Gender-affirming treatment desirable for both nonbinary, binary transgenders

Many nonbinary transgender individuals, like their binary counterparts, want to undergo gender-affirming medical treatment (GAMT), and that not being able to do so may result in negative effects on their mental and sexual health, suggests a study.

“In this online questionnaire study investigating GAMT desire (motives), the majority of binary and nonbinary transgender participants indicated having an unfulfilled treatment desire,” the researchers said. “Both groups indicated that their motives for GAMT were mostly related to body and/or gender incongruence and a need for gender affirmation.”

An online questionnaire was completed by 125 transgender men, 72 transgender women, and 62 nonbinary transgender individuals (mean age 30.4 years). Outcomes measured were as follows: GAMT desire, undergone GAMT, motives for (not) wanting (further) GAMT, Utrecht Gender Dysphoria Scale, Satisfaction With Life Scale, Hospital Anxiety and Depression Scale, Global Measure of Sexual Satisfaction, transgender-specific body image worries, and sexual self-concept discrepancies.

Based on the results, binary transgender participants had undergone more GAMT procedures than nonbinary transgender participants (p<0.0010 for both gender-affirming hormone treatment [GAHT] and gender-affirming surgery [GAS]). Binary participants also reported a stronger desire for GAHT than did nonbinary counterparts (p<0.001), but both groups showed no difference in their desire for GAS (p=0.411). [J Sex Med 2022;19:1173-1184]

Reasons for wanting treatment were similar between binary and nonbinary participants, and these were mostly associated with body and/or gender incongruence and gender affirmation.

For participants who expressed no desire for treatment, the most important reason was gender identity in the nonbinary group and possible medical complications in the binary group.

Majority of the participants in both groups reported an unfulfilled treatment desire (69 percent in the binary group and 64.5 percent in the nonbinary group), which was associated with lower levels of general life satisfaction (p<0.001) and sexual satisfaction (p=0.005), more anxiety (p=0.006) and transgender-specific body image worries (p<0.001), and larger sexual self-concept discrepancies (p<0.001 for actual and/or ideal; p<0.001 for actual and/or ought).

“Systemic barriers to GAMT (especially GAS) should be removed not only for binary but also for nonbinary identifying transgender individuals to decrease the discrepancy between treatment desire and actually seeking treatment,” the researchers said.

Earlier studies reported that nonbinary transgender individuals suffer less from body dissatisfaction and gender incongruence compared to their binary counterparts. However, this was not confirmed in the present study. [Transgender Health 2019;20:263-274]

“[M]otives such as wanting to change one's body, wanting to feel more masculine or feminine, and wanting to be seen as a woman or a man by other people were most prevalent in both participant groups when it came to desiring GAHT,” the researchers said.

The current study was the first to systematically examine the differences in treatment desire motives between binary and nonbinary transgender individuals, while also showing the possible negative consequences of an unfulfilled treatment desire, according to the researchers.

“Given the online character of the study, results may not generalize to the broader transgender community,” they added.