While your gender identity may be fluid, in transition or non-conforming, both the current and past sex of your body still impacts how your body processes alcohol. ADH is the enzyme that digests alcohol in our bodies (in the stomach and the liver), and our bodies only produce so much ADH during our lifetime. The amount of ADH we have in our stomach is determined by the sex we were assigned at birth. Individuals born female have half the enzymes that individuals born male have in the stomach. Thus when a man and an individual assigned-female-at-birth have the same amount of alcohol, the female’s blood alcohol concentration is much higher than a man’s.

If you are still biologically the sex you were assigned at birth (i.e., you haven’t begun to transition with the use of hormones), then you will still process alcohol the same way as your assigned biological sex at birth. However, if you have started hormone therapy, then the impact of biology is more complicated. For example, if you were born with the ADH of a male, but you have begun taking estrogen and/or progesterone, you will be more sensitive to the effects of alcohol. Taking testosterone may also heighten sensitivity to alcohol but in different ways than estrogen and progesterone. However, taking testosterone will not generate more ADH—so your blood alcohol levels will mirror that of a biological female.

Based on this information, we advise you to select the gender that you were assigned at birth. If, however, you are a person in transition and taking estrogen or progesterone, your increased sensitivity to alcohol makes the feedback we provide for women more appropriate. Click here to return to the assessment.