Background: The transition goals of non-binary individuals, comprising up to 38% of the gender diverse population in the US, remain largely unexplored. This study aims to characterize differences in medical and surgical transition goals between transgender and non-binary individuals. Methods: Individuals who completed an intake form at our gender-affirming health center between 2017-2019 were included. Our primary outcome was the frequency of desired and undertaken transition options. Demographics, desired procedures, barriers to care, and medical and surgical history were extracted. Chi-squared tests were used to compare outcomes between transgender and nonbinary individuals. Results: This study included 1276 transgender and 127 non-binary individuals with 55% (n=707) transgender and 77% (n=98) non-binary individuals assigned female at birth (AFAB). The median (interquartile range) follow-up was 37 (10-55) months. Non-binary individuals were significantly less likely to be on hormone therapy (HT) prior to intake and express interest in future HT compared with transgender individuals (76 [59%] vs. 1111 [87%], p<0.001; 22 [43%] vs. 117 [73%], p=<0.001). A smaller proportion of non-binary individuals had gender-affirming surgery prior to intake compared with transgender individuals (30 [24%] vs. 478 [37%], p=0.003). Among AFAB individuals, non-binary individuals were less likely to request phalloplasty compared with transgender men (23 [23%] vs. 374 [54%], p<0.001). Conversely, there was no difference regarding the interest in chest masculinization surgery (56 [77%] vs. 333 [86%], p=0.08). Overall, 46 (44%) non-binary and 454 (37%) transgender individuals received their desired surgeries. Insurance was the most commonly reported barrier to care in both cohorts (30 [24%], 318 [25%], p=0.82). Conclusion: Significant differences in medical and surgical transition goals exist between transgender and non-binary individuals. These findings highlight the need for tailored healthcare approaches to accommodate the diverse care needs of gender diverse individuals.
