Transmasculine People Research Articles

Brief Report:Availability of and Interest in Gender-Affirming Care, PrEP, and HIV Prevention Services in a Global Sample of Transmasculine Persons

Background: We assessed access to pre-exposure prophylaxis (PrEP) and interest in integration of PrEP with gender-affirmative care in a global sample of transmasculine persons. Methods: Transmasculine persons (N = 590) aged 18 years and above from 57 countries completed a brief online survey from April to July 2022 about sexual behavior, knowledge, and interest in PrEP, current access to PrEP and gender-affirmative care, and preferred context for accessing PrEP. Descriptive analyses were stratified by country income group. Results: Most participants (54.4%) lived near a health center offering care to trans people. Overall, 1.9% of respondents reported ever receiving a positive HIV test result. Among those who had not (n = 579), more than a third reported engaging in receptive sex in the past year (35.2%) or anticipated doing so in the next year (41.5%), 86.9% had never received information about HIV prevention specific to transmasculine people, and 76.3% had heard of PrEP. Among those who had heard of PrEP (n = 440), only 18.9% had discussed or been offered it by a provider, and only 3.6% were currently taking it—yet 67.9% who had heard of it but were not using it would “definitely” (28.5%) or “maybe” (39.4%) be interested in taking it were it available for free. Out of these participants, the majority (60.5%) preferred the idea of accessing PrEP from the same clinic where they received gender-affirming care. Conclusions: Interventions are needed to improve PrEP access for transmasculine people globally. Clinics already providing gender-affirming care to trans people are acceptable clinical contexts to integrate such interventions.

PrEP Use in a US National Sample of Trans Men and Other Transmasculine People Who Have Sex With Men: A Longitudinal Analysis

Introduction: Efforts to improve pre-exposure prophylaxis (PrEP) uptake among gay men, transgender women, and Black cisgender women are evident across the United States, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other transmasculine people who have sex with men (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning has yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. Methods: Using data from a prospective US national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. Results: Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24 months, with about one-third of users discontinuing within 1 year. Health insurance, having had lower surgery, used post-exposure prophylaxis, or recently having a sexually transmitted infection were associated with increased odds of PrEP use. Conclusion: We found low uptake of PrEP and high discontinuation rates in a US national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.

A qualitative exploration of knowledge attainment, safety practices and accessibility barriers to chest binding

ABSTRACT Objectives Chest binding is a common gender-affirming practice that transmasculine individuals can engage in for a range of reasons, including masculinising their physical appearance, which can facilitate gender euphoria, or alleviate gender dysphoria. In this study, we explored chest-binding experiences with a focus on knowledge attainment, understandings of safety and accessibility factors for those interested in binding. Method The study involved 15 semi-structured qualitative interviews with transmasculine people in Australia (aged 20–37 years) who have past or current chest binding experiences. These were analysed using thematic analysis. Results Data analysis resulted in the generation of four themes: 1) Online and social communities influence understandings of binding practices; (2) Learning about safety in binding is often self-directed; (3) Difficulties of navigating the application of safe binding within daily life, and (4) Common accessibility barriers to binding can be mitigated by trans communities. Conclusion The evidence in this study showed that chest-binding knowledge is acquired in diverse ways, and knowledge around safety and accessibility is not always readily available or easy to locate. However, participants unequivocally expressed that the practices are a crucial form of affirming care. Future research should continue to focus on creating strong, evidence-based affirming healthcare models for transmasculine Australians.

Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care.

Trusted networks: a study of communication flow and access to abortion information in Argentina.

In December 2020, Argentina approved a new abortion law following decades of feminist and social advocacy. This paper presents qualitative findings from interviews and focus group discussions with people in local communities focusing on how individuals of reproductive age access and communicate sexual and reproductive health information, particularly regarding abortion. Sixteen in-depth interviews were conducted with key informants working in the field of SRHR and four focus group discussions took place with cisgender women and girls, transmasculine people and non-binary people of reproductive age. We found that information exchange and communication about sexual and reproductive health issues, particularly abortion, took place mainly through informal social networks engaging with activists and feminist grass-root organisations. These informal social networks were built on trust as a collective affect that enabled open communication about abortion. Information sharing through word of mouth, in person and via digital means using different social media platforms, is an important means of information sharing and communication in Argentina. Monitoring the implementation of abortion policies in this country should include investigating the impact of people accessing abortion through informal social networks in terms of abortion pathways and intersections with the formal health system.

Toward a “Freedom Life”: Notes on Transmasculine Placemaking in the “World-Class” City of New Delhi

The epistemological formations of area studies and critical regionality have been instrumental in situating the politics of gender-sexual variance in the Global South. Recent scholarship in India encourages further rescaling of queer and trans studies to account for the mutual entanglements of sexual and caste modernity, rights-based organizing, and metronormativity. Following this work, this article considers the possibilities offered by emphasizing the micro-locality of the urban neighborhood. A reading of two Delhi-based documentary films, Who Can Speak of Men? (2003) and Yeh Freedom Life (2019), the article troubles the idea of a unitary global and national trans subject. Conceptualizing the urban neighborhood as method and mode of reading transmasculinity compels a rethinking of the dichotomous framings of metropolitan queer as elite and transgender as abject. This article provides a trans microcartography wherein the world- and place-making work of transmasculine people enables a reimagining of masculinity in the neoliberalizing Indian “world-class city”.

O-116 Fertility in transmasculine people

Abstract Transgender and gender diverse (TGD) people apply for gender-affirming care at any age to manage gender identities or expressions that differ from the gender socially attributed to their sex assigned at birth. Gender-affirming hormonal treatment (GAHT) and gender-affirming surgery (GAS) may alter reproductive function and/or anatomy, limiting future reproductive options to varying degrees, if persons have the wish to either give birth and, or to become a biological parent. The desire to have children in TGD people does not differ from that of the cis population. In those persons assigned female at birth but who identify as male or genderdivers medical transition often comprises testosterone to induce masculinisation. The effect of testosterone on the uterus and ovaries and further reproductive outcome has not been fully clarified so far. There are several histological studies showing ovarian cortical and stromal changes following testosterone exposure, it is uncertain what the consequences for future fertility may be. It seems there is persistent activity in folliculogenesis by the descriptions of follicle count, distribution and oocyte retrieval. However, there are studies showing a negative effect on fertilization rate in presence of testosterone. Reports on successful ovarian stimulation, fertilizations, pregnancies and live births have been published, with and without testosterone discontinuation. In this lecture an overview will be given of the recent literature and guidelines on fertility outcome in TGD people assigned female at birth, specifically the effect of medical transition. Recommendations on counseling and ways of fertility preservation will be discussed.

The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis.

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

The gender of PrEP: Transgender men negotiating legitimacy in France

Transmasculine people (TM) constitute an invisibilized group within the transgender population. Little is known about their relationship to sexuality in transgender medicine. Their presence and needs are still unacknowledged within HIV prevention research and services. Pre-exposure prophylaxis (or PrEP) is an oral medication that prevents HIV in HIV-negative individuals at risk of infection with the virus. This paper proposes to bring TM back into the focus of PrEP research by questioning how they navigate and situate themselves in relation to existing PrEP categorization and services, and how they think about and (re)shape the meanings of PrEP. It is based on the “interpretative descriptive” method and a transfeminist theoretical framework applied to the analysis of ten semi-structured interviews with TM conducted in France between 2019 and 2023. Findings show that PrEP is gendered. We identify specific barriers to getting PrEP as well as to access healthcare and we show that a cisnormative and homonormative approach to prevention generates them. PrEP use and PrEP disclosure are embedded in structural and symbolic power relations between cisgender and transgender MSM that are reflected in the intimate sphere. TM use PrEP to prevent sexual assault and to alleviate the difficulty of condom negotiation. PrEP comes into play following major changes in TM's sexualities and is integrated post-exposure.

One-third of amenorrheic transmasculine people on testosterone ovulate

Transmasculine people usually reach amenorrhea within 6months of adequate testosterone treatment. It is often assumed that no ovulation occurs during amenorrhea. However, in this study, we report recent ovulatory activity in amenorrheic transmasculine people on testosterone therapy at gender-affirming oophorectomy. Histological signs of recent ovulatory activity, including the presence of ovulatory follicles, corpus luteum, and corpus albicans, are observed in 17 of 52 individuals (33%). This is not significantly correlated to the duration, testosterone serum levels, or type of testosterone used. These results suggest that amenorrhea does not equal anovulation in transmasculine people on adequate testosterone therapy, emphasizing the importance of contraception for people who engage in sexual activity that can result in pregnancy.

Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities.

Bacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center. Retrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics. During 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13-0.27)]. The low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined.

A qualitative exploration of the motivations and implications of chest binding practices for transmasculine Australians

Introduction Trans and gender diverse individuals experience heightened levels of poor mental health outcomes compared to cisgender people. For transmasculine people, a contributor to this disparity can be chest dysphoria, which can be addressed through the masculinization of one’s physique in a practice known as chest binding. Current research is limited in its breadth and depth, with there being a scarcity of literature on chest binding motivations and subsequent implications. Addressing this gap, this study aimed to qualitatively explore the chest binding motivations and implications experienced by transmasculine Australians. Method Fifteen semi-structured interviews were conducted with participants recruited via convenience and snowball sampling techniques. Qualitative data were analyzed and presented using an inductive approach based in reflexive thematic analysis. Findings Six themes were identified during data analysis. Three characterized motivations for binding: (1) chest binding’s role in euphoric experiences of gender, (2) alleviating distress and improving wellbeing, and (3) interacting with the social world. Three characterized binding implications: (1) baseline experiences of negative physical discomfort, (2) contextual and environmental complexities of negative experiences, and (3) binding’s relationship with clothing and dress. Discussion Together, these findings revealed that transmasculine individuals often face a tradeoff of priorities when engaging in chest binding practices. The benefits driving motivations for binding come with implications that can create difficulty and occasionally hinder physical health. However, chest binding is viewed as a need as opposed to a choice by transmasculine individuals, with emotional wellbeing often being prioritized. Implications Findings have a practical view of guiding safe and effective use of chest binding in gender affirming care models, as well as informing transmasculine suicide prevention strategies.

Dietary Supplement Use in Transmasculine People: Results of an Online Survey of Volunteer Adults

Introduction Health inequities and disparities in nutrition research exist among transmasculine people. A dearth of evidence on dietary supplement use and motivations exist, partially due to constrained collection of sex and gender identity in national surveys. Objective We sought to investigate common motivations and use of dietary supplements in a voluntary survey of transmasculine people. Methods A total of 48 participants completed an online survey detailing dietary supplement use, motivations, and demographic information. Results 64.5 and 90.0% of participants reported use of 1+ dietary supplement within the past 30-days and during some point in their lifetime, respectively. Top reported product types used included multivitamins (52%), melatonin (52%), vitamin D (46%), vitamin C (35%), fish oil (33%), B-vitamins or B-complex (31%), iron (29%), green tea (29%), biotin (25%), cranberry (23%), zinc (23%), protein powder (23%), probiotics (23%), and calcium (21%). There was no relationship between the number of supplements reported and participant age, BMI, income, or mastectomy status (p > 0.05). Participants reported top motivations being for “improving my overall health” (60.4%), “maintaining health” (54.2%), to “supplement my diet due to not getting enough from food”(41.7%), “mental health” (39.6%), and to “prevent colds, boost immune system” (33.3%). Conclusion Transmasculine people in our study reported a high use of dietary supplements. Differences in the types of products and number of products used, as well as specific motivations for use likely exist within this subpopulation, however, future nationally-representative longitudinal studies are needed to fully elucidate these patterns and for informing evidence-based nutrition guidance.

(345) Sexual Health Outcomes After Gender Affirming Metoidioplasty: A Systematic Review

Abstract Introduction Previous studies have evaluated surgical outcomes and aesthetic results of Genital Gender Affirming Surgery (GGAS) while few studies have examined sexual outcomes after GGAS. Objective We sought to systematically review the literature on sexual health outcomes of metoidioplasty in the transmasculine population. Methods PubMed, Embase, and Web of Science was used to identify studies through April 29, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Figure 1 shows search terms, inclusion, and exclusion criteria. Results Fourteen papers were included. Findings on arousal/desire ranged from 86% (n=48) reporting desire for sex to 100% (n=1455) reporting no difficulty in arousal. Preserved erogenous sensation and no issues with masturbation was reported in 100% of people across studies (n=1164;1455). Orgasm ability ranged from 66-70% (n=115) who were able to orgasm during sexual activity or masturbation to 100% (n=1455) who had no problems with orgasm. Orgasm satisfaction was found to be 100% (n=48). A study found that 80% (n=15) had challenges with erections, with 83% (n=18) of Erection Hardness Scores were ‘larger but not hard’ or ‘hard but not hard enough for penetration.’ Earlier studies reported 100% of people had an erection (n=1599), and ratings of ‘satisfied’ or ‘partially satisfied’ in 94% (n=145). Across studies, 87-100% were unable to have penetrative sex (87% unable, n=15; 100% unable, n=737). For some, the inability to penetrate was the most dissatisfactory aspect of the metoidioplasty for 39% of patients (n=28). Conclusions Current literature on transmasculine people undergoing GGAS shows high ratings of arousal/desire, preservation of erogenous sensation, masturbation, and ability to orgasm following metoidioplasty. Data on the ability and adequacy of erection is less definitive. Overall ratings of sexual health appear high, but inability to have penetrative sex remains a source of persistent dissatisfaction for some. Further studies using surveys validated in transmasculine populations are needed to definitively describe sexual function after GGAS. Disclosure No.

Policing Motherhood, Controlling Families: Race, Reproductive Governance, and Trans Women’s Parenting Rights

Transgender people face multiple challenges to securing and maintaining parenting rights, yet most studies on trans parenthood focus exclusively on trans masculine people’s experiences and feature majority white samples. To address gendered and racialized gaps in knowledge, I conducted 54 semi-structured interviews with trans women in the United States, who parent or wish to parent, across race and class backgrounds. Using the intersectional frameworks of racialized transmisogyny and reproductive governance, I examine the barriers to parenting rights that trans women encounter in adoption and custody disputes. I find that judges and case workers use racist and anti-trans stereotypes when evaluating “parental fitness,” which (1) institutionalizes racialized transmisogyny in the law, (2) increases the regulatory power of legal institutions, and (3) reinforces dominant mothering ideologies. I also discuss how everyday people (i.e., partners and family members) co-construct the legal and symbolic meaning of motherhood, illustrating the centrality of trans reproduction to the policing of trans and other minoritized communities.

“Oh! Based on Voice, Assigned Female at Birth”: Transmasculine Voices and Gender Construction

The physical voice is one of the most noticeable gender signifiers utilized in everyday social interaction. For trans people, their voice can be a medium through which to affirm and assert their gender, or a source of dysphoria which regularly ‘betrays’ their identity to others. Because of the effects of masculinizing hormone replacement therapy (HRT), transmasculine people tend to have an easier time changing their voices to their desired pitch than transfeminine people. However, even when on testosterone, transmasculine people may feel pressure from both inside and outside their own communities to sound a certain way due to transnormative narratives that gain traction in mainstream media and online transmasculine spaces like Tumblr and YouTube. Transmasculine people who are nonbinary face further challenges asserting their identity through their voice due to having to frequently operate within the gender binary when it comes to gender membership. Through qualitative semi-structured interviews, I explore how two transmasculine participants view the relationships between their voice, gender identity, and the social world. I identify that trans people face pressures to sound a certain way from both cis- and transnormative lenses. I find that nonbinary transmasculine people particularly struggle with these pressures as having too high of a voice results in constant misgendering, and fears around both safety and keeping community arise with the threat of the “T-voice.”

Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation.

Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people.

Genderplay: Reclaiming and Reconfiguring Femininity through the Gendered Labor Practices of Transmasculine Sex Workers

Abstract This article explores the gendered labor of transmasculine sex workers as they navigate client requests for genderplay, an eroticized form of gender misrecognition. Drawing on in-depth interviews with transgender men and AFAB nonbinary sex workers, I conceptualize this specific form of gendered labor as reclaimed and reconfigured femininity, a skilled labor process that can produce unique pleasures and pains for this group of workers. Accomplishing reclaimed and reconfigured femininity requires negotiating the demands, anxieties, and erotic needs of clients, which can come into conflict with their identities as transmasculine people. Despite the potential costs of such investments of emotional labor, I find that this process can become a subversive practice of self-exploration and gender-making, as well as a source of pleasure for the workers themselves. The gendered consequences of paid genderplay are more complicated and even contradictory than they first appear. Although the process of reconfigured and reclaimed femininity described here is, in many ways, unique to sex work or to transmasculine experiences of work, it also offers fresh insight for sociological analysis of gender, labor, and pleasure.

Factors Associated with HIV Pre-Exposure Prophylaxis Use Among Transmasculine People Who Have Sex with Cisgender Men, at a Federally Qualified Health Center in Chicago, Illinois.

Transmasculine individuals who have sex with cisgender men (TMSM) remain an understudied population regarding pre-exposure prophylaxis (PrEP). We used electronic medical record data to assess PrEP eligibility and initiation in TMSM in a large LGBTQ+ focused federally qualified health center in Chicago, Illinois. We examined a sample of 430 TMSM from January 1, 2015 to December 31, 2019, and used logistic regression to model PrEP eligibility and initiation. Overall, 37% of participants were eligible for and 18% initiated PrEP. Eligibility was not associated with initiation. National PrEP guidance should be tailored to include transmasculine people.

Adaptation of a HIV Prevention Mobile App for Transmasculine People: A Pilot Acceptability and Feasibility Study

Adaptation of a HIV Prevention Mobile App for Transmasculine People: A Pilot Acceptability and Feasibility Study