Right now I am almost fully socially transitioned, but pre everything else. I’ve almost got enough saved up for top surgery now, and I’ve made an appointment to talk to my doctor about starting on T. However, I’m incredibly nervous that if I tell her that I’m non-binary, she won’t prescribe me and at this point it’s a need. I need to be on T, and I’m just so frightened that she’ll refuse me and I’ll be out of luck for the rest of my life. She’s done a lot of work with the trans community (which is why I became a patient), but still… I feel bad being dishonest, but would it be in my best interest to pretend to be binary in order to get a prescription?

First, let me lift a big weight off your back: if you don’t tell your doctor about your non-binary identity, you are not lying. You are not being dishonest. It is simply something you choose to keep private.

Secrecy vs Privacy

In the trans community there’s often a sense that other people have the right to know about your entire identity, or your past, or your reasons for choosing to transition; otherwise we are being “deceitful.” In the book The Transgender Child there is an entire chapter titled “Secrecy vs Privacy” where it is deftly pointed out that those two are very different concepts we must learn to untangle.

Disclosure, just like everything else, is a spectrum. What you disclose and to whom is completely up to you – you’re in control. If you choose not to disclose certain parts about your identity which are not “essential to treatment” (let’s call T treatment), it’s not lying, it is simply not relevant. For instance, you did not tell me your sexual orientation, whether you have a partner, or even your height and weight. Why not? Didn’t you feel obligated to? Because none of those are relevant right now. It’s something private that you chose to keep private.

Standards of Care and Non-Binary Identities

Second, you have every right to access hormones as part of your transition, if that’s what you feel you need to achieve your transition goals, regardless of whether your identity fits into the notion of a binary gender or not. This need is just as valid as any other need, like socially transitioning, or surgery.

This is not just me saying it. The new WPATH Standards of Care, version 7 (2011) are inclusive of non-binary and genderqueer identities. So it really shouldn’t matter if you tell your doctor or not that you identify as non-binary, because she shouldn’t deny you treatment based on that.

Unfortunately what should happen and what actually happens can sometimes turn out differently. There are many health providers that don’t know, or don’t care know, or refuse to follow what has become the new standard in transgender health care. In this case, it is best to tread with caution in order access the services you need. If possible, try to find another provider who will honor your identity and the unique needs of your transition path. But in your case, your doctor is already working with the trans community, so chances are she already knows about this, or at least she’ll be more open to learning about the newest recommendations from WPATH. She might even welcome this new knowledge and incorporate it into her practice.

Lastly, you do not need a therapist letter to access hormones. I’m throwing this out there just in case you didn’t already know. The new SOC outline an Informed Consent model for hormone administration (seriously, check out the linked documents). Given you are over the age of consent – 18 in the US – this literally means you see your doctor, she explains what testosterone does and doesn’t do, and you sign a form indicating you understand. In some clinics you might be asked to talk to the doctor or a counselor for a session or two, just so they can make sure transition isn’t something you’re just jumping into (remember, to them you’re a stranger who just walked through the door). In this case, you are clearly serious about transitioning, especially seeing as you’ve already taken certain steps.

My Experience with Doctors and Hormones

Now I’m going to take off my professional hat for a bit 😛

In my personal experience, my non-binary identity did not influence my doctors’ decision to prescribe me testosterone. Rather, my doctors were patiently waiting as I did the inner work to get “there” – to the point where I was ready. What being open about my identity did enable, however, was honest conversation regarding my fears and concerns with the effects of hormones as directly related to my goals. I was able to bring up the idea of low-dose or of stopping T, the best ways to go about this, and what effects it could have. It was a big relief to be able to get this information (and mostly, reassurance) directly from my doctors.

Taking T is actually pretty simple: you just take it. Really, that’s it. You can choose a low dose, mid dose, or “regular” dose, and a delivery mechanism (cream, gel, injectable), but in the end there’s not that much of a difference. [On the other hand, the combination of estrogen+anti-androgens can be a little more complicated, but it also just comes down to finding the dosage that works for you.] Hormones will do what they’re supposed to do, a little faster or a little slower. What the doctor is there for is to monitor your general health, check your hormone levels, adjust your dose according to your body and goals, and ensure hormones are not having adverse effects on you.

The tricky part for non-binary peoples is figuring out why we want it, and that’s something your medical doctor can’t usually help you with.