Androgynous hormone treatment

A strategy for nonbinary individuals

Some nonbinary individuals may not wish to achieve full masculinising changes or full feminising changes, but instead may wish to attain androgynous bodily changes. There are hormonal strategies that can help people attain these changes.

Microdosing hormones

Microdosing is when someone takes a lower than usual dose of hormonal medication (oestrogen or testosterone) as part of their gender affirming treatment. For people with testes who wish to achieve androgynous changes, microdosing oestrogen can be a part of androgynous hormone treatment. For people with ovaries who wish to achieve androgynous changes, microdosing testosterone can be a part of androgynous hormone treatment.

Microdosing can be an effective way to attain more subtle feminising or masculinising changes, which may be a desirable option for nonbinary people or for anyone who does not want to achieve full feminisation or full masculinisation (Cocchetti et al., 2020).

Microdosing can allow the feminising or masculinising effects of oestrogen or testosterone, respectively, to occur more slowly. This may give the person more control over the rate at which they progress through their transition.

Although microdosing can give you more control over how quickly masculinising or feminising changes occur, it is important to understand that different people’s bodies may respond in different ways to gender affirming hormone treatment and that it is often not possible to predict how each individual person will respond. Hence, it is not possible to predict the extents to which specific changes (such as breast development in feminising hormone treatment and voice deepening in masculinising hormone treatment) will occur.

Antiandrogens and blockers

For people with testes who wish to achieve androgynous changes, antiandrogens can be used to suppress testosterone production. Antiandrogens include gonadotropin releasing hormone analogues (leuprorelin, triptorelin, nafarelin), 5-alpha-reductase inhibitors (finasteride, dutasteride), spironolactone, and cyproterone acetate.

For people with ovaries who wish to achieve androgynous changes, gonadotropin releasing hormone analogues such as leuprorelin, triptorelin, and nafarelin can suppress the production of the hormones that usually stimulate oestrogen production.

Selective estrogen receptor modifiers (SERMS)

SERMs work by binding to oestrogen receptors at various sites in the body, including the breasts, the skin, and the reproductive organs. This alters the effects of oestrogen at these sites. Different SERMs have different bodily effects because they bind to different oestrogen receptors to different degrees.

In people with testes who are seeking partial feminisation but want to minimise breast growth, raloxifene is thought to inhibit the effect of oestrogen on breast tissue and reduce breast growth. This can make it a potential option for nonbinary people who do not want too much breast growth. However, it is important to note that raloxifene may not completely prevent breast development.

Timescale for androgynous changes

Unfortunately, there is no established timescale for the expected rates of bodily changes with androgynous hormone treatment. This is for three reasons. First, there has been very little research on androgynous hormone treatment, and so there is no consistent evidence on the rates of bodily changes. Second, different people’s bodies respond in different ways to hormone treatment, and so it is not possible to predict how any individual person will respond. Third, different people who seek androgynous hormone treatment may have different embodiment goals, and so the desired outcome for one person may not be the desired outcome for another person.

Nonetheless, there are some estimated timescales for full feminising hormone treatment and full masculinising hormone treatment. These may give some indication of how quickly certain bodily changes can be expected to occur with hormone treatment. If you are microdosing as part of androgynous hormone treatment, then these changes can be expected to occur more slowly. Again, it is important to note that these timescales are estimated averages and that there are considerable variations between people.

Feminising hormone treatment

EffectOnset (months)Maximum (months)Details
Skin3–6Unknown– You may notice a change in the texture of your skin, which may feel drier and softer.
– The skin pores may become smaller and produce less oil.
– You may notice that you sweat less and that your odour changes.
Testicular volume3–624–36– Testicular volume is likely to decrease.
– Sperm production may decrease, but the effect is variable, and so it is recommended to use a birth control method if you are sexually active with someone who is able to become pregnant.
Breast development3–624–36– Within a few weeks, you may notice small buds developing under your nipples. These may initially be tender, but this is likely to lessen significantly over the following months.
– Breast development can differ from person to person. As with all women, the breasts of transgender women vary in size and shape.
Body shape3–624–36– You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat collects more around your hips and thighs.
– You may notice that your eyes and face develop a more feminine appearance, due to changes in fat distribution under the skin.
Muscle mass3–612–24– Muscle mass may decrease in your arms and legs so that they have a smoother appearance.
– Regular exercise can help to maintain muscle strength and tone.
Bodily and facial hair6–12>36– The hair on your body and face is likely to become thinner and grow more slowly. However, it may not go away altogether, and so some people choose to pursue hair removal treatments.
– It is important to remember that many cisgender women also have bodily hair and sometimes also pursue hair removal treatments.
Scalp hairVariableVariable– Feminising hormone treatment is likely to stop balding of the scalp, although the extent to which scalp hair will grow back cannot be predicted.
This table is adapted from the Endocrine Society (Hembree et al., 2017)

Masculinising hormone treatment

EffectOnset (months)Maximum (months)Details
Skin1–612–24– You may notice a change in the texture of your skin, which may feel thicker and oilier.
– The skin pores may become larger and produce more oil.
– You may notice that you sweat more and that your odour changes.
– Some people notice acne, which can usually be managed with skincare practices and treatments.
Stopping periods1–6Variable– You may notice at first that your periods become lighter or are shorter in duration, but some people may notice heavier or longer periods for a few cycles before they stop altogether.
– Ovulation may stop or become less frequent, but the effect is variable, and so it is recommended to use a birth control method if you are sexually active and wish to avoid pregnancy.
Changes in genitalia3–612–24– You may notice that your clitoris grows and becomes even larger when you are aroused.
– Some people notice vaginal atrophy, which is the thinning and drying of the vaginal tissue.
Body shape1–624–60– You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat decreases around your hips and thighs, and increases around your abdomen.
– You may notice that your eyes and face develop a more masculine appearance, due to changes in fat distribution under the skin.
Muscle mass6–1224–60– Muscle mass may increase in your arms and legs, although this depends on other factors such as diet and exercise.
Bodily and facial hair6–1248–60– The hair on your body and face is likely to become thicker, darker, and grow more quickly.
– It is important to remember that facial hair growth varies from person to person. As with all men, trans men have varying degrees and patterns of facial hair growth.
Scalp hair6–12Variable– Many people notice thinning of the hair on the scalp. As with all men, the extent to which scalp balding occurs is influenced by various factors and cannot be predicted.
– If balding of the scalp becomes a concern, some treatments can be prescribed, such as minoxidil and finasteride.
Voice deepening6–1212–24– Testosterone causes the vocal chords to thicken, which can result in deepening of the voice.
– It is important to remember that voice deepening varies from person to person. As with all men, the voices of trans men vary in pitch and tone.
This table is adapted from the Endocrine Society (Hembree et al., 2017)

References

Cocchetti, C., Ristori, J., Romani, A., Maggi, M., and Fisher, A. D. (2020) “Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals”. Journal of Clinical Medicine, 9 (6): 1609.

Hembree, W. C., Cohen-Kettenis, P., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”. Journal of Clinical Endocrinology and Metabolism, 102 (11): 3869–3903.

Hodax, J. K., and DiVall, S. (2023). “Gender-Affirming Endocrine Care for Youth With a Nonbinary Gender Identity”. Therapeutic Advances in Endocrinology and Metabolism, 14.

Xu, J. Y., O’Connell, M. A., Notini, L., Cheung, A. S., Zwickl, S., and Pang, K. C. (2021). “Selective Estrogen Receptor Modulators: A Potential Option for Non-Binary Gender-Affirming Hormonal Care?” Frontiers in Endocrinology, 12: 701364.

Updated on March 21, 2024

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