Non-binary is an umbrella word for people whose gender is not exclusively man or woman. Some feel they are both, some neither, some move between genders, and some find that the categories simply do not fit. People use many words for this, such as non-binary, genderqueer, genderfluid or agender, and many more in other languages.
Non-binary people come to therapy for all kinds of reasons. This article looks at some experiences that are specific to living outside the binary, and at what can help in therapy. Your own experience may be quite different.
A large and diverse group
Non-binary people are far from a small exception within trans communities. In a survey of trans and gender-nonconforming adults in Massachusetts, 41% described their gender as non-binary (Reisner & Hughto, 2019). England’s GP Patient Survey included 6,333 trans and non-binary adults. Compared with other respondents, they were younger on average and more likely to live in deprived areas. They also reported much less positive experiences of communication with their doctors, while access to appointments was broadly similar (Saunders et al., 2023).
Some people’s sense of their gender stays the same throughout life and some people’s changes over time. Both are ordinary, and neither makes a non-binary identity less real.
Genders beyond two are also far from new. Many cultures have long recognised other genders, for example the muxe of Zapotec communities in Oaxaca, Mexico, or the hijra in South Asia. These identities have their own histories and meanings, and they are not simply another name for non-binary. They do show that a world with only two genders is one possibility among many.
Stress that is specific to non-binary people
Non-binary people share many experiences with binary trans people and also face particular stresses. A systematic review of the health of non-binary and genderqueer people found mixed results when comparing them with binary trans people and noted how limited the research still was. It also found that not a single study had yet tested a psychological intervention designed for non-binary people (Scandurra et al., 2019). Among young people, a meta-analysis of 21 studies found poorer general mental health among non-binary youth than among both transgender and cisgender peers (Klinger et al., 2024).
These numbers describe groups. Behind them are everyday conditions: a world organised around two genders, in which forms, toilets, grammar and everyday greetings assume that you are one or the other.
Misgendering
Being called by the wrong name, pronoun or gendered word is part of daily life for many non-binary people. In the Trans PULSE Canada survey, 59% of more than 1,000 non-binary participants were misgendered every day, and most found it very or quite upsetting. Only about one in eight corrected others most or all of the time (Jacobsen et al., 2024). Correcting people costs energy and can feel risky. Leaving it uncorrected can feel like slowly disappearing.
Blending in or standing out
Many non-binary people keep weighing how visible to be. An analysis of almost 10,000 non-binary participants in the 2015 US Transgender Survey found a hard trade-off. People who were more open about their identity reported more victimisation, while people who blended into the binary environment reported more distress, which the authors linked to identity erasure (Flynn & Smith, 2021). Each choice has a cost, and many people move between them depending on where they are and who they are with.
Beyond misgendering
Being called the wrong name or pronoun is only one part of what can weigh on non-binary people. Many face a whole web of everyday challenges, and these often add up.
Health care that does not fit
Many health systems are built around two genders, from forms to examination routines. In a large survey of LGBTQ+ people, non-binary participants felt less comfortable with physical examinations, less respected by providers and less confident that providers had the knowledge to care for them than cisgender lesbian, gay and bisexual participants did (Nowaskie & Menez, 2024). Some people avoid care because of this, which can mean that health problems are noticed later.
Violence and harassment
Non-binary people can be targets of harassment and violence, both in public and in private relationships. In a population-based survey in California, more than half of the non-binary respondents reported sexual violence in the past year (Closson et al., 2024). The number of non-binary participants was small, so the exact figure should be read with caution, but it fits a wider pattern of high risk among trans and gender-diverse people.
Neurodivergence and gender diversity
Autistic people are more likely than others to be trans or gender diverse (Warrier et al., 2020). Being both autistic and non-binary can make it harder to be understood. In interviews with autistic trans and non-binary adults, many described professionals who knew little about either autism or gender diversity, as well as bureaucratic and financial barriers when they tried to access gender-related health care (Bruce et al., 2023).
Doubt from others, and from inside
Non-binary people are often asked to prove or explain their identity, sometimes even within queer communities, where they may hear that they are “not trans enough” or “just confused”. Over time, this outside doubt can turn into inner questions about whether one is allowed to take up space. In therapy, these experiences deserve attention as much as misgendering does.
What non-binary people bring to therapy
- exploring and naming their gender, without pressure to arrive at a final answer
- tiredness from misgendering, explaining and being doubted
- feelings about the body, which may or may not include wishes for medical steps
- relationships with family and partners, and how to talk with them about being non-binary
- work, studies and official documents
- everything else in life: grief, stress, relationships, migration, anxiety, low mood
What can help in therapy
A good therapeutic space for non-binary people shares a lot with affirming therapy for trans people in general. Some points matter in particular:
- Your pronouns and words are used, whether they are they/them, neopronouns or something else, and in other languages the forms you prefer. In languages with strongly gendered grammar, it can help to agree together how the therapist will refer to you.
- The therapist does not assume that you are on your way to a binary identity, or that your gender needs to be explained by something in your past.
- Questions about medical steps are approached individually. Some non-binary people want hormones or surgery, some want certain steps only, and some want none.
- Invisibility is recognised as a real source of stress, together with the energy it takes to keep explaining yourself.
- Joy, humour and creativity have a place in the conversation as well as the hard parts.
The survey data from England suggest that communication is where health care most often falls short for trans and non-binary people (Saunders et al., 2023). In therapy, communication is the core of the work, so it is reasonable to expect your therapist to have done their own learning before you arrive.
If you are unsure what to say in a first session
You do not need to have your gender figured out. You can start with “I’m not sure how to describe it yet”, or with whatever brought you there, whether it has to do with gender or not.
When to look for support
You might consider therapy if misgendering or invisibility leave you drained, if you feel alone with questions about your gender, if family or relationship conflicts weigh on you, or if anxiety or low mood are taking up a lot of space. You can also come simply because you want a place where all of you is welcome.
If you are in crisis or having thoughts of ending your life, please call your local emergency number (for example 112 in Europe or 911 in North America and Mexico), or find a free, confidential helpline in your country at findahelpline.com. Many countries also have helplines run by and for trans and non-binary people.
You may also find Living as non-binary: names, pronouns, visibility and everyday life and Therapy as a trans person useful.
More about therapy with me.
References
- Bruce, H., Munday, K., & Kapp, S. K. (2023). Exploring the experiences of autistic transgender and non-binary adults in seeking gender identity health care. Autism in Adulthood, 5(2), 191–203. https://doi.org/10.1089/aut.2023.0003
- Closson, K., Boyce, S. C., Johns, N., Inwards-Breland, D. J., Thomas, E. E., & Raj, A. (2024). Physical, sexual, and intimate partner violence among transgender and gender-diverse individuals. JAMA Network Open, 7(6), e2419137. https://doi.org/10.1001/jamanetworkopen.2024.19137
- Flynn, S., & Smith, N. G. (2021). Interactions between blending and identity concealment: Effects on non-binary people’s distress and experiences of victimization. Plos One, 16(3), e0248970. https://doi.org/10.1371/journal.pone.0248970
- Jacobsen, K., Davis, C. E., Burchell, D., Rutherford, L., Lachowsky, N., Bauer, G., & Scheim, A. (2024). Misgendering and the health and wellbeing of nonbinary people in Canada. International Journal of Transgender Health, 25(4), 816–830. https://doi.org/10.1080/26895269.2023.2278064
- Klinger, D., Oehlke, S. M., Riedl, S., Eschbaum, K., Zesch, H. E., Karwautz, A., Plener, P. L., & Kothgassner, O. D. (2024). Mental health of non-binary youth: a systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health, 18(1), 126. https://doi.org/10.1186/s13034-024-00822-z
- Nowaskie, D. Z., & Menez, O. (2024). Healthcare experiences of LGBTQ+ people: non-binary people remain unaffirmed. Frontiers in Sociology, 9, 1448821. https://doi.org/10.3389/fsoc.2024.1448821
- Reisner, S. L., & Hughto, J. M. W. (2019). Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample. Plos One, 14(8), e0221583. https://doi.org/10.1371/journal.pone.0221583
- Saunders, C. L., Berner, A., Lund, J., Mason, A. M., Oakes-Monger, T., Roberts, M., Smith, J., & Duschinsky, R. (2023). Demographic characteristics, long-term health conditions and healthcare experiences of 6333 trans and non-binary adults in England: nationally representative evidence from the 2021 GP Patient Survey. BMJ Open, 13(2), e068099. https://doi.org/10.1136/bmjopen-2022-068099
- Scandurra, C., Mezza, F., Maldonato, N. M., Bottone, M., Bochicchio, V., Valerio, P., & Vitelli, R. (2019). Health of non-binary and genderqueer people: A systematic review. Frontiers in Psychology, 10, 1453. https://doi.org/10.3389/fpsyg.2019.01453
- Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1
This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.
