Prevalence of gender-affirming hormone therapy in non-binary and genderqueer individuals, a systematic review and meta-analysis.

Sixteen eligible articles were identified, comprising a total of 1948 NBGQ individuals and 3991 BT individuals across retrospective cohort series.

• All 16 studies were retrospective cohort series published between 2018 and 2024.
• Studies were identified through systematic search of PubMed, Embase, and Web of Science databases following PRISMA guidelines.
• The studies included both clinical and non-clinical cohorts of NBGQ and binary transgender individuals.

Hormone use varied widely among NBGQ individuals, ranging from 4% to 93%, compared to 52% to 95% among BT individuals.

• GAHT prevalence ranged from 4–93% in NBGQ individuals across included studies.
• GAHT prevalence ranged from 52–95% among BT individuals across included studies.
• The wide range in NBGQ individuals reflects the heterogeneity of this population and the diversity of clinical and non-clinical settings studied.

Overall, significantly fewer NBGQ individuals were on GAHT compared to BT individuals, except among those referred to gender-affirming care clinics.

• The difference in GAHT prevalence between NBGQ and BT individuals was statistically significant across most cohort types.
• The exception was cohorts referred to gender-affirming care clinics, where the difference between NBGQ and BT individuals was not significant.
• This finding suggests that clinical referral context modifies the relationship between gender identity category and hormone therapy use.

GAHT was significantly more frequent in clinical cohorts compared with non-clinical cohorts, both among NBGQ and BT individuals.

• Among NBGQ individuals, the odds ratio for GAHT use in clinical vs. non-clinical cohorts was OR 6.4 (CI 5.1–8.0).
• Among BT individuals, the odds ratio for GAHT use in clinical vs. non-clinical cohorts was OR 3.1 (CI 2.6–3.8).
• The effect of clinical setting on hormone use was notably larger for NBGQ individuals than for BT individuals.
• This indicates that clinical context is a particularly strong predictor of GAHT use in NBGQ individuals.

There was insufficient information in the literature to draw conclusions regarding differences in types of GAHT used by NBGQ individuals.

• The systematic review could not characterize whether NBGQ individuals use different formulations, doses, or regimens of GAHT compared to BT individuals.
• The authors noted this as a gap requiring additional studies to explore tailored endocrine treatment needs in NBGQ individuals.

The findings highlight heterogeneity in treatment needs among both NBGQ and BT individuals, with not all NBGQ individuals seeking GAHT.

• Caregivers, particularly in clinical settings, should be aware that not all NBGQ individuals seek GAHT.
• The authors emphasized the need for more personalized counseling and treatment strategies for NBGQ individuals.
• Additional studies were called for to further explore tailored endocrine treatment needs in NBGQ individuals.