Non-binary: medical experimentation and the avoidance of sex

In our first blog on non-binary identities, we sought to present the conceptual invalidity of this construct alongside examples of the psychosocial function adopting a non-binary identity may serve e.g. to gain social capital or to escape a sexed body. We summarised the risks of social and institutional affirmation for the individual and for society. What makes even less sense and brings arguably more risk and potential for harm, is the pursuit of medical treatments for people who identify as ‘non-binary’. In 2022 WPATH published a chapter on non-binary identity stating that ‘some non-binary people seek gender affirming care to alleviate gender dysphoria or incongruence and increase body satisfaction through medically necessary interventions’. In this blog we argue that offering medical interventions for an evolving sense of gender identity is contraindicated, non-sensical and harmful.

The pressure of the ‘wrong-body’ narrative

People who identify as ‘non-binary’ may seek medical interventions to varying degrees. They may feel a pressure of ‘trans-normativity’ such that they must conform to the ‘wrong body’ narrative pushed by trans rights activists, lobby groups and gender identity clinics. Many are led to believe they must medically transition in some way to be valid (‘if I just leave my body as it is, it is not trans enough’). But medical interventions are likely to lead to a more masculinised or feminised appearance, potentially leading to reinforcement and exacerbation of gender dysphoria.

Experimental medical treatments to non-binary identities

The endorsement by WPATH appears to have given NHS England and UK gender clinics the green light to offer medical and surgical interventions. Indeed the NHS England’s service specification for gender dysphoria services states that ‘gender diverse people with such identities (and who are known by a variety of other names, including non-binary, transfeminine, transmasculine, genderqueer, non-gender and others) who meet the criteria for access to the NHS pathway of care must have access to treatment and the interventions described in this document that is equitable to the access available to people with binary identities’. However the recently published US HHS gender dysphoria report states that ‘this creates a new set of ethical challenges, as patients seek interventions that have never before been contemplated, including keeping patients in puberty suppressed states for extended periods of time to allow them to maintain a sex-ambiguous appearance. The risks of such interventions may be considerable.’

Medically affirming treatments for people who identify as ‘non-binary’ include all the interventions available to people who identify as the opposite sex e.g. cross-sex hormones. Surgery is also an option: the US HSS report states that ‘in a study of youth who received mastectomies, 11% identified as non-binary or other’.

The Tavistock shared care agreement for testosterone proposes that the use of cross-sex hormones for people identifying as non-binary should be ‘individualised’. In other words this is experimental. They reference WPATH Standards of Care 8 guidelines and suggest that those who ‘opt for hormone therapy are routinely offered appointments in the endocrine department for an individualised discussion of their goals of hormone therapy, taking account of their desired degree of feminisation/ masculinisation/ androgyny’. Despite admitting in a roundabout way that it is experimental they tell the mistruth that it is safe: ‘the totality of available evidence demonstrates that for carefully selected clients, hormone treatment is a safe and effective means of alleviating….gender dysphoria’. Firstly, there is no evidence as to who is or how you select for a member of this group of ‘carefully selected clients’. Secondly there is mounting evidence that cross sex hormones lead to significant harms which include stroke, ischaemic heart disease, cancers and early mortality.

Attempting to give patients their desired effects is a clear example of ‘my body my choice’, where a patient’s autonomy overrides non-maleficence, beneficence and justice. Patients are given micro doses of either testosterone or oestrogen experimentally to produce their desired effects e.g. with testosterone it may be coarsening of the skin, hirsutism and a deeper voice. Treatment is stopped when their goal is achieved. However other irreversible harms are silently at play. Atrophic changes that may take years to manifest cause vaginal dryness, painful intercourse and urinary incontinence. Intense chronic pelvic pain that in some patients has resulted in hysterectomy for pain management. A life lived with the risk of stroke, ischaemic heart disease and early mortality. Note some shared care agreements state the mistruth that long term adverse effects are reversible. The consent agreement form for the West of England Specialist gender clinic states ‘I know that the following changes are usually not permanent; they are likely to go away if I stop taking testosterone’ going on to mention ‘vaginal dryness’. Vaginal dryness is a symptom of atrophy that can be a permanent change to the tissue.

GenderGP tells the mistruth that micro-dosing in ‘non-binary’ identities will ‘neutralise’ hormones. ‘For this group of people, the aim is to get their hormone levels to what might be considered a mid-zone – not too much estrogen and not too much testosterone. Our bodies need hormones, so switching off hormones altogether is not an option. However, balancing the male hormone, testosterone, and the female hormone, estrogen, can be one way of achieving a good “middle ground”’. Gender GP does however admit it is experimental: ‘Currently, research on the impact of micro-dosing hormones like testosterone and estrogen is not available. Much of what we have to go on are the firsthand accounts shared by those brave souls who took steps along this path and found the peace they so desperately craved.’ Treatment is therefore based on the lowest possible evidence: lived experience.

On March 9^th, 2026, following a temporary ban on CSHs under 18 years, NHSE admitted ‘no evidence was identified that allowed any conclusion to be drawn about the clinical effectiveness or safety’ of oestrogen or testosterone in patients identifying as ‘non binary’, resulting in a temporary ban under 18 years. This experimentation must also end in adults.

The pressure on GPs without evidence-based protocols

This unsafe experimental practice does not remain within gender clinics. Patients are discharged into primary care leaving GPs ‘holding the proverbial baby’. GPs are expected to monitor patients for evidence of long term harms despite there being no specific protocol for ‘non-binary’ patients. The GMC guidance and BMA guidance support this experimentation, both stating that GPs must co-operate with gender clinics and specialists ‘to provide effective and timely treatment for trans and non-binary people’. However GPs are not obliged to refer to gender clinics. Given waiting times to access clinics, some GPs may feel pressured by patients and lobby groups, such as TransActual, to issue bridging prescriptions as’ harm reduction’, further increasing the incidence of unsafe experimental practice. Prescribing when medication is used experimentally leaves GPs wide open to litigation. GPs should never have been involved in this high risk prescribing and must be reassured that they are not obliged to prescribe cross sex treatments to either ‘trans’ identified people or those with ‘non-binary’ identities.

The contraindication of medical interventions for a changeable sense of self.

As discussed in our previous blogs, the concept of gender identity is often presented as ‘fluid’. Some of this fluidity is normal, when it is seen in the context of developmentally appropriate questioning of many aspects of identity during adolescence and young adulthood. This is supported by the fact that most young people who question their gender, ‘grow out’ of this to settle in their sexed bodies. Some of this ‘gender fluidity’ refers to lack of stability in this aspect of self for some people. Both of these positions suggest that medicalisation and the offer of treatments with irreversible consequences are profoundly contraindicated as opposed to being ‘medically necessary’.

The medicalisation of non-binary identities is testimony to the breadth and depth of influence of trans rights activism and gender ideology across the NHS and other regulatory bodies in the UK. Experimental treatments using off-licence medication within the NHS is a huge red flag, and further evidence of the very poor clinical governance of gender clinics.

It must be ended.

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