Invisible gender: even non-binary people seek medical transition

3/28/2026

The process of becoming aware of one's own identity and "coming out" can be very challenging for non-binary people. If they decide to seek support within the healthcare system, they still face additional obstacles.

I meet with the first of non-binary people at a café, from whom I want to learn about their experience (not only) with sexology. Noe tells me about their first visit: „I thought to myself: this is the only sexologist who is accepting of non-binary people and who had free time, so I must not mess up. The trip to him takes over four hours. Because I wasn't sure how he would react to non-binarity, I dressed more masculine for the appointment. And I still do so today.“

„The psychiatrist arrived late, didn't apologize. She made a remark about my breasts, saying what others would give for them, maybe even herself. She said that I obviously don't know what I want, and that she will recommend me further only if I continue therapy.“

It is not uncommon for people in childhood and adolescence to not meet the expectations associated with their gender – for example, having different interests or wanting to dress differently. But for non-binary people, it is something deeper than mere defiance. As Robin describes: „I realize my own non-binarity, for example, in situations where people take off their shirts in summer. Why is it okay for some and not for others? When someone says ‚boys go here, girls go there‘, I ask myself, where is the place for me? And when others call me a girl or a woman, I experience great frustration and helplessness.“

To understand non-binarity, one must first accept the idea that gender is not black and white and that there are more than just two categories. This is still not a given in today’s society, and it is understandable that confusions arise. But the problem occurs if even those who are supposed to care for non-binary people are uninformed. In such cases, it is hard to overlook the professional responsibility of these doctors and doctors.

Non-binary people undergo transition, just like binary trans people – those who shift from male to female (male-to-female) or from female to male (female-to-male). Transition is a process leading to feeling more aligned with one’s gender identity, and it is divided into multiple components. Social transition can include coming out, changing the name used, appearance, and social role. Medical transition mainly involves hormone therapy and/or various surgical procedures. This part of transition is entirely voluntary, and many people choose not to pursue it. The medical aspect is often the most difficult and longest part of transition for those who do.

How their body looks often has a significant impact even on the general population and can cause deep psychological problems. Many non-binary people also experience gender dysphoria, where their appearance does not match their experienced gender. Therefore, in some cases, they wish to make physical changes to their bodies and seek assistance from the healthcare system. And that is where misunderstanding can occur.

Bite the bullet and don’t deal with it

Already in 2022, a study titled Being LGBTQ+ in the Czech Republic found that, according to subjective assessment, non-binary people live the worst in our country among all subgroups. In everyday life, even introducing oneself is a challenge for those who use, for example, a gender-neutral pronoun, plural forms, or have neutral names, creating opportunities for misunderstanding and conflict. Due to the rigidity of the Czech language and the still low public awareness, it is often easier to accept the form of address that is assigned to us. It is a way to reduce the otherwise omnipresent minority stress.

For some, such self-denial can be quite painless. Enduring misgendering is just one of many compromises that society pushes us into and that make it harder for us to fully express our own gender, as experienced by Alex. „I work in an office with young people, but even so, non-binarity is incomprehensible to them,“ he says. „They took it as a figment of today's times. They could understand the 'normal' transition. I usually don't talk about non-binarity and answer questions by saying that I ‚just don't care‘.“

In the Czech environment, the debate about non-binary people is still often framed by the question of what ‚they want from us‘. Instead, the conversation could focus on ways to treat non-binary people with understanding and respect. Once the discussion approaches a more complex idea than ‚this person no longer has gender A, but gender B‘, defensive reactions often occur. However, respecting how a person wishes to be addressed is not particularly difficult – and there is always room for mistakes and gradual learning.

The term „transnormativity“ refers to the conscious or unconscious attempt to erase non-binary existence and categorize these people into two „tangible“ categories, namely trans men and trans women. It is contributed to by both the broader society and many institutions, including media. Issues in access to non-binary people also concern the more liberal segments of the political spectrum. As Saba describes, „a non-binary person in today’s society basically passing – it’s almost impossible for them to find a position where society perceives them as they wish. People will always see what they want to see.“ „They don’t know what to expect,“ adds René. „For binary trans people, it’s from point A to point B, but for us, it’s not that simple.“

Non-binary people can easily feel that society expects them, within social transition, to explain or even defend their identity, and also to „look“ according to it. But non-binary people do not owe these things to anyone. They do not have to dress androgynously nor do they have to have specific pronouns or sexual orientations.

Many non-binary individuals who cannot or do not want to come out at work, school, or family seek refuge within the LGBTQ+ community. Even there, where one might expect „among their own,“ misunderstandings can occur. Sam also experiences this: „Most often, I encounter discrimination from binary trans people and cis gay men. We are seen as strange, not trans enough for them. For example, trans men sometimes adopt these attitudes to fit in more with the male community.“

„Many tend to categorize me as ‚not quite a trans guy, but almost‘. I personally don’t mind, but I don’t see it that way,“ admits Viki.

All respondents mentioned that they perceive this discrimination from within the community to some extent. Even in this seemingly accepting environment, non-binary people may not feel safe. And if even this basic step in their transition – finding understanding people around them – is not easy, what about the other steps?

Some genders are more equal than others

The situation regarding access to sexology in the Czech Republic has been critically long-standing for trans* people (note – the star is used when the term includes not only trans but also non-binary and intersex identities). Truly understanding sexology that is empathetic and follows the latest recommendations could be counted on one hand. Due to overloaded capacities of their clinics, many trans* people are forced to undergo a much more unpleasant process at facilities with a worse reputation. Non-binary people often do not have this option because other doctors refuse to treat them, claiming they do not recognize non-binarity. If they want to access medical transition, they are sometimes forced to pretend to be binary trans persons.

„Since 2019, I’ve tried to get somewhere in sexology. The first sexologist I contacted refused me because of non-binarity. I didn’t know anyone at the time, didn’t know what my options were. I repeatedly wrote to the second doctor because she was fully booked, and I only got to her two years later,“ describes Lee. Given the long waiting times, a person might wait more than half a year to change their sexologist, as Sam experienced: „The first one I visited was terrible. One visit was enough; he told me he does ‚real life tests‘ with everyone. He repeated myths and homophobic stuff. The second sexologist was intolerant of bisexuality and claimed, for example, that trans people cannot enter into marriage, which was only corrected by my third sexologist.“ All these complications mean significant delays for those affected, prolonging their time in an unsatisfactory body state. This can also be associated with worsening mental health, among other things.

The latest standards of care from the WPATH (World Professional Association for Transgender Health) date from 2022. They are the most widely used document for professionals working with transgender and gender-diverse people worldwide. The newest version is the first to mention non-binary people and recommends offering individually tailored care – for example, medical care without social transition or surgery without hormone therapy. Still, even today, from our probably most well-known sexologist Hana Fifková, we hear things like „she doesn’t believe in non-binarity“ or that „from a medical perspective, it is not an exactly defined state“ (We will be who we are?, p. 189). Fifková is also one of the main authors of the outdated, yet still widely used Czech textbook Transsexuality and other disorders of sexual identity (2008), which is practically the only publication on this topic produced in our country.

Doctors and physicians are already advised during their studies that it is their duty to educate themselves throughout life and stay informed about new developments in their field. However, the reality is different. Who then can non-binary people trust when most experts, according to professional guidelines, do not act accordingly or, at best, misinterpret, and at worst, completely ignore them? „The psychiatrist arrived late, didn't apologize. She made a remark about my breasts, saying what others would give for them, maybe even herself. She said that I obviously don’t know what I want (I was 50 and have known about myself for about four or five years) and that she will recommend me further only if I continue therapy,“ gives Ari as an example.

Sexology is not the only discipline that trans* people commonly encounter. Statements from colleagues in internal medicine, endocrinology, psychiatry, clinical psychology, and others (depending on associated diagnoses) are usually the minimum required to start hormone treatment. Noe also had an unpleasant experience: „I had to see a psychiatrist several times, and it was complicated. Even though I see her regularly, she said she needed a referral from a sexologist. Then she gave me an incomplete assessment, which wasn’t enough for the sexologist, and I had to travel across the country to see one.“ Due to long waiting times, a person might wait more than half a year to change their sexologist, as Sam experienced: „The first one I visited was terrible. One visit was enough; he told me he does ‚real life tests‘ with everyone. He repeated myths and homophobic stuff. The second sexologist was intolerant of bisexuality and claimed, for example, that trans people cannot enter into marriage, which was only corrected by my third sexologist.“ All these complications mean significant delays and longer periods in an unsatisfactory body state, which can also negatively affect mental health.

The latest standards of care from the WPATH (World Professional Association for Transgender Health) from 2022 are the most widely used document for professionals working with transgender and gender-diverse people worldwide. The newest version mentions non-binary people for the first time and recommends offering individually tailored care – for example, medical care without social transition or surgery without hormone therapy. Still, even today, from our probably most well-known sexologist Hana Fifková, we hear things like „she doesn’t believe in non-binarity“ or that „from a medical perspective, it is not an exactly defined state“ (We will be who we are?, p. 189). Fifková is also one of the main authors of the outdated, yet still widely used Czech textbook Transsexuality and other disorders of sexual identity (2008), which is practically the only publication on this topic produced in our country.

Medical professionals are already advised during their studies that it is their duty to educate themselves throughout life and stay informed about new developments in their field. However, the reality is different. Who then can non-binary people trust when most experts, according to professional guidelines, do not act accordingly or, at best, misinterpret, and at worst, completely ignore them? „The psychiatrist arrived late, didn't apologize. She made a remark about my breasts, saying what others would give for them, maybe even herself. She said that I obviously don’t know what I want (I was 50 and have known about myself for about four or five years) and that she will recommend me further only if I continue therapy,“ gives Ari as an example.