Neither male nor female: Why some nonbinary people are 'microdosing' hormones
The goal is to appear "somewhere in the middle" on the gender spectrum, one nonbinary Los Angeles resident said.
By Julie Compton
Marisa Rivas never felt comfortable living as a woman, but doesn’t identify as a man either.
Last year, Rivas, 30, a college admissions coordinator in Los Angeles, had a mastectomy. This year, Rivas started using gender-neutral “they” and “them” pronouns.
Then, at the end of June, Rivas went to the Los Angeles LGBT Center in West Hollywood to talk to a doctor about going on “low-dose” testosterone, known colloquially as “microdosing.” Rivas hopes to achieve a sharper jawline and a more androgynous physique without overtly masculine features like facial hair. The goal is an appearance that is not clearly male or female.
“I still want to be somewhere in the middle,” Rivas said.
Hormone microdosing is of growing interest to some nonbinary people like Rivas who want to masculinize or feminize their bodies in subtle ways. There is little research on the technique’s prevalence, but doctors who treat transgender and nonbinary people say the medical community should consider the needs of those who want to change their bodies without medically transitioning fully to the opposite gender.
“There’s this kind of assumption with transgender individuals that everyone should get surgery and everyone should get hormones to become as ‘male’ or ‘female’ as possible — and that’s simply not true,” said Dr. Tri Do, an internist and assistant professor of medicine at the University of California, San Francisco.
Nonbinary advocates are calling for a broader definition of medical transition as more Americans identify outside the gender binary. Fifty-six percent of “Generation Zers” — those born between the mid-1990s and the early 2000s — report knowing someone who uses gender-neutral pronouns. And more than a third of almost 28,000 adult respondents to the 2015 U.S. Transgender Survey, the largest survey devoted to the experiences of trans people, reported that they were nonbinary or genderqueer.
Not all nonbinary people seek medical transition, and it’s unclear how many do, since medical systems in the United States typically only track sex assigned at birth. But for those who want to move toward a more gender-neutral appearance, microdosing is an increasingly discussed option. Several YouTube videos describing the experience have received thousands of views.
Do, who has been treating transgender patients since 2001, said he starts all his patients on lower hormone dosages to give them time to adjust and to find a comfortable dose. Low doses have the same effects as higher ones, but it takes longer for those effects — bulky muscles and facial hair in the case of testosterone and increased body fat in the case of estrogen — to develop. The results of a particular dose can vary greatly by person due to genetics, he said, and patients often ask to switch to higher or lower doses as they see changes to their bodies — or, in rare cases, may choose to stop taking hormones entirely.
For Rivas, the appeal is simple: a sense of control.
“The thing about microdosing is that it’s such a little bit at a time that if it’s not something I like doing, I can always stop taking it,” said Rivas, who learned about microdosing through an essay published on Vice in April. “And if it’s something that I feel like at some point I may need more of, then that’s an option.”
Doctors and surgeons are seeing more nonbinary patients
In 1979, when the first international transgender health care guidelines were published, trans people who sought treatment were under pressure to identify as either male or female to be taken seriously by providers, according to Dr. Asa Radix, senior director of research and education at the Callen-Lorde Community Health Center, which provides health care to LGBTQ people in New York City.
Since then, attitudes about gender and sexuality have radically evolved. In the 1980s and the ’90s, words such as “nonbinary,” “genderqueer” and “genderfluid,” which describe identities outside “male” and “female,” started to appear in academic and activist discourse, and have since made their way into mainstream culture.
Over the past decade, some health professionals have shifted away from treating gender identity as a disorder and are focusing instead on dysphoria, which is the distress a person feels as a result of their gender not being recognized. This distress decreases or disappears for many people who take masculinizing or feminizing hormones, according to the American Psychiatric Association. Microdosing hormones is just the latest evolution of this treatment.
Doctors and therapists who specialize in transgender care say nonbinary people have been coming to them for years, though they’ve only recently had the language to explain it.
Dr. Leandro Mena, medical director of Open Arms Healthcare Center in Jackson, Mississippi, estimated that about 100 of his 250 transgender patients are nonbinary, a number that has increased since he opened the clinic in 2013, though the number who take hormones, and dosages, vary.
“In retrospect, if you ask me, I probably gave hormones to my first nonbinary patient probably about 10 years ago,” he said. “I just didn’t recognize it or I just didn’t ask the questions that I should have asked at that time to recognize that that person was nonbinary.”
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