Gender Identity: Pending? Health and Mental Health Care Experiences of Transmasculine Individuals

Background/Purpose:

A growing body of literature has documented the medical, mental health, and psychosocial needs of members of the transgender community. However, much of the existing research focuses on transgender women, or, individuals who were assigned male at birth but who transition to female through the use of hormonal and/or surgical interventions. Less attention has been given to the needs, experiences, and barriers to accessing health and social services that are faced by individuals who identify on the transmasculine spectrum. The transmasculine community consists of gender variant individuals who were announced as female at birth but who identify their gender with a prominent masculine component. 

This qualitative research study explores the medical and mental health care experiences of individuals who identify along the transmasculine spectrum. The study addresses the following research questions: 1) What are the experiences of transmasculine individuals in seeking and receiving medical and mental health services? 2) What role do medical, mental health, and social services providers and systems play in transmasculine identity development?

Methods:

Using a qualitative grounded theory approach, data were collected through semi-structured interviews with 28 adult participants.  They ranged in age from 23 to 59 (mean age 34.4). A majority of participants were white (71.4% white, 10.7% African American, 3.6% each Native American, Asian, and mixed race). In terms of gender, 16 respondents identified as “male”; other categories included genderqueer (n=4), trans (n=3), ftm (n=2), and other (n=7).   Multiple participants (n= 8) described themselves using more than one gender category. Participants were recruited using electronic calls for participants disseminated through social networking sites and the LGBT listserv at a large public university.

Participants shared their experiences with health and mental health services across a variety of settings (private therapy offices, hospitals, public clinics, and primary care physician offices). Participants also shared how their interactions with providers, organizations, and the larger managed care system impacted (both positively and negatively) their experiences of identity development. Interviews were transcribed verbatim and analyzed using grounded theory analysis techniques, using Atlas.ti qualitative analysis software.

Results:

Through examining participants’ lived experiences from a non-medicalized, social-psychological framework, the complex interactions between transmasculine individuals and health practitioners and systems are highlighted. The results indicate that various components of health care provision appear to impact transmasculine identity development. Access to trans-friendly care, trans-friendly organizational qualities, health insurance coverage for transgender health services, and relationship-centered communication with providers all lend themselves to a positive, affirming experience of identity. Conversely, lack of access/avoidance of health care, absence of organizational policies, health insurance denials, and provider hostility all contribute to a pathologized sense of identity and avoidance of the health care system.

 Conclusions/Implications:

This study provides valuable insight into the nature of barriers and hostility that transmasculine individuals face in health settings. While transgender identity is often viewed as an individual “problem” or disorder, the results of this research highlight that there are complicated individual, social, and political components to the development and maintenance of transmasculine identities.