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1. Introduction: The Limits of the Binary

Western society has long operated under the assumption that there are only two genders: male and female. This binary system has been encoded into laws, institutions, medical frameworks, and everyday language. It dictates how people are expected to dress, behave, love, and move through the world. It leaves little room for complexity, for contradiction, or for the lived realities of those who do not see themselves within either of these narrow categories.

But the gender binary is not a universal truth. It is a cultural construct—one that erases the experiences of millions. Nonbinary and genderfluid people exist outside or beyond this binary, and their identities expand our collective understanding of gender, embodiment, and humanity itself.

This article seeks to explore who nonbinary and genderfluid people are, the challenges they face, the joy and strength they bring to the world, and how allies can show up in meaningful ways.

2. What Does Nonbinary Mean? (And What It Doesn’t)

“Nonbinary” is an umbrella term for gender identities that fall outside the categories of exclusively male or female. It can include identities like agender (having no gender), bigender (having two genders), genderqueer (a rejection of normative gender categories), and many others.

Nonbinary people may identify as partially male and female, neither, a mix, or something entirely different. The key point is that their gender identity does not fit neatly into the binary.

Importantly, nonbinary is not synonymous with “confused,” “trendy,” or “attention-seeking.” These harmful stereotypes stem from societal discomfort with gender variance, not from the realities of those living it.

There is no single way to “look” nonbinary. Some present in androgynous ways. Others embrace more traditionally masculine or feminine aesthetics. Clothing is not identity. Gender is not performance.

3. Genderfluidity: Motion, Change, and Embodiment

While nonbinary is often a static identity, genderfluidity is dynamic. Genderfluid people experience their gender as shifting over time. These shifts may occur daily, monthly, or irregularly. Some may move between two gendered experiences; others may move through many.

Genderfluid individuals often face an extra layer of misunderstanding. Society is generally more comfortable with static categories. The idea of changing one’s identity—even if it’s authentic and deeply felt—is seen as suspicious, unstable, or performative.

But for those who are genderfluid, this motion is not a problem to be solved. It is their truth. Their bodies and souls speak many languages, and they are fluent in all of them.

4. The Cultural History of Gender Diversity

Nonbinary and genderfluid people are not a modern invention. Cultures around the world have long recognized more than two genders.

• Two-Spirit people in many Indigenous North American cultures hold sacred roles and embody a spectrum of gendered and spiritual identities.
• Hijras in South Asia have existed for thousands of years and are recognized in Indian law as a third gender.
• Fa’afafine in Samoa and Kathoey in Thailand are other examples of culturally specific gender diversity.

Colonialism and Christian missionary efforts worked aggressively to erase these identities, replacing local understandings of gender with Western binaries. The myth that trans and nonbinary people are a recent phenomenon is rooted in that erasure.

5. Navigating a Binary World

For nonbinary and genderfluid people, daily life often involves navigating a world that is not built for them.

• Healthcare: Medical systems still heavily rely on binary gender markers. Many nonbinary people struggle to access competent, respectful care, especially when it comes to hormone therapy, reproductive health, and mental health services.
• Legal Systems: Most forms, IDs, and bureaucratic systems require individuals to declare “male” or “female.” Though some states and countries offer a third “X” gender marker, these options are not universally accepted.
• Workplaces: Professional dress codes, gendered language, and HR systems rarely reflect or accommodate nonbinary experiences.
• Public Spaces: Bathrooms remain a flashpoint. Being forced to choose between two binary options can be dysphoric and unsafe.

In addition to these institutional barriers, nonbinary and genderfluid people endure constant social invalidation: comments like “You don’t look nonbinary,” “That’s not a real thing,” or “Make up your mind.”

The cumulative impact of these microaggressions and structural obstacles takes a toll. Higher rates of anxiety, depression, and suicidality among nonbinary individuals reflect a lack of societal support, not any inherent flaw.

6. Language, Pronouns, and the Struggle for Respect

Pronouns are a basic form of respect. Using someone’s correct pronouns is not about politics or personal belief—it is about acknowledging their humanity.

Nonbinary people may use they/them pronouns, she/they, he/they, neopronouns like xe/xem, or no pronouns at all. There is no universal formula. When in doubt, ask. Then respect the answer.

Misgendering is not just a slip-up. It can be a painful reminder of erasure. While mistakes happen, the key is to apologize briefly, correct yourself, and move on. Making a scene about how hard it is centers the discomfort of the speaker, not the person misgendered.

Language evolves. The existence of neopronouns or nontraditional grammar is not a burden. It is a reflection of human complexity. If English can accommodate “they” for a group of people, it can accommodate “they” for one person.

7. Visibility, Safety, and the Decision to Come Out

Visibility is often treated as the goal. But for many nonbinary and genderfluid people, visibility is dangerous.

Coming out can mean losing housing, jobs, or family. It can mean harassment or violence. The pressure to be publicly “out” ignores these realities.

Some people cannot come out, or choose not to. That decision is valid. Safety and survival are priorities. There is no moral obligation to be a representative, especially when the cost is so high.

For those who are out, visibility can be a radical act. It can also be exhausting. Representation in media, politics, and culture matters—but it must be supported by policy, protection, and real community care.

8. Joy, Creativity, and Resistance

Despite everything, nonbinary and genderfluid people create. They celebrate. They thrive.

They build community online and offline. They make music, art, and fashion that defy categories. They rewrite language and reimagine family. They resist quietly and loudly. They live in ways that unsettle oppressive systems—not for the sake of rebellion, but because that is where their truth leads them.

Their existence is not a debate. It is a form of resistance. It is also a source of immense beauty.

9. Allyship: What Real Support Looks Like

Allyship is not a performance. It is a practice.

• Listen more than you speak. Educate yourself. Don’t expect nonbinary people to do the emotional labor for you.
• Normalize pronoun sharing in meetings, email signatures, and conversations.
• Challenge gendered assumptions. Don’t correct people for not being “masculine enough” or “feminine enough.”
• Push for policy change in your workplace, school, or local government.
• Interrupt transphobia when you hear it—even when no trans people are present.

Being an ally is not about being perfect. It’s about being accountable, consistent, and willing to grow.

10. Resources and Further Reading

Mental Health & Support

• Trans Lifeline – A peer-run support and crisis hotline for trans people.
• The Trevor Project – Crisis intervention and suicide prevention for LGBTQ youth.

Education & Community

• Nonbinary Wiki – A community-driven resource for gender-diverse identities.
• Gender Spectrum – Education and tools for creating gender-sensitive environments.
• National Center for Transgender Equality (NCTE) – Policy advocacy, legal info, and resources for trans and nonbinary individuals.

Legal & Practical Resources

• Name Change Resources by State – Trans Lifeline – A guide to name change processes and legal assistance.
• Point of Pride – Offers free binders, gaffs, HRT access, and gender-affirming surgery support programs.

11. Final Words

Nonbinary and genderfluid people are not anomalies. They are not trends. They are not threats to society. They are part of the vibrant spectrum of humanity.

Their existence does not diminish anyone else’s. It expands what’s possible. In honoring their identities, society moves closer to justice, to empathy, and to truth.

There is no single way to be a person. And there never was.

 

 

We strive to provide individuals with disabilities equal access to our website. If you would like information about this content we will be happy to work with you. Please email us at: McKinsey_Website_Accessibility@mckinsey.com

 

 

To read the article, see “Being transgender at work,” November 10, 2021.

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Several states in the United States are introducing bills to restrict access to gender-affirming care for young adults, and possibly even adults. Republican-led efforts include seeking to ban or limit gender-affirming care for people into adulthood or making it harder for adults to access such care.

“It’s interesting that initially we heard that this was a thing to protect youth, but now we are seeing that it’s really about all transgender people,” Rep. Gloria Johnson

House Republicans in Oklahoma passed a bill that prohibits any institution receiving public funds from providing gender-affirming care to minors or adults, and also prohibits insurance coverage for such care. Additionally, a separate bill was introduced which would make it a felony for doctors to perform hormone treatments or surgeries related to gender transition on individuals below the age of 26.

“Let’s put children first and look out for them first and let them make those decisions as adults. I support your right to do so, when you’re an adult, not when you’re a child and you do not have the mental capacity to do so.” Republican state Sen. Jack Johnson

In Virginia, a proposed bill would ban gender-affirming surgeries for people under the age of 21, while in South Carolina, a bill identical to the original Virginia bill would ban gender-affirming procedures for people under 21 and make it harder for people to access that care when they’re over 21. Transgender activists argue that lawmakers are slowly trying to legislate trans people out of existence.

“Last year, the rhetoric was to protect kids, but now they are going after adults,” said Allison Chapman, a legislative researcher and transgender rights advocate based in Virginia.

The bills that aim to restrict gender-affirming care access for young adults have caused tensions in various states, leading to public hearings and protests. For instance, when Lindsey Spero, who is nonbinary, approached the podium at a public hearing of the Florida medical board on a gender-affirming youth trans care ban, they used their allotted time to inject testosterone in front of board members and the audience, as they believe action is necessary because historically speaking, queer freedom and liberation have never been won through words alone.

In Virginia, a proposed bill would ban gender-affirming surgeries for people under the age of 21. The legislation was amended to remove bans on hormone therapies.

The bills may also affect adults. In Florida, adults are banned from using Medicaid to receive gender-affirming care. In Virginia, the proposed bill would make it harder for someone over the age of 21 “to receive gender transition procedures” by requiring them to first obtain a referral from their primary care physician and a licensed psychiatrist. State Sen. Mark J. Peake, who is behind the Virginia bill, wants to restrict gender-affirming surgeries until patients are 21 because “juvenile brains really are not developed as a teen.” In South Carolina, Zoë Glass, an LGBTQ advocate, argued that “we have trans people who are under 21, but they’re adults. Why do they not have their own bodily autonomy?”

Transgender activists argue that gender-affirming care, which includes hormone therapy and gender-affirming surgeries, reduces the risk of mental health problems and suicidal thoughts. Contrary to claims by some lawmakers, research shows that rates of regret for gender-affirming procedures are extremely low, estimated to be around 1%. Studies show that rates of regret for knee and hip replacement surgeries are much higher than gender affirmation surgery.

Research shows that rates of regret for gender-affirming procedures are extremely low — estimates are around 1%. Rates of regret for knee and hip replacement surgeries are much higher than gender affirmation surgery, according to studies.

According to the American Civil Liberties Union, there are roughly 275 anti-LGBTQ bills that are currently in state legislatures or have been passed in the United States this year. Many of these include banning transgender care for minors and criminalizing people who provide such care, banning transgender girls from playing on girls’ sports teams, discussing or teaching about sexual orientation and gender identity in schools, and more.

Photo byAlexander GreyonUnsplash

“The existence of trans people under 21 [is] being criminalized in South Carolina and it’s extremely frightening – extraordinarily frightening.”

Advocates argue that lawmakers are slowly trying to legislate trans people out of existence, and are preparing for the worst by ensuring that all of their medical documents and paperwork are in order.

“As somebody who felt acutely suicidal … who was placed through multiple rounds of conversion therapy, I can tell you that it is incredibly hard to stay alive as a young trans person. Bans will impact the lives of trans youth … will cause mental distress and will cause, unfortunately, a lot of negative effects in the lives of these youth because they’re not able to access life-affirming care.”

Policies or laws that limit transgender health care have been passed in states such as Tennessee, Arizona, Utah, Arkansas, Alabama, Mississippi, South Dakota, and Florida. Advocates of these laws argue that gender transitioning can be detrimental to the well-being of adolescents and young adults, and suggest that such decisions regarding health should be postponed until they are older.

Studies have shown that gender-affirming care can be life-saving for transgender and nonbinary children and adolescents, promoting positive mental and physical health and well-being.

Republican lawmakers in four states have currently approved laws to prohibit gender-affirming care for minors

Utah and Mississippi this year, and Arkansas and Alabama in the previous year. The definition of minors under these laws is under 18 in Utah, Mississippi, and Arkansas, while in Alabama, a minor is under 19. The laws in Arkansas and Alabama are currently being challenged in court. In Florida, the state Board of Medicine has endorsed a ban on gender-affirming care for minors, and the state no longer provides Medicaid coverage for such care for individuals of any age.

Minnesota Gov. Tim Walz signed an executive order protecting and supporting access to gender-affirming health care for LGBTQ people in the state on Wednesday.

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— The bill — H.R. 734 (118), the Protection of Women and Girls in Sports Act of 2023 — was introduced by Rep. Greg Steube (R-Fla.) several times, but was taken up by the House Education and Workforce Committee for the first time last week in a 16-hour markup. It would amend Title IX, the federal education law that bars sex-based discrimination, to define sex as based solely on a person’s reproductive biology and genetics at birth.

— The measure was recommended by the committee in a vote on party lines and is now primed for a vote on the House floor. While H.R. 5 (118), the Parents Bill of Rights Act, cleared the committee the same day and is slated for a vote in two weeks, House Majority Leader Steve Scalise’s office said they haven’t made any announcements on when they will take up the sports bill for a vote. House Republicans are expected to pass the bill with their slim majority, but it’s not likely that the Democrat-controlled Senate will allow the bill to move.

— The legislation will be a way for the GOP to force Democrats to go on record with their support for transgender students to play sports, a key part of the GOP’s 2022 midterm policy agenda. It is also a direct rebuke of the Biden administration’s proposed Title IX rule, which seeks to codify protections based on sexual orientation and gender identity. The Education Department is expected to unveil its final rule in May, though it said it would make a separate rule for sports.

— Meanwhile, West Virginia has decided to appeal a stay on its transgender sports law to the Supreme Court, marking the first opportunity for the high court to weigh in on the issue. “West Virginians and the American people are animated,” West Virginia Attorney General Patrick Morrisey said at a Thursday press conference. “They know this is a matter of basic, common sense and basic fairness. We believe we’re absolutely correct on the merits. And I know that there’s always a debate as to when you go up to the high court, but … we think it’s justified to make sure that the law that was put in place by the legislature, reflecting the will of the voters, gets back in place very, very quickly.”

IT’S MONDAY, MARCH. 13. WELCOME TO WEEKLY EDUCATION. Let’s grab coffee (even virtually!). Reach me at [email protected]. Send tips to my colleagues Mackenzie Wilkes at [email protected], Juan Perez Jr. at [email protected] and Michael Stratford at [email protected]. And follow us on Twitter: @Morning_Edu and @POLITICOPro.

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BONAMICI’S BILL OF RIGHTS — Rep. Suzanne Bonamici (D-Ore.) introduced her Bill of Rights for Students and Parents, a Democratic response to the GOP’s Parents Bill of Rights, which is headed to the House floor for a vote in two weeks. “Parental involvement is critical to developing and sustaining high-quality public schools, and we must do all we can to involve parents and break down barriers that prevent or discourage participation,” Bonamici said in a statement.

— The bill, which is supported by dozens of education groups including the National PTA, outlines that a student “should be able to receive a well-rounded education,” and parents and families “should be able to collaborate effectively” with their children’s teachers. Additionally, it dictates that public schools should be “responsive and inclusive,” students should be able to learn in environments “free from all forms of discrimination,” and all students should “receive an education that is historically accurate, reflects the diversity of our nation, and prepares students to think critically and participate actively in a representative democracy.”

— House Republicans unveiled their “Parents Bill of Rights” earlier this month. It would require mandates for school districts to offer teacher-parent meetings, publicly disclose budget materials and allow parents to address the school board — things that are already present in many schools across the country.

— “The previously introduced ‘Parent Bill of Rights’, HB5, completely misses the mark and has discriminatory undertones that distract us from the seriousness of this moment,” the National Parents Union said in a statement. “Pitting parents against parents, parents against teachers, and adults against students does nothing to move us forward.”

BIDEN BUDGET FALLS FLAT WITH CHARTERS — President Joe Biden has proposed a $440 million budget for federal charter school grants, irking advocates after consecutive years of flat funding, Juan reports. The flat funding is a problem for charter boosters concerned about rising inflation that cuts the buying power of nearly half a billion dollars and higher interest rates that swell borrowing costs to pay for facilities.

— The National Alliance for Public Charter Schools is asking Congress to approve $500 million for the programs. “We are disappointed that President Biden is proposing flat funding [for] the vital Charter Schools Program, which has been level funded by Congress since FY2019,” said Nina Rees, the alliance’s president and CEO, in a statement on Friday.

— But charter supporters are also praising a renewed department proposal to bring “greater flexibility” to how the program’s funds are spent. The department’s budget pitch notes a request for flexibility to “adjust” federal charter spending “in response to demand across the program components.” Similar language has also appeared in prior year charter program budget proposals.

— “As in past years, this year’s budget will again include a request of Congress to provide greater flexibility to the Department in its allocation of funds under the multiple authorities provided in ESSA’s Charter School Program,” a department spokesperson told POLITICO in a statement. “The Department is interested in utilizing this flexibility to ensure it can efficiently respond to demand for federal funds from the charter school community.”

PROMISE IN DUAL ENROLLMENT — More high schoolers are taking dual enrollment courses, which allow them to take their classes and simultaneously apply the credits toward a diploma and an associate degree. And while Biden’s college affordability agenda has stalled on Capitol Hill, the two-for-one special could cut the cost of college for many teens as the programs grow in popularity.

— It’s also helping community colleges shore up their enrollment. The two-year institutions saw a 12 percent spike this academic year in these programs. The resulting uptick in dual enrollment students has spurred a small increase in overall community college attendees from the last academic year — a much needed boost after those institutions faced the worst enrollment plunges due to the pandemic.

— Governors in Arizona and Florida, and elsewhere, have been pushing to expand dual enrollment options as a way to streamline the path from high school to the workforce or quicken the path to a bachelor’s degree. Nearly all states have dual enrollment policies.

— Dual enrollment also provides access to courses in welding and other hands-on technical education to help high schoolers build skills that they can apply to a job or a certificate, a path Republicans in Congress have long touted as an alternative to a traditional college.

— Last week, Biden urged Congress to fund what his administration called the Career-Connected High Schools initiative, which would dole out $200 million for programs that align high school and college by expanding access to dual enrollment, work-based learning and college and career advising for students in high school.

CAL’S NOISE COMPLAINT — The People’s Park, a park near UC Berkeley that once hosted iconic protests against the Vietnam War, is now at the center of another public furor: loud parties, POLITICO’s Blake Jones and Matthew Brown report. The university, a state appellate court found, failed to account for “excessive noise” when it considered the environmental effects of building housing for 1,100 students in a park abutting a residential neighborhood.

— The neighborhood group that filed the lawsuit pointed to hundreds of complaints to the city about student parties and even hired a “noise expert” to describe the role of college partying in undergraduate life.

— UC Berkeley might still get the project at People’s Park built, but the legal challenge has set construction back months, if not years. The court ruling — based on a 1970 state environmental law meant to serve as a check on rampant development — has injected new uncertainty into housing plans at California’s public university campuses, many of which are in dire need of housing amid a yearslong expansion.

— Justice Teri L. Jackson worried aloud during oral arguments about a “great deal of social implications” that could stem from a broad reading of environmental rules on noise. But, she said, she was constrained by the law. “Noise is noise,” she said.

— School district sued over handling of student’s pledge of allegiance protest: The New York Times

— Arizona launches hotline for public to report ‘inappropriate’ school lessons: CNN

— WA college-going rate dropped sharply during pandemic: The Seattle Times

— Republicans race to outdo each other on education: The Hill

— Texas families would get $8,000 in tax dollars to send students to private school in sweeping ‘parental rights’ bill backed by Lt. Gov.: The Texas Tribune

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*This information is no substitute for, or pretends to be, medical advice. I am a web developer and writer, not a medical professional. Any information here is presented based on research and experience. However, we stress that you speak to your medical provider about any questions you have and before you begin treatment.

What are Hormones?

Hated science class? Well tough falsies because one- science rocks, and two- you wouldn’t work on a carburetor if you didn’t know what it did or how it worked. So tough it out and learn about your body.

Here’s the quick answer, hormones are one of the three main components of what makes up the physical facets of gender. Chromosomes and gonads are the other two. The rest of what you think is male or female is really a secondary gender marker and can honestly occur in men or women. Some women have square jaws, some men develop breasts. What can I say? Bodies are weird that way.

For men, the hormones consist of Testosterone and its derivative 5alpha-dihydrotestosterone (DHT). Strong stuff, which we will get to later. For women you are looking at Estrogen and progesterone, which are no slouch themselves. However, in HRT the effect and scope of change is very different. But we will get into that later.

So What Do Hormones Do?

Often, we see gender attributed solely to chromosomes, and don’t hear as much about hormones. However, it is these hormones that set many of the secondary gender markers like body hair, voice pitch, etc. And so for those wishing to attain certain visual characteristics, hormones are a must.

Hold up keyboard warriors, that isn’t to say that being gender non-conforming or being trans means you HAVE to undergo HRT (Hormone Replacement Therapy), or that it is a requirement of transition. For health, financial, religious, or personal reasons- there are many people who opt to be non-op or non-hrt or both. Some people identify as transgender and don’t transition. It’s all valid, of course. But somethings just won’t happen without HRT.

TransgenderCare.com offers this explanation:

Testosterone and its potent derivative 5alpha-dihydrotestosterone (DHT) induce penile growth and secondary sex characteristics as sexual hair, deepening of the voice, a muscular build and the greater average height in males in comparison to the females. In girls, estrogens in conjunction with Progestogens induce breast formation and a fat distribution predominantly around the hips; subcutaneous fat padding produces a softness of the body configuration and of the skin. The skin in women is further generally less oily than in men; the latter on the basis of activation of the sebaceous glands by androgen.

So puberty comes along, and blammo- secondary gender markers all up in the joint. Up until puberty, we generally have to go out of our way to express our gender identity. As we saw in “Stranger Things” a preteen girl with a shaved head and neutral clothing had no problem passing as male (unintentionally). And it was even harder in the past when everyone pretty much put all kids in the same clothes- mostly dresses. Aside from a primary gender marker like genitalia to discern out- there is little difference outwardly.

So What Does that Mean to Me?

Me, me, me. That’s all you talk about. Well, to answer your question, it means that we are attempting to induce secondary gender markers and traits after puberty- to varying degrees of time. Or, we are trying to hold off puberty and avoid having these hormones start doing their remodeling work in the first place so that HRT can be begun. In many cases we are looking to also minimize unwanted gender markers as well as making changes to the body.

In the case of trans women, we are looking to not only block testosterone and DHT but also introduce estrogen or progesterone into the body. We will talk a bit more about how exactly this is done a bit later. Seriously, buckle up, it’s a long article.

So if that is your goal in mind, then HRT might be your ticket. Of course, there are some things to consider when starting HRT.

Some Things to Consider When Starting HRT

I know, great literary transition. Call me Hemingway.

So, the first thing you have to know is this- there is a process to medical transition. If you want to use medical procedures to alter your body, you have to go through the proper channels. If you were curious, they also won’t do spinal surgery without going through all the steps either. They generally like to check some boxes first.

The biggest thing is a letter from a therapist. Pretty much any Endocrinologist (think “hormone doctor”) is going to look at you vacantly and play out the movie “Diner” in their head while you talk if you try to go in and talk to them about HRT without a letter from your therapist recommending you for hormones. That’s because they tend to like their job. And performing a procedure on someone that hasn’t been properly checked out amounts to malpractice. So you will have to obtain a letter before an endocrinologist will see you.

Ah, the golden letter. What many transgender people seek, it is seen as a magical ticket that opens up the doors to the rest of your life. That’s right, one letter can change your life. So, for the life of me, I don’t understand why so many people think they can just call a therapist and ask them to write a letter or go to one session and get one. This is a big step- one that can have some irreversible effects. And, frankly, I’d be leery of any professional therapist handing out letters like a vending machine. We call those “letter factories”.

Generally, the rule for both therapists and Endocrinologists is one year of therapy to begin HRT. That’s when you can usually expect to get a letter. It might not be consecutive, or with the same therapist. But you at least need to show you’ve put in some consistent effort and made a commitment to this.

The letter itself is usually pretty straightforward. It essentially says that they’ve seen you for however long and that they’ve found you to be of sound mind and rational enough to make this decision. So that everyone can see it isn’t symptomatic of another condition. Usually, it is also covered that you are not being coerced in any way into this decision and you are doing it of your free will. Also, that it is not sexually motivated.

Once you have this letter, you will get referred to an Endocrinologist. This is either done through your regular doctor, a clinic like planned parenthood or directly from your therapist (ONLY if they are a psychiatrist).

The endocrinologist will run several tests to make sure that you are healthy and suitable for HRT. This will include a medical history and a good amount of blood work. After you get the all clear, your endocrinologist will sit down and work out a plan with you for your treatment including schedule, exact medication, and dosages.

For the record- we won’t be talking about dosages here. It’s considered a no-no. You need to stick to the dosage you are given. Even if you feel it isn’t happening fast enough and your friend is on a higher dosage than you. Just know that you are on the right dosage for you, and if you aren’t then your doctor will adjust that. Taking too much, or an incorrect dosage can lead to blood clots, strokes, seizures, taking not good blood thinners and death. Did you come all this way to wind up like that? Read more at http://sideeffectsofxarelto.org/current-xarelto-lawsuits/ and think.

Do I Have to be on HRT Forever?

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Unfortunately, the answer is yes. You will be on HRT for the rest of your life. Some of the effects of hormone replacement therapy are reversible and you will wind up right back where you started if you quit. You will need to discuss this further with your endocrinologist.

What Will I Be Taking?

This is entirely dependent on what your endocrinologist prescribes for you. But here are the types of hormones you can expect to receive:

Male to Female

• Estrogens
  The most commonly prescribed estrogens in HRT for transgender women are micronized estradiol, certain estradiol esters such as estradiol valerate and estradiol cypionate (which are prodrugs of estradiol), and conjugated equine estrogens (Premarin). Estrogens may be administered orally, nasally, sublingually, by intramuscular injection, from an implant, or transdermally (via gel, spray, or patch).
• Progestogens
  Progestogens include progesterone and progestins (synthetic progestogens). Progestogens commonly prescribed for transgender women include progesterone, cyproterone acetate, and medroxyprogesterone acetate. They may be administered orally, sublingually, rectally (by suppository), transdermally (in gel form), or by intramuscular injection.
• Anti-Androgens
  Anti-androgen medications work by blocking the effects of testosterone. For example, they will help slow male-pattern baldness, reduce growth of facial hair, and stop spontaneous/morning erections. They are not needed if one has undergone a bilateral orchidectomy (removal of both testicles).Anti-androgen drugs are often prescribed in addition to oestrogen, as the two have effects that complement each other. Taking anti-androgens reduces the amount of oestrogen you need to get the same effects, which minimizes the health risks associated with high doses of oestrogen. Anti-androgen drugs can be prescribed alone for those who want to reduce ‘masculine’ characteristics for a more androgynous appearance, as it’s less ‘feminizing’ than oestrogen.
  • Steroidal
    The most commonly used antiandrogens for trans women are steroidal: spironolactone and cyproterone acetate. Spironolactone, which is relatively safe and inexpensive, is the most frequently used antiandrogen in the United States. Cyproterone acetate, which is unavailable in the United States, is more commonly used in the rest of the world.
  • 5α-Reductase inhibitors
    Certain antiandrogens do not reduce testosterone or prevent its action upon tissues, but instead prevent its metabolite, dihydrotestosterone (DHT), from forming. These medications can be used when the patient has male-pattern hair loss and/or an enlarged prostate (benign prostatic hyperplasia), both of which DHT exacerbates. Two medications are currently available to prevent the creation of DHT: finasteride and dutasteride. DHT levels can be lowered up to 60–75% with the former, and up to 93–94% with the latter. These medications have also been found to be effective in the treatment of hirsutism in women.
  • Non-Steroidal
    Non-steroidal antiandrogens used in HRT for trans women include flutamide, nilutamide, and bicalutamide, all three of which are primarily used in the treatment of prostate cancer.[45][46] Unlike steroidal antiandrogens such as spironolactone and cyproterone acetate, these drugs are pure androgen receptor antagonists. They do not lower androgen levels; rather, they act solely by preventing the binding of androgens to the androgen receptor.
  • GnRH analogues
    In both sexes, the hypothalamus produces gonadotropin-releasing hormone (GnRH) to stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn cause the gonads to produce sex steroids such as androgens and estrogens. In adolescents of either sex with relevant indicators, GnRH analogues such as goserelin acetate can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies.
  • GnRH agonists
    GnRH agonists work by initially overstimulating the pituitary gland, then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. Conversely, GnRH antagonists act by blocking the action of GnRH in the pituitary gland.

Female to Male

• Androgens
  A natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics. This is usually just generically referred to as “T” or testosterone.
• GnRH agonists
  In all people, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle-stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH agonists, such as nafarelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH agonists work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced.
• Progestin injections
  Depo-Provera (depot medroxyprogesterone acetate, or DMPA) may be injected every three months just as it is used for contraception. Generally, after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy. These work to help eliminate menstruation and acts as birth control.
• Supplements
  Andro ‘Pro-hormones’: Androstenedione, 4-androstenediol, 5-androstenediol, 19-androstenediol, and 19-norandrostenediol are sold as supplements that are purported to increase serum testosterone, increase muscle mass, decrease fat, elevate mood, and increase sexual performance (i.e. many of the effects transgender men seek with androgen therapy). However, there is no good medical evidence that the pro-hormones do any of these things. However, there is evidence that ingestion of these substances can cause elevated estrogen levels, and decreases in HDL (good) cholesterol.

What Will Change?

This will vary depending on dosage, length on therapy, and whether you are a trans male or female.

Female to Male

• deepening of the voice,
• growth of facial and body hair
• male pattern baldness (in some individuals)
• an enlargement of the clitoris
• growth spurt and closure of growth plates if given before the end of puberty
• possible shrinking and/or softening of breasts, although this is due to changes in fat tissue
• increased libido
• redistribution of body fat
• cessation of ovulation and menstruation
• further muscle development (especially upper body)
• increased sweat and changes in body odor
• prominence of veins and coarser skin
• acne (especially in the first few years of therapy)
• alterations in blood lipids (cholesterol and triglycerides)
• increased red blood cell count

Male to Female

• Breast development and enlargement
• Softening and thinning of the skin
• Decreased body hair growth and density
• Redistribution of body fat in a feminine pattern
• Decreased muscle mass and strength
• Widening of the hips (if epiphyseal closure has not yet occurred; see below)
• Decreased acne, skin oiliness, scalp hair loss, and body odor
• Decreased size of the penis, scrotum, testicles, and prostate
• Suppressed or abolished spermatogenesis and fertility
• Decreased semen production/ejaculate volume
• Changes in mood, emotionality, and behavior
• Decreased sex drive and incidence of spontaneous erections

Potential Side Effects

Male to Female

• Blood Clots
• Prolactinoma
• Gallstones
• Possible Risk of Cancer
• Heart Disease
• Infertility

Special note about Spironolactone
Spironolactone is often prescribed in MTF therapy for pre-op trans women. It’s used off-label to this end, as it is usually prescribed for high blood pressure or edema. It is a diuretic that expels water and holds on to potassium. However, you can hold on to too much potassium and wind up with a life threatening situation. So you have to make sure you have your levels closely monitored.

Female to Male

• Heart disease
• Stroke
• Diabetes
• Increased red blood cells and hemoglobin
• Onset or worsening of headaches and migraines
• Cancer
• Mental Health

That’s a very broad overview to start, what questions do you have that you would like answered in part 2? We will be covering supplements, online ordering, administering medication, and more. Let us know what you want in the comments below.

And this year was worse. Not only was it my oldest son’s first day of middle school, but I wasn’t going to be there. I had back surgery a couple of weeks ago (I’m going to be fine), and I am not yet supposed to do things as exciting as leaving the house for major emotional events. This was the first year I was going to miss. It sucked. For me. My son was totally cool about it and absolutely blase about my inner turmoil.

All day I waited. And I worried. And scenes of bullies in John Hughes movies kept scrolling through my head, and I just knew there was some barely pubescent little hellion who would be totally deserving of my wrath before the day was out. It didn’t matter how carefully we had picked his school as somewhere that would embrace and celebrate who my kid is, the awful scenes of bathroom swirlies and kids being bashed against lockers kept rolling. And by 3pm, I was mess.

Instead, that afternoon my kid burst into the house, all smiles and said, “I made a transgender friend today! She has other gay friends!” He was bouncing. My oldest son is gay, and the idea of having other gay kids in his classroom for the first time (there were no other out gay kids in his elementary school) was what made him really look forward to middle school.

My son went on to tell me that his new friend’s parents want her to be a boy and not a girl. “So I told her my parent’s will like her a lot.”

I leaned over and kissed his forehead and both of his cheeks. “I am sure we will, baby.”

“Mom!” he swatted my hands away. “Just stop.”

(I am going to stop here and take a moment. I don’t have a trans kid. My gay kid is about as gender conforming as you can get. I have no experience having a transgender or gender nonconforming child. But if you are a parent with transgender or genderqueer kid, it’s time to get with the program. Your kid needs you to love who they are, and not who you think they should be.)

I really wish I had been a fly on the wall at the school that day, but instead I just tried to get the story out of my son of how this conversation had transpired. I just couldn’t imagine some 11-year-old transgender girl announcing her gender identity to my kid out of the blue.

So from the details I can piece together from my 11-year-old (who thinks his mother is ridiculous) here’s what happened:

My son was lost and couldn’t find his next class, so he found someone who looked like they were lost too.

He walked up to this other student and said, “Hey guy, what’s up?”

The other student said, “I’m not a guy. I’m a girl.”

“Oh,” said my kid. “Hey girl, what’s up? Are you transgender?” The girl looked at him for a minute and then nodded. “That’s cool,” he continued. “I’m not transgender, but I’m gay.”

“That’s cool,” she said back. “I have some gay friends who go here too.” My son was very excited to hear this. It turns out they were both lost and looking for the same classroom.

Then they walked past the bathrooms, and the girl explained she needed to go, but wanted to go into the girls’ room because that was her real bathroom. My son said he would stand outside the door while she was inside and wait until she was done, and then they could find their class together.

After that was completed, they continued through the halls and she asked him how his parents felt about him being gay. He just shrugged. “It’s fine. We know a lot of gay people. A lot.” She told him about her parents, and things went from there.

They found their classroom, and afterwards promised they would find each other the next day.

And now I feel like my kid really is in some 80s movie, but the 2016 version. Because come on!? For real? I am 40 years old, and the idea of two lgbt kids just happening to randomly find each other both looking for the same class just seems too perfect a set up, too unreal. If I watched a movie or a TV show where a conversation like that happened, I would probably roll my eyes at the too-perfectness, the fakeness, of it all.

But it did happen, and it made my kid’s first day of middle school awesome.

So, maybe it is time to put emo-mom away for awhile, and just let his life happen. Because we are in a new age, a new world, a new reality. Will there be assholes and homophobes? Yes, always. But there will also be two LGBTQ kids who find each other randomly walking down the hall. And that is pretty fantastic.

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You may not have thought about it- but makeup actually does expire. I know, crazy at it sounds, but makeup does breakdown over time. Or sometimes, based on the type- it can become unsafe due to potential for bacteria buildup.

So what’s a girl to do? Sure you paid $60 for that bottle of Kat Von D or Marc Jacobs- but is it still good? Using expired makeup doesn’t do you any favors dearhearts. Yeah, you bought the good stuff. But if it’s past it’s prime, then it won’t work as well as it should. It’s time has passed.

Much like Eddie Murphy.

Damn, I wanted a leather jumpsuit.

I digress. Makeup has a shelf life, and thankfully makeup guru Wayne Goss is here to help us out.

And here is the cleaner that Wayne talks about:
[amazonjs asin=”B00775RTJQ” locale=”US” title=”BeautySoClean Cosmetic Sanitizer 4.1 oz (120 ml)”]

Can’t watch now, or want an easy to copy list? Here are some guidelines.

The Expiration Guidelines

Foundation

Water-based foundation lasts for up to a year and the more common form of oil-based, up to 18 months. The two different types will be clearly visible on the label.

Concealer

Has a shelf life of one year. Avoid using the concealer directly on the spot, as this can leave bacteria on the product and, when used elsewhere on the face, lead to further outbreaks. Instead use a short, pointed brush to dot the concealer over the spot, then clean the brush using Mac’s brush cleanser.

Powder

Lasts, in pressed form, up to 18 months with the loose variety lasting up to one year. Makeup sponges don’t need to be thrown out but they do need to be washed every week. Use soapy water and allow them to dry naturally before you place them back in the compact to avoid encouraging bacteria. But once a sponge has lost it’s original shape, smells off or is shredding at the edges, replace!

Blusher

Has a shelf life of one year. Over time, they get cakey and dried out, making them difficult to apply, so toss them! Cream blushers will last longer, as the pigment and oils preserve them.

Eye shadow

Has a shelf life of one to two years for both powder and cream formulations.

Lipstick and Lip Gloss

Both have a shelf life of up to two years. As with cream blushers, pigment and oils preserve lipsticks but if you get a cold sore while using one, throw it out immediately – the same goes for gloss. And if you use a lip brush, wash it twice a week with Mac’s brush cleanser.

Nail Polish

Lasts for up to a year or two years if stored properly.

Mascara

This is the product that got the short straw in the shelf life stakes – it needs to be replaced after a mere four months. Don’t share mascaras with friends – the wand harbours a host of bacteria that are naturally present on our eyelashes but can cause infections to others. If you have a stye or any other kind of eye infection replace your mascara immediately. Oh and NEVER SHARE MASCARAS!!

You can also make your mascara last longer by not double dipping and using disposable mascara brushes.

[amazonjs asin=”B014R19NT6″ locale=”US” title=”Smilesun Disposable Eyelash Eye Lash Makeup Brush Mascara Wands Applicator Makeup Kits (100PCS Pink)”]

Why should I care?

Always remember, this isn’t to get deeper in your wallet, it’s to make sure you get the highest quality. But more importantly, it’s to protect your health and avoid any infections.

Plus, these are just guidelines. It’s not like milk. If you take care sanitizing and keeping your makeup and brushes clean, as well as the other tips here- your investment will last.