Data show some nonbinary people prefer lower testosterone doses
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Key takeaways:
- Most nonbinary people who initiated low-dose testosterone therapy were still not taking a full dose by 12 months.
- People identifying as nonbinary may desire a slower or lower degree of physical changes.
BOSTON — Most nonbinary people who initiated low-dose transdermal testosterone for gender affirmation continued taking doses that were lower than current guideline recommendations at 1 year, researchers reported at ENDO 2024.
Current guidelines for initiation of testosterone for gender affirmation assume that transgender people desire “both rapid and complete masculinization,” according to Brendan J. Nolan, MBBS, PhD, a research fellow in the Trans Health Research Group at the University of Melbourne, Australia. However, an increasing number of transgender people, particularly those with nonbinary gender identity, desire lower testosterone doses than recommended to induce slower masculinization, Nolan said.
“The take-home message is the significant number of nonbinary people who not only initiate but continue testosterone at lower doses than those typically recommended in consensus guidelines,” Nolan told Healio. “People continuing low-dose testosterone might have slower or a lower degree of physical changes. Hopefully, more patients and their clinicians will initiate and continue testosterone doses that align with each person’s affirmation goals.”
For the retrospective study, researchers analyzed data from 46 nonbinary people (median age, 27 years) who initiated low-dose testosterone and were followed for at least 6 months. The primary outcomes were transdermal testosterone dose and serum total testosterone concentration.
The median duration of transdermal testosterone dose therapy was 14 months; median transdermal testosterone dose at initiation was 25 mg, rising to a mean 37.5 mg at the last follow-up (P < .01). The median serum total testosterone concentration was 11 nmol/L, within the low-normal range for cisgender men.
By the last follow-up, 87% of people who initiated low-dose testosterone remained on low-dose treatment, whereas 13% increased to full-dose testosterone, Nolan said. Among a subgroup of 30 people with at least 12 months of testosterone treatment, 87% remained on low-dose testosterone therapy by last follow-up.
Guidelines from the Endocrine Society for testosterone treatment of transgender adults wanting masculinizing characteristics recommend 50 mg to 100 mg per day of testosterone 1.6% gel formulation. There are currently no standardized guidelines for people who desire low-dose testosterone treatment.
“We need further research to establish the impact of low-dose testosterone on mental health and physical health outcomes in nonbinary people,” Nolan told Healio.
Perspective
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Joshua D. Safer, MD, FACP, FACE
Although it is interesting to confirm that the dosing needs reported initially for some patients correlate with the needs of those same patients later, there are several important caveats.
While it seems that the number is increasing of people reporting that they are nonbinary, how people label themselves may not correlate tightly with gender-affirming treatment needs. Many people who report that they are nonbinary seek conventional, binary hormone treatment regimens. In addition, people who start with lower-dose regimens may find that they would like to advance the regimens to those that are more conventional over time. Conversely, there are people who identify in binary ways but who seek lower-dose hormone regimens. The separation between how someone identifies and treatment needs is observed in other contexts. For example, many trans people on treatment do not report that they identify as transgender.
For those being prescribed gender-affirming hormone therapy, there is no general medical reason to favor a more masculine hormone profile vs. a more feminine hormone profile or anything in between as long as there are some sex steroids circulating and the person is not hypogonadal. The existing guidelines reference cisgender hormone ranges without actually insisting that anyone is obliged to be at one pole.
The important thing is that clinicians should be asking patients two categories of questions: “How do you identify/What pronouns do you use?” Independent of that, “What hormone regimen are you seeking with what body change goals?”
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Nolan BJ, et al. SUN-502. Presented at: ENDO annual meeting; June 1-4, 2024; Boston.
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