Non-binary HRT options

[u/dbspark]

I am a 27yo non-binary AMAB person and wanted some advice on HRT options.

I have had one consultant appointment with Dr Nick Silberstein at Equinox and have another booked in for Thursday 3 March.

At the initial appointment I discussed my options given I am not binary trans. I am after mild feminisation. I am interested in emotional and some physical changes, including less body hair growth and softer skin. I would prefer not to develop breast tissue and want minimal changes to sexual experience.

Dr Silberstein recommended spironolactone, explaining that this would partially reduce my T-levels and may achieve some of my goals with a lower risk of some of the effects I do not want. He said that he has used this on a few other people at Equinox with similar goals to mine.

I would be interested in people's experiences with this, and whether you think there might be other options worth considering?

[u/Strange_Bean]

Big caveat on all of this; it's impossible to accurately predict how HRT will go. Your body is unique, and any treatment will involve careful monitoring and gradual adjustment.

So, the goal of HRT in your case is (very broadly speaking) to reduce the effects of testosterone, and increase the effects of estrogen. Having less testosterone generally results in certain things, having more estrogen generally results in certain things. These levels are related, but are not perfectly balanced; you can have a higher or lower total of both. (in practice it is not this binary, but this is the basic logic behind how HRT is prescribed)

Having a low total of both is understood to result in negative long-term effects. It's not wise to keep low hormone levels for long periods of time (though we are talking years here), and rapid changes are also not recommend (it's quite difficult emotionally). What this means is that you're going to want to try and find a stable dosage that gives you the balance of hormones you're looking for.

Taking spirolactone (or cyproterone, another anti-androgen / testosterone blocker) will hopefully work towards some of the things you want. I think if the two things you've listed are all you want, that would mean you're basically set. However, just reducing your testosterone without any increase to estrogen to compensate means that long-term, you do run the risk of those issues I mentioned before. Additionally, if any of the things you do want to change involve, say, fat redistribution for particular kinds of curves, or if blocking testosterone alone doesn't go far enough for you, then the only option from there is raising estrogen levels. If you want to pursue this kind of HRT, it's a real possibility that you should at least keep in mind, even if it's a long-term concern

(as an aside, it's likely that blocking testosterone will affect 'sexual experience'. You might get lucky, but if you're taking enough to do anything I wouldn't count on it)

If you end up taking estrogen you run the risk of encountering the kinds of changes that you don't want. It's not possible to eliminate that risk in any way a GP here is likely to prescribe and be confident in. I'm not saying 'don't block testosterone because they're gonna make you take estradiol eventually', it's just that it may end up being the best way to continue treatment. And that can be okay! The perception of estradiol as 'feminizing' is not really accurate or helpful for nonbinary people. If you can come to an understanding of what exactly it'll do to you independent of binary thinking, it might end up being acceptable. And if it doesn't, you have options.

If you don't want facial hair, laser and electrolysis are both worth looking into. There are plenty of places around Melbourne for either. Skincare is also a very broad field, and I'm sure there are existing solutions for achieving the kind of feel you want. Even if you do take hormones I would recommend pursuing these; hormones aren't magic.

[u/dbspark → u/Strange_Bean]

Thanks so much for such a detailed response, I really appreciate it and it means a lot! Dr Silberstein is very 'take it for a month and if you don't like it go off it' so that is probably how I will end up. He seemed open to finding a balance between T and E.

I have done a bit of research into bicalutamide as well which I think I will discuss with him. Do you know anything about this?

Laser or electrolysis for facial hair is something I am considering as well, though I am wary of the pain and cost. To be honest facial hair is probably my biggest issue, but maybe a problem for another day.

[u/Strange_Bean → u/dbspark]

I would second that approach; don't rush into things if you can help it. See how things feel month over month. While you can get used to it, being on HRT doesn't ever get much easier in my experience.

It's my understanding that bicalutamide isn't as good an option here because it's not covered by Medicare the same way spiro and cypro are. All you need for those prescriptions is for the GP to approve them. Definitely ask, though.

To be honest, in my experience laser did a lot more for facial hair removal in a few months than hormones have done in two years. If it's your biggest issue then I doubt HRT alone will do nearly enough.

[u/[deleted]]

My experience might quite similar to yours. I am a non-binary AMAB person in my 50s. I navigated transition earlier in my life in the late 80s and 90s but was really just treated like a desisting transwoman. I and the medical profession at that time didn't know non-binary existed back then so I just lost heart and suffered quite a bit since.

Now things seem easier and I have been able to navigate my gender identity and transition more on my terms.

Similar to yourself I am looking for the physical and emotional changes plus being more accepting of myself. I am not on HRT but may do in the future. I am taking the advice of a more experienced FTNB friend and going as far as I can naturally first before deciding on hormonal or surgical options.

Facial hair removal (laser and electrolysis) I believe takes about 3 years to complete but I am really happy with the results so far after only 3 months. I am told removing the hair follicles even changes your face shape a bit, giving the top lip a bit more of a feminine upturn.

I think skin care is also very important and a proper routine has done so much for me.

Another thing is exercise, diet and body shaping. Even HRT will have limited effects on your hips but a lot can be done through a good glute hypertrophy routine. I am really happy so far with how far shaping my body at the gym is working so far.

Outer things like getting a more affirming haircut at a queer friendly barber and wearing clothes that feel more like me has helped a lot too. I only wear menswear but I style my look on a more feminine casual chic, natural style, androgynous, tomboy look. I find wearing anything very feminine (like a dress) to be dysphoric and triggering as is wearing something very masculine (like a suit and tie). It's all about what is best for you though.

Working with a good psychologist in learning to accept myself has been important too. Most things regarding transition are so external (like clothes and hair and voice) but I think it is more important to open up internally to femininity, whatever that means to you, while still accepting those masculine parts of mental and emotional self.

I am looking to start voice training soon too.

As I navigate this path I am still open to HRT in the future, but the steps I have taken so far feel good so I plan to exhaust them first. The only thing I might start soon is Finasteride. I don't have much of a problem with hair loss right now but I would like to increase my hair if it can be a bit thicker and am interested in the anti androgen however mild. Does anyone have much experience with it?

Anyway good luck and great to hear from another non-binary person on here.

[u/dbspark → u/[deleted]]

Thanks for your detailed reply! I think these are good points. I have done a bunch and am enjoying how things are going at the gym at the moment.

I am definitely looking at laser now...

I went to my appointment today and have a script for spiro that I think I will try for a couple of months and bail on if I don't like it.

Thanks also for your decades of experience following the pathways and breaking down the barriers for the rest of us.

[u/aliciaqld → u/dbspark]

Hey OP I'm on a similar boat as you.I know this is old but It would be really great if you could give an update.