Ask a Gender Therapist: Can I Transition if I’m Non-Binary or Genderfluid?

In this week’s edition of the Ask a Gender Therapist Video Q&A Series I answer the question:

Can I Transition if I’m Non-Binary or Genderfluid?

As always the transcript is below. Be sure to send me your questions through the Contact Me page on this site!

Transcript

Hey, welcome to “Ask a Gender Therapist.” This is a video series where I do my best to answer your transgender questions from the perspective of a gender therapist. I’m your host Dara Hoffman-Fox, and I’m a licensed professional counselor in Colorado.

So, this week’s question has to do with whether or not someone who is non-binary or genderfluid is able to transition. I actually got this question twice this week—once from someone in Illinois and once from someone in the United Kingdom. How cool is that? I’m going to read them to you.

The first one says:

“Hey Dara, I was wondering if you could address non-binary identities in one of your videos? I know I have personally gotten a lot of questions about that from people looking to transition, but worrying they won’t be allowed to since they aren’t FtM or MtF. I’d love to hear your thoughts on the matter.”

That’s from Brandon in Illinois. The other question is from Luke, in the United Kingdom, and Luke asks:

“I want to know if you know what kind of precedence there is regarding non-binary gender fluid identified people transitioning? I don’t think I want HRT but I can see myself being a lot happier in my body if I had top surgery, but I have no idea how to go about making that a reality. Thanks for your help.”

My guess is that a lot of you who are watching this video already know what non-binary or genderfluid means because you maybe wouldn’t have looked up this video otherwise. However, I do want to pause for a second to cover that terminology for those of you who are watching this who aren’t quite sure what those terms mean.

First of all, there are lots of definitions out there and it seems like they are changing quite frequently, but the best one I could find for non-binary gender identity is: those who are outside of the male and female binary. So there is male (indicate with left hand on one side of screen) and female (indicate with right hand on other side of screen) binary. Then if you’re non-binary, you are somewhere in the middle (flows one hand back and forth).

Note: This helpful comment was left on YouTube after I posted the video: “I would also add that non-binary could mean that instead of being in between the two “endpoints” of male or female, they may also identify completely off of that binary, or not believe in the binary at all since it doesn’t apply to them.”

Now as for gender fluid, it is kind of the same thing but I think the difference is that somebody who is non-binary may feel like they fall somewhere between male and female and they are comfortable being right in this place most of the time. Someone who is gender fluid not only is not on the male or female binary but they flow in between the two—and for each person it is different as to how frequently they flow or in what ways they flow.

I know that is extremely brief, and of course we can get more into that later. But for the sake of time…

Let me also define MtF and FtM. That was in Brandon’s question. FtM means Female to Male, MtF means Male to Female and it refers to, in the context of this question that binary where someone is transitioning from one to the other.

So in these questions, there are a couple of words I want to make sure we pay attention to. Brandon has said, “be worried that they won’t be allowed to transition.” And Luke had said, “Is there a precedent for this?” The reason they are asking that is because there are standards of care that physicians and surgeons and therapists are given as guidelines to follow when it comes to transgender healthcare.

They are put out by the WPATH, which is the World Professional Association for Transgender Health and the Standards of Care for the Health of Transsexual, Transgender and Gender Non-Conforming People. Whether or not we agree or disagree with the very existence of these standards of care, they are in existence— they are the strong guidelines that we are supposed to follow.

So let’s get into that because I have some good news for you.

In 2011 Version 7 of the Standards of Care came out and there were significant changes that were made to it compared to the previous six versions. The first version came out in 1979. The President of WPATH at the time, in 2011, when version 7 came out, his name was Walter Bockting, and Walter said this about the new Standards of Care:

“These new Standards allow for a broader spectrum of care of identities. They are no longer so binary. There is no one way of being transgender. These standards allow for a genderqueer person to have breasts removed without ever taking hormones.”

And so, genderqueer is a similar term in which it’s an umbrella term to cover where we’re not still talking about the gender binary. So he’s referring to non-binary and gender fluidity. Like I said, this is good news. It means that the new Standards of Care say ‘Yes, absolutely. You can transition if you fall within the genderqueer, non-binary, gender fluid, gender identities.’

However, I do want to specify that just because this is what’s being said, it doesn’t mean that everybody knows this. I’m talking about therapists, physicians, and surgeons. So this is the part where you may have to step in and act as an advocate for yourself. You may have to educate the practitioners that you’re working with and be sure do your research beforehand.

The first question you need to find out is whether or not the physician or surgeon that you are using requires a letter from a gender therapist. Because that can save you a lot of time if it turns out they don’t need one. So I would say at this point, chances are they do want a letter, but you might as well find out. That means contacting the physician that you would use for Hormone Replacement Therapy, find out if they require a letter from a gender therapist. Also contact whichever surgeons you’d be interested in, whether that’s for top surgery or for any of the bottom surgeries. More often than not they are used to answering this question so go ahead and find that out first.

If it does turn out they do want a letter from a gender therapist the next step is to try to find a gender therapist who can write you a letter in which they would refer to you as non-binary or gender fluid. If they are willing to do this for you but they don’t quite understand how to do this, you might have to step in and educate them a bit about what that means so you can provide them with information about what it means to be non-binary or gender fluid.

Let me give you a couple of examples though. When I have written an HRT letter for somebody who is more on the non-binary spectrum, or gender fluid, there’s just a few ways that I change the letter to make it reflect that instead of having to be FtM or MtF.

So, for instance, one of the more recent letters that I’ve written has verbiage in it like this:

“Gender Dysphoria is present in this client and it needs to be alleviated through Hormone Replacement Therapy.”

For other clients it could be this is a letter that has to do for surgery, so you just fill that in instead. See how simple and general that sounded? “Gender Dysphoria is present and it needs to be alleviated.” You’re not saying anything about going female to male or male to female.

Another way you can say this would be:

“Such and such client has not felt aligned with their assigned gender of male or female for as long as they can remember.”

Again, you’re being very general there.

“This client discovered the meaning of gender fluid at such and such age and recognized that this is what they were experiencing.”

You can also say something like:

“This client has been expressing their gender identity as fluid ever since high school with significant increases over the last two years.”

So you can let your therapist know that’s a different way they can phrase things in the letter so that way they are able to reflect your true gender identity which is gender fluid. It does not have to be going from male to female or female to male. There’s different ways you can word that.

As you continue going thru this process, if you have a therapist or a physician or a surgeon who perhaps gives you some resistance about this, go ahead and have those WPATH Standards of Care ready. You can get that on the internet in PDF form and I will put a link in the comments below for you to be able to find that.

Look for the parts in there that support what it is that we are talking about and let them know this is something that WPATH supports. From there, hopefully they will be able to understand this is completely within your rights to do this.

Thank you Brandon and thank you Luke for your questions!

That’s it for this episode. Feel free to check out my blog at Conversations-with-a-Gender-Therapist.com and if you have a question you’d like it email to me, send that to Darahoffmanfox@gmail.com.

I am very happy to be here to help however I can and I will see you next time!