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!


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.

Click here to view and download the WPATH Standards of Care

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 and if you have a question you’d like it email to me, send that to

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

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  • cynthialee

    October 29, 2014 at 4:06 PM Reply

    As the spouse of a medically transitioned genderqueer I am happy to see this information becoming more available. When ze start per medical transition (5 years ago) we were in new unexplored territory. Ze was unable to get a therapist to write a HRT letter and ze only was able to start HRT due to our family doctor willing to go with an informed consent approach. The HRT did wonders for per and it has set up a pattern of events in per life that has launched per career and life path as a result.
    Now there are therapists who will write letters for genderqueer people but it is all so much new territory for society.

    Not enough genderqueer visibility out there yet. But wonderful people like my spouse are changing perceptions.

    • Dara Hoffman-Fox

      October 30, 2014 at 3:24 PM Reply

      What a great story to share, am so glad to hear your spouse has had such success and indeed has paved the way for others in the future. My best to you both!

  • micah

    November 12, 2014 at 5:59 PM Reply

    Thank you Dara for the detailed explanation.

    Of course you can medically transition even if you are non-binary, and of course there is precedent. People were going around the WPATH SOC even before they were updated to be inclusive. It’s just not well documented, and as you mentioned, sometimes even the providers don’t know! So thanks again, as this adds another excellent resource for people.

    • Dara Hoffman-Fox

      November 12, 2014 at 9:37 PM Reply

      Thank you for your comment Micah, means a lot to me!

    • John Clark

      July 23, 2016 at 1:46 PM Reply

      Thanks to the “People [that] were going around the WPATH SOC even before they were updated to be inclusive”. They made the path in v7 so we don’t have to “go around” anymore. And you are helping save us.

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    May 15, 2015 at 8:37 PM Reply

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  • alex

    August 11, 2015 at 7:50 AM Reply

    A valid point that may partially affect transgender decision is whether or not folks transition because of what society deems acceptable. For instance there are some folks who want to be a woman and sound and act “Feminine”, but society has influence.

    In many conservative societies this is more engrained, boys do man stuff, and woman do women stuff, in some countries it can mean the absence which is still partially true of jobs and occupations considered “manlike” so not so many women construction workers, blue-collar workers, firefighters, miners, police, oil rig workers,etc.

    Women who join those fields are often viewed as less feminine or in some cases other woman judge them for trying to steal their husbands or whatever. A boy who acts emotional is viewed as unmanly and ones who laughs a lot sometimes, but would a girl who is not as emotional and “babyish” be viewed positively and with less sympathy or in some cases expected to be a brat and more emotional (even though he or she will have empathy in other areas).

    The list goes on and on, for instance it is often woman who are viewed as scardy cats and men aren’t, okay that is partially true in reality competition shows that feature dares, but perhaps women get less embarrassed because they have less of an ego, for instance for a guy to wear a dress is more humiliating, but I notice for instance that women among women have a different bond then men among men, for men among men they seem to be less touchly feely amongst eachother even in non-sexual appropriate ways then women, it has to do with emotion. In movies you often see women as being helpless or damsels and cute in some ways when rescued but for a man its more humiliating and associated with violence. Just a thought.

    In a perfect world, we could change genders back and forth, I think the issue is sometimes where your somewhat comfortable with your gender, may want to have children, and recognize that perhaps living as say a woman instead of a man is not completely for you, however in many ways you identify with the opposite gender and maybe bullied or harassed or perceived wrongly as not being manly, of course violence and bullying shouldn’t influence the choice, but what I say is that suppose your are somewhat comfy being a man although you would probably go back in time if you had the choice to be a woman, and the transition is not worth the hassle of its consequences.

    I often bring up this ambiguously, trans folks are a different folks, just like gay men and lesbians, they have different sexual orientations and should have equal rights and anti-discrimination, but its different when a girl is attracted to a girl and sees girls on locker rooms but may not be as “aggressive” or the same with gay men. A transwoman can never fully be a woman, I am not saying that they aren’t a woman at all, but in terms of having periods,pregnancy,childbirth, although they can breastfeed. A trans-male may never experience what it is like to have a penis,semen,erections, and be attracted to girls in a heterosexual male fashion.

    Often times I wonder this question, if its so bad and uncomfortable for instance to be a man, why do folks transition as transman, perhaps talking to transmen would make the more “Somewhat comfortable” aspect be okay, there are much greater transwoman than trasmen, and more lesbians than gays, so it seems society is judging or stereotyping what it is to be manly, or maybe its hormones and genes?


  • alex

    August 11, 2015 at 7:58 AM Reply

    I forgot to also add the issues of transwoman, a transwoman may never experience some of the health issues that some with a woman also things like menopause, so its interesting.

    A transmen may also feel different, perhaps not like male slow a pulse since there is no menopause although testestorone levels decline.

    I would be curious to hear from transmen who converted after hitting menopause as former woman. I could say transwoman could be close to post-menopausal women but not sure about transmen. Transmen may not know what it is to have erections,semen,urinating at different times and a scrotum although surgical procedures can have a certain effect and of course as I mentioned transwoman the periods,childbirth,pregnancy, birth control hormone fluctuations, and sex drive related issues.


  • […] Fears around transition regret can also come from a lack of knowledge – whether it’s myths about surgical regret (often pushed by anti-trans activists) or an “all or nothing” understanding of hormones (for example, the misconception that non-binary people cannot hormonally transition). […]

  • viki

    March 18, 2016 at 11:48 PM Reply

    Hi Dara , I was wondering if he could tell me how can you tell if someone is transgender or if they are non-binary I have been questioning but I didn’t see for a long time that I have finally told my mom about how I felt I’m still confused about my identity what is your thoughts on this needs your help sincerely Viki

  • Pasha

    May 10, 2016 at 3:07 PM Reply

    This is really useful!

  • Jules

    June 6, 2016 at 4:34 AM Reply

    I’m just curious does this count for the USA only or also in other countries like the netherlands?

    • Dara Hoffman-Fox

      June 7, 2016 at 4:40 PM Reply

      Technically it should apply, but it requires finding physicians, surgeons, and therapists who are aware of this…

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