Met and unmet need for medical gender affirmation in the Australian non-binary community

Background: There is a widely held assumption that non-binary people do not, or rarely, pursue gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS), however, little is known about the medical gender affirmation needs of non-binary people in Australia.Aim: This study aimed to assess the rates of met and unmet need for GAHT and GAS amongst a community sample of non-binary people in Australia. Methods: This online, cross-sectional survey was open to non-binary people, living in Australia and aged >= 16 years between 11 June 2021 and 21 April 2022. Survey questions assessed history of and desire for GAHT and GAS. Outcomes: The main outcome measures were rates and types of GAHT and GAS that were desired and accessed. Results: Of 271 non-binary respondents, 80.4% were presumed female at birth (PFAB) and 19.6% were presumed male at birth (PMAB). Respondents ranged from 16-68 years of age, with a median age of 28 years (IQR 23, 34). In respondents PFAB, there was 63.1% total need for GAHT, and in those respondents who reported need for GAHT, the rate of unmet need was 8.8%. Over half of respondents PFAB reported need for GAS (52.8%) and in those respondents, the rate of unmet need was 43.4%. In respondents PMAB, there was 77.3% total need for GAHT, and in those respondents who reported need for GAHT, the rate of unmet need was 14.6%. One third of respondents PMAB (32.1%) reported need for GAS, and in those respondents, the rate of unmet need was 82.4%. Conclusion: Given the frequency with which non-binary people desire and access medical gender-affirmation, healthcare professionals urgently require additional training, to increase awareness about the variety of medical affirmation options and how to provide good quality, patient-centred care to improve psychological functioning and quality of life for non-binary people.