Most of the discourse around gender transition focuses on transmasculine or transfeminine people, and rarely do we discuss what “transition” can look like for people who identify elsewhere on or outside of the binary.

This means that often, non-binary people can find themselves locked into more binary transition paths, limiting them to a grab-bag of feminine and masculine options without alternatives. But those options are not the complete picture for non-binary transitions.

With more people than ever questioning gender in themselves and society, now’s a great time to talk about the possibilities of being non-binary. Non-binary existence shouldn’t play second fiddle to binary existence. Especially not when non-binary people bring such vibrance to our understanding of what it means to be… “gender.”

The Connected Domains of Gender Transition

Good transition care considers all the social, medical, and bureaucratic aspects of a transition and how they fit together and relate to each other. It’s helpful to look at transition as a set of interconnected domains — as something that involves numerous actors and linked paths — rather than as one uniform undertaking.

Social transition covers sweeping changes to someone’s interpersonal interactions. These include changing how we dress, our body language, our names and our pronouns.

Medical transition covers the stuff we can’t do through Google, shopping, and willpower. The most well-known aspects of medical transition are hormone replacement therapy and surgery, but there’s often countless allied healthcare professionals involved in these and other medical processes, such as mental health providers, speech therapists, and patient advocates.

And, finally… nobody escapes bureaucracy. Legal transition involves changing our legal documentation and amending all the associated paperwork. This process can be highly frustrating, but we do it despite the difficulties because legal recognition and valid paperwork are important to a stable life.

Social Transition: Being Non-Binary

There isn’t one way to be non-binary, and non-binary social transitions run the whole range of possibilities because they’re not restricted to an existing framework. People often understand being non-binary as a mix of feminine and masculine characteristics. That’s a start, but it doesn’t do justice to non-binary diversity.

So I like to add another layer: More Gender and Less Gender.

More gender approaches purposefully add gendered characteristics to non-binary personhood. Mixed pronoun clusters (he/she/they/any; he/they) and uncommon gendered names (Maximilian, Princess) allow people to gender themselves, but resist normative masculinity and femininity.

Less gender is another option. This represents the removal of gendered characteristics to create a non-binary expression. Here, we may find androgynous and “gender neutral” presentations, gender-neutral or “genderless” names (Ash, Onyx, Pixel, Zee) and the classic “they” pronoun.

These ‘more gender’ and ‘less gender’ options aren’t just categories to fit into, either. They’re just more ways to be ourselves. Consider some of these possibilities for expressing our gendered (and genderless) selves:

Names, pronouns and forms of reference

• Choosing a new name
• Mixed gender pronoun clusters (he/she)
• Genderless pronouns (they; it)
• Neopronouns (xe/xem/xyr/xemself) or nounself pronouns (leaf/leafself)
• Single-gender pronouns (he/his; she/hers)
• Unspecific pronouns (they; any)
• Alternate titles (Mx.; M.; Msr)

Presentation

• Clothing (cuts and shapes; color choices; accessories)
• Body modification (tattoos, piercings, scarification, biohacking, bodybuilding)
• Hair (removing; growing; adding; styling; coloring)
• Voice and speech (modifying via practice or medical means)
• Body language and posture

Gender is felt internally, but expressed externally. When we feel safe to do so, presentation becomes a tool we use to express the feelings inside. This is reflected in fashion, body art, and surgical decisions alike. Through expression, transition becomes an extraordinary act of personal agency. Nowhere is that better reflected than in how we choose to transition socially.

Medical Transition 

We can’t do everything alone, and the physiological part of transition requires interacting with the healthcare system. “Trans people are already marginalized, and medicine as an industry, profession, and institution remains deeply conservative, particularly when it comes to social and cultural values,” Doctor, activist, and trans woman Dr. Anastacia Tomson told me. “Healthcare providers are most comfortable with concepts that they can easily fit into boxes, even if the boxes themselves aren’t up to date with scientific knowledge.”

While many trans people feel aligned to femininity or masculinity while being non-binary, others only use feminine/masculine identification to access care, a practice which Dr. Tomson notes can be “rooted in cisnormativity,” adding, “while binary trans identity challenges [cisnormativity], non-binary identity challenges it doubly.”

There are nonetheless options for non-binary people within the medical system.

Hormone replacement therapy

Where accessible, non-binary people can shape themselves with hormone replacement therapy (HRT).

Conventional feminizing or masculinizing HRT administers sex hormones and/or hormone blockers to achieve a desired result. However, HRT doesn’t have to be all-or-nothing. It is possible for an attentive clinician to develop personalized hormone care, which typically involves modifying a feminizing or masculinizing hormone plan to reflect a client’s needs.

A personalized care plan of this type can introduce opposite sex hormones to a person alongside their natural sex hormones. This is in contrast to binary plans that reduce existing sex hormone levels while raising the levels of a new sex hormone. E.g. using testosterone blockers/orchiectomy alongside estrogen in trans women. Hormone regimens like this need to be carefully monitored, but can allow non-binary people to develop new secondary sexual characteristics while retaining existing ones. An AMAB non-binary person could use estrogen to pursue l skin changes and limited breast development while retaining masculine secondary sexual characteristics like high body hair volume and penile function.

Dr. Tomson notes that these plans can have some risks. “Absolute deficiencies of both estrogen and testosterone is not healthy for the human body,” she says. “So just using hormone blockers, or just having a gonadectomy with no hormone replacement, is likely to cause problems.”

A person’s anatomical responses to HRT are also unpredictable, and she notes that “some changes are reversible, whilst others are irreversible, and similarly some are primarily dose-dependent, whilst others are primarily time-dependent… we can’t always (or even often) offer a menu from which to pick and choose.”

Despite how unpredictable our bodies are, HRT offers non-binary people a hormone treatment that trans and cis people have benefitted from for decades. Client-centric clinicians who deliver personalized care are a small, but always-growing group.

Surgery

Existing gender affirming surgeries are also options for non-binary people. Most of us are aware of procedures like breast augmentation/removal, and facial reshaping (chin/cheek/jaw), as well as mainstream cosmetic procedures like rhinoplasties that can fit into a gender-affirming process. Some surgeries are combined into packages for easier access and insurance coverage. The most famous is facial feminization surgery (FFS), which combines several procedures to feminize the face.

Moving below the ribcage, we have remarkably complex ‘bottom’ surgeries. Vaginoplasties convert existing genitals into a sexually functional vagina, while phalloplasties build a sexually functional penis from tissue and synthetic implants.

Although these surgeries are often tailored to binary trans people, non-binary people can benefit from any of them to meet their vision. Non-binary people can de-feminize their chest by removing their breasts, or use bottom surgery to alleviate genital dysphoria. These incremental steps don’t have to be linked to broader feminization or masculinization, even if they’re often associated with binary transition.

There are also pioneering non-binary specific procedures, mostly available in the USA and Europe. These include breast removal with nipple excision (removal of all breast tissue and the nipples) and gender nullification (removal of genitalia). Meanwhile, the phallus preserving vaginoplasty answers the question of, “what genitals?” with, “more“. Non-binary people and their physicians pioneer these procedures while challenging cisnormative rhetoric about what affirmation looks like.

Of course, any new and uncommon procedure comes with risks. “With any new technique, there isn’t a large enough sample set to extrapolate meaningful data around specific risks,” Dr. Tomson told me, “and this is largely the situation we find ourselves in with these novel procedures.”

Despite the risks, trans people’s need for gender affirmation often makes them worthwhile. However, demand for gender affirming surgery far outstrips the medical system’s capacity (and desire) to provide it. It’s even harder for non-binary people because surgery primarily caters to people at the poles of the gender binary. The main barriers to quality surgical care are monetary, bureaucratic, and legal, which means more specialized procedures are even harder to access.

Legal Transition: Gender non-compliance and you.

State recognition of non-binary people is inadequate. While binary trans folk struggle for legal recognition and to have legal documentation that matches our gender, we’re also in the fortunate position of fitting into an already-existing box. Paperwork like driver’s licenses, social security, and passports may ‘only’ be an adjustment away for a binary trans person. For non-binary people, a fitting category does not always exist.

When it exists, non-binary recognition is often relegated to an ‘Other’ or ‘third’ category that isn’t adequately representative.

In most places, non-binary people are required to align themselves with one of two legal genders: M or F. Some nations offer non-binary or ‘third’ options. Bureaucratic options for gender recognition are, ironically, to diverse to easily summarize. Despite most bureaucracies only catering for two or three genders there are diverse restrictions on how to, and who can change their legal gender.

Whenever my state fails to recognize me, I take pride in knowing that my very existence is an act of rebellion. The heart of protest is inconveniencing the status quo to draw attention to marginalized people. To that end, simply being a trans woman is very inconvenient to established social and legal norms. Gender non-compliance may not be a standalone identity, but it’s weirdly affirming sometimes.

Be Non-Binary, do crime.

The fact is, it’s impossible to do justice to non-binary expression in any single definition or explanation. The beauty of being non-binary lies in living beyond convenient explanation. It also means that there’s no right way to be non-binary. The closest thing we have is the ongoing pursuit of well-being.

As Dr. Tomson told me, “the point of transition should be the improvement of quality of life, and that they are the only ones who can decide if that goal is being achieved. In other words, don’t take steps, or feel forced to take steps that make someone else happy — whether it’s the pathology lab, the doctor, the workplace, or anyone else.”

So the real question is what can a non-binary transition look like, but which elements available to me are ones I want to pursue? What would make me a more comfortable and affirmed version of myself?

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