be challenging to figure out how you identify within the scope of various gender identities existing today.
Because gender is a personal, subjective sense of self, paying attention to how you feel in regard to various gender identities is important.
Some of the key questions to ask yourself on the way to self-exploration are:
How do I feel about my gender assigned at birth?
How do I feel when people gender me based on my gender assigned at birth?
What are my personal thoughts on what is gender identity?
What are my thoughts about male and female gender identities?
Do I experience my gender identity as exclusively male or female?
How do I like to express myself in regard to gender? What is my gender expression?
How do I feel about various gender roles? Is there a gender role I feel more resonant to?
Do I notice my gender fluctuating between masculine and feminine from day to day?
What are my thoughts on pronouns?
How do I want to feel about myself in regard to gender?
These questions can yield a depth of information and I encourage anyone questioning their gender identity to journal while pondering these questions.
For some people, their gender identity may feel more fluid and they wonder if they are nonbinary or genderfluid. To help you make a distinction I highly recommend reading Non-Binary vs. Gender Fluid: What’s the Difference?
GENDER DYSPHORIA AND NONBINARY IDENTITY
4. How does gender dysphoria present in nonbinary individuals?
Nonbinary people also experience gender dysphoria, ranging from mild to severe. In addition to intensity, gender dysphoria varies in frequency and duration.
It can be challenging to pinpoint patterns of gender dysphoria in nonbinary individuals because as people who are neither male nor female nor a combination of the two, dysphoria presents itself differently.
Sometimes people may feel dysphoria toward their secondary sex characteristic on one day and feel completely fine on the other.
Because for some, nonbinary identity is experienced as a fluctuation between male and female, any misgendering often leads to an increase in dysphoria.
Because for some, nonbinary identity is experienced as neither male nor female, misgendering also leads to an increase in gender dysphoria.
Lack of societal markers for a nonbinary identity and expression may increase dysphoria.
A lack of societal conscientiousness toward nonbinary pronouns may lead to an increase in gender dysphoria.
As I have written in To Be Seen | A Nonbinary Struggle for Validity, for a nonbinary individual, it is almost impossible to pass as their gender identity because there is no slot in the public consciousness for a “nonbinary person.” As a result, a nonbinary person ends up filed into a binary category and that can and does trigger dysphoria.
HORMONE OPTIONS FOR NONBINARY PEOPLE
5. How to decide if hormones are right for you as a nonbinary person?
It can be challenging to consider medical transition in the form of hormone therapy as a nonbinary person.
This is primarily because you may want some of the secondary sex characteristics of the gender identity you identify with, but not all.
And because many nonbinary folks may experience dysphoria toward a particular secondary sex characteristic today but not tomorrow, deciding on hormones becomes challenging.
For those who identify as neither male nor female, deciding on hormones to alleviate dysphoria may also be challenging.
Some people think microdosing, taking a low dose of hormones, is a way to go and is an available option.
What’s important to note is that you can’t cherry-pick which changes you want on hormones and which changes to avoid. That’s because everyone’s body metabolizes hormones differently, and given individual genetic characteristics, some people may experience changes they do not desire, even on a low dose of hormones.
So how does one decide on hormones? Here are key questions to ask yourself if you are considering hormones as a nonbinary person:
Which secondary sex characteristics do I experience gender dysphoria with?
How often do I experience dysphoria, and how severe?
Which changes do I desire on hormones?
Which changes do I not desire on hormones, and how will I feel if I get these changes?
How do I feel about changes that are irreversible on hormones?
If I list all the desired changes and potential undesirable on hormones, which outweigh the most?
Sitting down and asking yourself these questions will help you figure out where you land in regard to hormone therapy.
6. What are hormone options for nonbinary people?
Hormone therapy for transgender adults, for the most part, has been mainly focused on the binary concept of gender. As such, it has mainly focused on gender-affirming hormonal treatments capable of inducing nearly complete masculinization or feminization for trans feminine and trans masculine individuals.
Today, it can be challenging to find a hormone provider open to various non-standardized treatment options for nonbinary adults, but they do exist.
If your provider is not familiar with nonbinary treatment options, offering recent publications, such as Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals, aimed at diversifying gender-affirming hormonal treatment for nonbinary folks can help.
This article summarizes various treatment options depending on your goals and how your provider can pair them up based on your need to masculinize or feminize secondary sex characteristics.
As the Possible Hormone Treatment Options for Nonbinary chart shows, there are numerous options that can work together depending on your transition goals.
If you are an adult and plan on starting hormones, here are my top tips:
Hormone replacement therapy is a great option for adults who know their gender identity.
It’s an important step for nonbinary adults who want medical transition as part of their plan.
Informed consent clinics are a fantastic resource for nonbinary adults ready to step into medical transition. The main function is to provide you with access to medical care, NOT help you figure out what your gender identity is.
If you are planning on starting HRT, and want a local provider, visit my resources page in the states I am licensed to find a gender-affirming prescriber in California, Texas, New York, or Florida.
And if you are in the states not listed, no worries; any of the links below offer online consent-informed gender-affirming hormone care.
If you would like a more personalized plan tailored to your specific goals and circumstances and would like to work with me one-on-one, book your free phone consult with me below.
7. What is microdosing?
When people first hear about microdosing they think about microdosing primarily testosterone and I have written about this in the article Nonbinary. Consider Microdosing Testosterone.
The truth is, microdosing equally applies to estrogen.
Microdosing is taking a small dose of hormones for a short or long period to achieve desirable changes.
Many nonbinary people seek microdosing to produce a more androgynous look than full masculinization or feminization. Additionally, many choose microdosing as an option to help alleviate psychological symptoms of gender dysphoria they feel.
Microdosing is often used without testosterone blockers. That's because your body requires certain levels of hormones to function, therefore, microdosing while also taking blockers could be dangerous, as it may reduce your hormones below the optimal levels.
This is why a close discussion with a medical provider is essential, especially in discussing your desired outcomes.
If you want to hear 4 most common myths on microdosing T, I encourage you to watch this video: Microdosing Testosterone | 3 Myths on Microdosing T From Gender Therapist.
SURGICAL OPTIONS FOR NONBINARY PEOPLE
8. How to decide if surgery is right for you as a nonbinary person?
Deciding if gender-affirming surgery is right for you has similar challenges as mentioned above in regard to deciding on hormone therapy.
This is primarily because many nonbinary folks may experience dysphoria toward a particular secondary sex characteristic today but not tomorrow, and deciding on surgery becomes problematic.
As I mention in this video, which I highly recommend watching if you are considering gender-affirming surgery How to Make the Right Decision When it Comes to Non Binary Surgery, one of the best ways is to ask yourself;
What results will I achieve with the surgery I desire?
Am I comfortable with these results long-term regardless of my gender identity and gender presentation?
Will desired surgery help alleviate the dysphoria I feel?
Will the desired surgery help me achieve the congruency I seek in regard to my gender identity?
If I make a list of pros and cons, which column dominates? Am I comfortable with the pros and cons long-term?
It can be very helpful to sit down and ask yourself these questions.
Sometimes, you may still feel unsure and that is OK. Rarely do people feel 100% certain about their decision. What matters most is spending time examining wants vs. needs and diving deep into the exploration of what surgical results may offer you on your path to your authentic self.
9. Top surgery options for nonbinary people.
There are various options of top surgery when it comes to nonbinary gender identity.
Chest or breast reduction surgery.
Transmasculine top surgery or a subcutaneous mastectomy.
Male chest contouring.
Cosmetic mastectomy.
Breast augmentation.
When it comes to nonbinary surgery aiming at delivering masculine or androgynous results, there are a number of surgical techniques available, and most surgical techniques depending on the size of your chest and its level of elasticity or firmness.
The location of the incision is also critical. As well as your desire for the preservation of nipple sensitivity.
For these reasons, selecting a surgeon specializing in gender-affirming care is crucial! Trust me. I have sadly written numerous revision letters of approval for nonbinary folks with botched results. Please do not make this mistake.
Today, there are many skilled gender-affirming doctors available to choose from. My top three are Dr. Mosser, Dr. Gallagher, or Dr. Garramone. All are incredibly skilled at nonbinary gender-affirming top surgery.
The 6 main mastectomy options available to you are:
Keyhole procedure
Periareolar procedure
Double Incision procedure
Inverted-T (Anchor) procedure
Buttonhole Procedure
Fishmouth Procedure
As you can see, each of the above procedures comes with benefits and costs and I have outlined a clear PROS and CONS list of each procedure in The 6 Main Mastectomy Options for Trans Chest Surgery, Including Pros & Cons!
PRO TIP:
Remember that one year on hormones is NOT required per the WPATH guidelines before considering nonbinary top surgery. Many inaccurately assume they must be on hormones for at least a year, prolonging their suffering from gender dysphoria.
You will require one or two (depending on your insurance requirements) letters of approval from a mental health provider certifying the presence of a Gender Dysphoria diagnosis. If you do need a letter, you can obtain gender-affirming letters from the below list of providers:
If you are planning on getting top surgery and need help finding a doctor, I highly recommend checking out my gender resource page in the states I am licensed in to find a gender-affirming surgeon in California, Texas, New York, or Florida.
10. Bottom surgery options for nonbinary people.
With gender-affirming care expanding, we see more treatment options tailored to nonbinary individuals’ personal needs.
Some of the most common options to consider when thinking about bottom surgery are:
Orchiectomy: refers to the removal of the testicles through a scrotal incision. This interrupts testosterone production, making androgen blockers unnecessary and allowing some people to lower their estrogen dose.
Penectomy: refers to the removal of the penis. It's sometimes performed for nonbinary individuals who wish to no longer have a penis and don't plan to pursue any further genital feminization.
Nullification: when Penectomy is performed in conjunction with Orchiectomy and Scrotectomy it's called Nullification or Emasculation. The urethra is re-routed down to the perineum. If preservation of an erogenous zone is desired, sensate glans tissue can be buried in the deep tissue of the lower mons, above the urethra.
Vulvoplasty: is the creation of the labia and clitoris. Unlike Vaginoplasty, Vulvoplasty does not include the creation of the vaginal canal. Vulvoplasty is a suitable surgical solution for those who identify as nonbinary and feel that Vulvoplasty offers a result that's more gender-affirming than Vaginoplasty.
Penile-Preserving Vaginoplasty: for some individuals, preserving the penis is desired while creating a fully functional vagina. With Penile-Preserving Vaginoplasty, the vagina can be created using a scrotal or other skin graft or peritoneal tissue.
If you decide on a bottom surgery, the most important things to know about are:
Even though WPATH issued the latest Eight Version of Standards of Care in 2022, outlining one letter requirement from a mental health provider before bottom surgery, your doctor and insurance company will most likely require two evaluation letters. That’s because insurance takes a long time to conform to the new standards. Make sure you are prepared with two letters, one of which has to be obtained from a Ph.D.-level provider.
You can obtain gender-affirming surgical letters from the below list of providers:
Ensure your gender-affirming provider is experienced in genital reconstructive surgery! To help you with the process, I have put together 11 Tips on How to Choose a Gender Affirming Surgeon!
Get your support system in place or have one person who can be there for you during the surgery. Do not underestimate this part of the process.
Above all, BREATHE! I promise you got this!
