FOR THIS BODY TO FEEL LIKE HOME
When Our Body is Our Home: Where Do Non-Binary Transitions Stand in the Current Gender System?
Despite the increasing visibility of hormone therapy, the healthcare system's support for transitions remains largely binary, favoring transitions from male to female or female to male. This leaves non-binary transitions largely unaddressed, posing significant challenges for non-binary individuals seeking hormone therapy.
A common experience shared by non-binary individuals worldwide includes:
- Medical Misunderstanding & Barriers: Before initiating hormone therapy, medical practitioners must assess if the person is "truly eligible" for hormones. This often results in invasive questions like, "Do you want to be a man or a woman?" Such questions can cause non-binary individuals to doubt themselves and feel discomfort even at the consultation stage. Consequently, some resort to sharing hormones among themselves or purchasing them online, which are both risky practices, as hormone levels intricately link to kidney function, liver health, cholesterol levels, etc.
- Inappropriate Hormone Dosages: Standard clinical doses of estrogen, testosterone, or anti-androgens are intended to induce clearly masculinising or feminising physical changes. However, these binary outcomes may not correspond with the physiological goals or gender-affirming needs of many non-binary individuals.
Therefore, a healthcare system that recognises and accommodates non-binary transgender individuals is something that the non-binary community is actively advocating for.
It’s important to understand that Hormone Replacement Therapy (HRT) is not only used by transgender people. It is also given to postmenopausal women and men with low testosterone. For non-binary individuals, microdosing HRT can help adjust their physical appearance in small, gradual ways. This allows them to feel more comfortable in their body without having to take on clearly male or female traits
Non-Binary Conversations
This is a dialogue between Tawan, a recent graduate about to pursue a Master's in International Relations, who is intersex and identifies as non-binary (currently on testosterone microdosing), and Arm, a filmmaker, tattoo artist, director, and trans-feminine non-binary person (currently on estrogen therapy). Both agree that conversations about trans-non-binary issues are essential during Pride Month, especially in societies that claim to be "Queer friendly."
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Tawan:
I never intended to start hormones because I didn't know microdosing was an option. I only knew I wanted hormones but had no idea how to access them. In March 2025, I was diagnosed with intestinal inflammation. After MRIs, blood tests, and other checkups, the doctors found that my body barely produced sex hormones. This health issue relates to my intersex condition. At first, the doctor recommended estrogen because I was assigned female at birth. But I explained that I wasn’t comfortable with that — I felt more masculine inside. That's when they mentioned testosterone microdosing. So, I asked for that instead. I didn't want to be 100% male. The doctor and I discussed it thoroughly, finally settling on a 50mg dose instead of the usual 200mg. Now, I inject every two weeks, while most trans men inject every three months.
I regret not starting earlier. As a child, I considered puberty blockers, but the doctor refused because my puberty was progressing slowly. Additionally, at that time, the understanding of non-binary identities was limited in Thailand. Even now, with growing awareness, if you ask for blockers, it's still seen as needing to choose a side. Luckily, I had a medical condition that stopped natural hormone production, which made the process easier for me.
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Arm:
I didn't even know what "microdosing" was. I just went to the hormone clinic because I felt disconnected from my body. At first, I had to take testosterone blockers every other day. The doctor constantly asked, "Are you satisfied with your body?" "Are you satisfied with your chest?" "Want more estrogen?" At the time, I was satisfied. The euphoria hit when testosterone diminished. My sex drive almost disappeared, which I liked. But I still wanted a little, so we adjusted the dosage. Thankfully, my doctor was understanding. I only discovered microdosing later from the DAZED documentary and realized that's what I was doing—a "soft change," adjusting just as much as I wanted.
The doctor only adjusted the dosage to allow my body to gradually adapt to my desired changes. If the results were acceptable, that was the end of the discussion. He never mentioned terms like 'microdosing' or 'non-binary transition.
Tawan:
My journey wasn't at a gender health clinic, but my doctor was understanding and supportive. Due to my bone diseases and complex health issues, my doctor had to monitor other aspects, too. They understood that my body didn't produce hormones naturally, so they were cautious. They often asked, 'Why not just fully transition to male?' I had to explain that I'm non-binary. Thankfully, I was already seeing a psychologist who understood this, and they wrote a certification letter to ease the process of getting microdosed hormones without excessive questioning. Having healthcare professionals who understand and respect my identity has been crucial in my journey.
My latest checkup showed no detectable estrogen and low testosterone levels. I'll continue monitoring. I prefer a proper hormone clinic, especially since I want chest surgery, but I'll wait until my family worries less.
Arm:
How has your body changed since starting hormones?
Tawan:
At first, it felt like nothing was changing. But by the next month, I noticed my hips had slimmed down. The curves softened, and my frame became straighter. Seeing that difference in the mirror made me really happy. I have been going to the gym a lot, focusing on running and weightlifting, but I’ve never built up much muscle. After starting testosterone, I noticed that my arms had bulked up slightly. It wasn't a dramatic change, but I could definitely feel it. I also began to sweat more than before. My voice dropped in pitch as well, although I still unintentionally feminized it due to the teasing I experienced in childhood. If left on its own, my voice deepens a little.
I'm okay with the changes so far, but I'm not completely satisfied. For example, I don't want genital changes like many trans men. I don't feel like a man, but I don't want to reduce my dosage either, for fear my body will revert to something I dislike. It's still a compromise with my doctor. Overall, I'm happy.
Arm:
For me, I feel good about myself in a way that I can’t fully explain. Ever since my body shifted just enough that I’m no longer cisgender, I’ve felt more at ease with myself. This transition makes my hormones finally align with how I feel inside. It’s like my inner emotions and my body are finally on the same page, and I just felt right.
Tawan:
Exactly. I feel that, too.
Arm:
Even with mood swings, I feel more at peace. But having a chest makes daily life complicated. I never know which bathroom to use.
Tawan:
Bathroom issues are significant for non-binary individuals. Women's restrooms feel uncomfortable, especially when cleaners ask questions. However, using men's restrooms often feels wrong—like, "I don't feel right, but I need to pee."
Arm:
Before, with long hair and no hormones, I looked like a woman. Once, a cleaner scolded me for using the men's room. I had to lower my voice and say, "I'm a man." It was sad but funny.
Tawan:
Society needs to evolve beyond obsessing over how masculine or feminine someone appears. When I came out as non-binary at university and asked people to use "they/them" pronouns, some professors didn't understand. While some tried to be supportive, others mocked me and misgendered me even more than before. As a result, I decided to focus on explaining my identity to close friends and family, as it felt easier.
Arm:
Does the growing queer community seem to trigger certain groups of people?
Tawan:
I run a non-binary page. I've noticed a rise in incels, and some younger folks see incel culture as acceptable. Queer acceptance is growing, but so is extremism. It's scary.
Arm:
Some think diversity means "just gays or katoey" in Pride events. But the community is broader than that.
Tawan:
Even when non-binary, agender, and genderfluid flags appear at Pride for optics, few people like us are truly visible.
Arm:
The media and medicine don't provide sufficient information about microdosing. Clinics mostly show binary trans women and trans men in their materials.
Tawan:
I'd never heard of microdosing until I stumbled across a Reddit post: "Can non-binary people take hormones?"
Arm:
There's research into estrogen options like SERMs (Selective Estrogen Receptor Modulators) that help non-binary folks feminize without significant breast growth. However, there is very little research data from non-binary groups, and most of it is conceptual and has not undergone in-depth clinical trials.
I never wanted large breasts, but they developed anyway. It's not a complete dysphoria, but it makes me uncomfortable. At home, I am comfortable in my body. I don't view my breasts as a symbol of feminism; rather, it's society that assigns meaning to how I look. When I'm in public, people perceive me as female, and using the men's restroom feels odd to me.
I believe the medical field is making efforts to address this issue, and I really believe that all-gender bathrooms should be a thing. On the testosterone front, we should definitely talk about how to manage side effects like a smaller penis size or less cracking sounds. But honestly, if the trade-off is going bald, it seems like the only option left is to get a hair transplant, right?
Tawan:
I don’t know what the future holds since it hasn't yet happened to me. If I experience any side effects, I will need to find a way to cope with them. But what I really worry about are my liver and kidney levels. Every time I get tested, I’m scared—scared of dying. It feels like I have to take care of my health more than the average person. Some people buy estrogen and take it on their own without any proper healthcare system to support them. As they age, they may develop liver problems or high cholesterol, even if they take care of their bodies like anyone else. We should be aware of these risks, and there should be doctors and the government to help look after us.
Arm:
Absolutely. Transitioning on your own can be very unsafe. It involves more than just taking hormones; you need to regularly monitor your hormone levels every 2 to 3 months with a doctor who can conduct blood tests. For instance, the last time I was tested, my estrogen level spiked to 500, while it should only be around 200. As a result, the doctor had to help adjust the dosage downward. It’s crucial not only to take hormones but also to track and adjust them regularly to ensure they promote your long-term health.
Tawan:
Middle-aged men with low testosterone often receive treatment and government support. This helps them manage the effects of aging. Similarly, transgender people experience changes similar to menopause or andropause because their hormone levels do not match their bodies.
Women with Polycystic Ovary Syndrome (PCOS) also receive estrogen to fix hormone imbalances. Some women have higher testosterone levels but are classified as female at birth, so they get estrogen as treatment. This shows how access to care often depends on what is on a person’s birth certificate. In contrast, transgender individuals often need to consult psychiatrists and engage in numerous discussions before receiving care. If transgender people cannot afford to see a psychiatrist, they may have to repeatedly explain their situation.
Cisgender people find it easier to access hormone replacement therapy (HRT). When they have hormone issues, doctors quickly provide the necessary treatment without added obstacles.
Arm:
Many non-binary people want hormone therapy but avoid transitioning due to limited visibility in the media. Only Chulalongkorn Hospital's gender health clinic in Bangkok mentions non-binary transitions. Some gender health clinics call it "individualized hormone therapy tailored to each body," which is excellent—but we need broader awareness and acceptance of non-binary transitions.
When I first visited a clinic, I felt pressured to commit to being identified as a woman, as if I had to choose a side. This situation could be different if people understood that non-binary individuals who wish to transition or access hormones should also be able to go through that process.
Tawan:
Commitment is another factor that can make non-binary individuals uncomfortable. The key question is: What types of services should we have access to during the transition? Many people believe that transitioning is solely about feelings, but in reality, it encompasses both emotions and the physical body.
Non-Binary Transitions Still Await Medical Liberation
To answer where non-binary transitions stand within modern medicine, we spoke to Garfield Pitchapa Kasemsap, former Miss Tiffany 2022 contestant, pharmacist, and content creator known for hormone education under the hashtag #สาระฮอร์โมน (Hormone Facts).
Garfield says she hasn't had non-binary clients inquire about hormones, but she's advised fem gay seeking a softer appearance. She recommends low-dose testosterone blockers like Cyproterone Acetate to reduce body hair, muscle mass, and acne. However, prolonged use may lead to infertility.
At the same time, each person’s estrogen receptors respond differently, and their body reacts to medication in varying ways. Some people only need to take one tablet of estrogen, and their appearance becomes comparable to women. Others might take three tablets, yet their estrogen levels remain low. The amount of hormones needed depends on each person’s liver’s ability to absorb the medication.Therefore, for non-binary individuals who may only want specific physical changes, transitioning depends entirely on their personal needs and unique bodies. That’s why it’s so important to have open conversations and consultations with doctors — so they can recommend the proper medication for each individual.
“This is a very delicate issue. Even the free hormone treatment guidelines for trans people under the National Health Security Office (NHSO) still require multiple rounds of discussion about which medications to provide, what the procedures are, and at what dosage — because it affects everything. If a doctor starts prescribing hormones to a young person, they are also responsible for that treatment, as it becomes part of the NHSO system. If side effects occur, or if the young person later decides they want to reverse the process, the doctor must also protect themselves. That’s why informed consent is required before any medication is prescribed. This decision is critical.”
Moreover, using microdoses of medication means that any leftover drugs must inevitably be discarded. For example, a non-binary person transitioning from female to male might only need 50 milligrams from a vial that contains 250 milligrams. Each milligram wasted not only contributes to increased medical waste but also places a financial burden on non-binary individuals. Producing smaller amounts is possible but very difficult. It requires high precision and careful biological and physical assessments, raising production costs and making it potentially unprofitable for pharmaceutical companies.
Garfield explained that pharmaceutical companies must consider market demand when developing new medications. For microdose hormone treatments, it’s essential to see if other groups, besides non-binary individuals, also need lower doses. Women with breast cancer may need hormones but can’t handle high doses. Additionally, menopausal women with certain cancer conditions might want to use lower-dose hormones. These groups could help make production more cost-effective, as research on non-binary people remains scarce. At the same time, research on this topic is currently concentrated in regions such as North America.
“In the future, medicine should be more flexible, not only regarding this issue but for all health conditions. If demand grows and adjustments can be made, microdosing presents an appealing option. It allows individuals to receive the lowest possible dose of hormones that they desire, preventing drastic physical changes or, at the very least, enabling gradual, fine-tuned adjustments in line with what non-binary individuals want so they can feel comfortable and satisfied with both their body and their mind,” Garfield concluded.
Eight days into his second term, Donald Trump signed an executive order that restricts gender-affirming care for individuals under 19, Reuters reported . This policy bans puberty blockers, surgeries, and hormone treatments for minors, representing a direct attack on LGBTQ+ rights and echoing his earlier ban on transgender individuals serving in the military.
The order has also affected the United States’ global Diversity, Equity, and Inclusion (DEI) policies, as many organizations worldwide receive funding to support DEI initiatives. One such organization is a hormone clinic in central Bangkok, which recently increased its service fees for hormone testing as a result of Trump’s executive order.
In January 2025, Thailand's National Health Security Office (NHSO) approved a budget of 145.63 million baht for hormone therapy aimed at promoting safe mental and physical health services for over 200,000 transgender individuals.
While this budget addresses policy, legislation, healthcare development, and awareness-raising, the hormone therapy manual does not mention non-binary transgender individuals. Additionally, existing hormone replacement therapy (HRT) guidelines rarely address non-binary transitions. Information from The101.world indicates that this budget provides approximately 725 baht per person, which barely covers the costs for a month. Realistically, hormone replacement therapy requires monthly intake, along with medical monitoring every three months to once a year, with checkup costs ranging from 500 to 1,000 baht each time.
Currently, free hormones are limited to Thailand's Universal Health Coverage scheme. Those under social security or civil servant healthcare lack this access. Broader public consultations are ongoing.
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