Starting HRT as a Non-Binary Person in My Mid 40s

I am trans/non-binary. I am also 45 years old, a few days away from being 46, and I just started testosterone. To be clear, I have been genderqueer since birth, long before I had the language to explain my gender identity. At some point in my late 20s, I started to identify as a not feminine female. When I was in my mid 30s I first heard the term non-binary. After a few hours of internet research, I knew that this was the language I had been missing.

It wasn’t until I was 40 that I started socially transitioning outside of online spaces. There were a variety of reasons for this, but the main one was that I still had a child under my care who … well, to put it bluntly, I didn’t have the energy or time to really devote to my own identity. But then I did, and one of the first things I did was correct my pronouns at work. My last dash ultra fem phase (that I have since learned happens more often than not) had me chopping off the long hair that I hated. I have no idea why I thought to give it a try, my hair had been short since I was ten.

When a job refused to use anything except my full name, I legally changed my name. It hadn’t been a priority before then, because either way, my name is MJ. Over time, I stopped performing gender and started selecting what I enjoyed wearing. I went back to cargo pants, T-shirts, and hoodies. The same uniform I wore when I was young.

My youngest kid is also non-binary, and when they were getting top surgery, I realized that I would not be medically eligible due to various health concerns. I wrote a story about it, Lucas, the first book in my Ember Town series.

I am autistic, which means I only have so much bandwidth, and it always goes to my kids. Now my youngest had everything they needed, and it was time to focus on my next steps. I knew I wanted to start Testosterone (T) for a variety of reasons, and I finally decided to start when I was laid off. Without insurance or money coming in, it seemed like I had to put my goal on hold once again.

As of a week ago, that wait has come to an end, and I wanted to talk more about my journey starting T and part of why it personally took me so long to start.

You do not have to medically transition to be trans

This is a big one. Just because I hadn’t started on hormone replacement therapy (HRT) did not make me any less trans. To be clear, I am non-binary, agender to be correct, but I am also trans. My gender identity does not align with the sex assigned at birth. I remember gender dysphoria as early as fifth grade when I started puberty. Yet, nothing required me to do any sort of medical transition. This is true regardless of whether a person is binary trans (male/female) or non-binary trans.

I have never not been non-binary, although I tend to refer to myself as genderqueer when I was young, as I didn’t have the language back then. For a while, T was not a top priority for me. Socially transitioning was more important. I knew I wanted low-dose T, but it took me some time before I was ready for that step.

Everyone’s transition is different. And everyone’s transition pacing should be respected.

I have a deep fear of the medical community

Look … I know there are good doctors out there. There are also plenty of bad ones. As a genderqueer autistic person, I have had pretty traumatic experiences within the medical community. All my effort went to navigating those resources for my kids. I do not regret that, and it took me a while to get to the point where I could start navigating the resources for myself. 

I wrote a bit about this with Jupiter in my book NeurodiVeRse. They also have a hard time even taking the step to connect to their medical needs. I don’t think this is uncommon, but I do think it is more common in the autistic community. For one, we are taught from a young age not to trust the instincts of our bodies. We are told to stop stimming, are unable to communicate when we are in pain, and are often told the reactions we do have are inappropriate.

I needed to prioritize my mental health first

The fear of the medical community also included therapy. I had some pretty horrible incidents with therapists as a child. And you may think pursuing my education in psychology would help with that. It did not. Even while I was getting my MS in Developmental Psychology, I had some majorly ableist situations happen. It is like my own professors refused to believe that autistic people grew up. This was two decades ago, so it was worse back then than even now—and it isn’t great now.

So, my energy first went into finding a therapist and doing personal growth. I have C-PTSD and some pretty intense childhood trauma. I’m not going into that here, but you can see themes of it through my books. I’ve done a lot of work over the last two years. Enough that I knew I was ready for the next step.

To be clear, no one said I needed to wait before getting on T. Everyone’s timeline and needs are different. I waited because I needed to deal with things before I was even mentally ready to take the next steps.

Why I finally decided to go on T

Ultimately, I was ready. Don’t get me wrong. It is still scary starting my own business. Writing full-time. Helping other authors. My insurance is … not great and more than I can afford, and given all the work we did to find services for my adult non-binary kid, I knew that using my insurance wasn’t a route that I could go.

The excuses started piling up. Then I asked myself if I really wanted it—yes. Then I asked myself if I would move forward if it were for my kids—yes again. Then I finally gave myself permission to move forward.

I did mention the last two years of therapy to get to this point.

Once that was decided, I did it. And things went fast from there.

How am I getting my HRT

Several companies now offer hormone replacement therapy through various plans. After doing research, I decided to go with Folx. It ultimately was the most affordable since using insurance was not an option. Everyone needs to figure things out for themselves. This is not a sponsorship, nor a recommendation. I’m still fairly new with them, but so far, I am happy.

How are things going

Each day I look in the mirror and wonder if there are signs, even though I know it takes longer than days. I talk and hope that this time my voice will start cracking. Again, I know it is too soon. But I already feel more comfortable in my own skin, more than I expected this early on. It is more than I have ever been.

For 45 years, I coped with gender dysphoria by disconnecting from my own body. Now I know that I am doing what I need to be connected physically to myself. 

This is not the start of my journey

Getting on HRT is not the start of my journey. It is just one more step—a step that I am very happy to be taking. How I have coped with my own gender dysphoria hasn’t been the healthiest way, and I am thrilled that the opportunities available to trans people are so much more available now.

I know that things are dark at the moment. Each day brings more legislation and attacks. Politicians are punching down on people they don’t think anyone cares about—but we exist. We have always existed, and the language, culture, and community that have blossomed in the last 45 … nearly 46 … years is amazing.

I went on T for myself. But being myself is resistance. Remember, don’t let the fuckers win.

Written by MJ James

MJ James is an own-voice science-fiction and fantasy author for queer and neurodiverse readers. With themes of found family, aromantic and asexual representation, and a focus on belonging, MJ hopes their stories can provide companionship for their readers along with a sense of validation, understanding, and being seen.