“I Had Completely Ignored My Sexuality...That's for a Different Time to Figure Out”; Sexual Orientation and Gender Identity Development Among Young Transgender Adult Men Who Have Sex with Men

Background and Purpose: Making meaning of previous life experiences and constructing a sense of self are important developmental tasks associated with adolescence and emerging adulthood. For many lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, these tasks are made more difficult by a lack of available narratives or representations of LGBTQ identities. While previous research has explored the identity development processes and challenges of LGB youth, a comparatively small number of studies consider the experiences of transgender youth. Transgender men who have sex with cisgender males (TMSM) in particular represent an understudied and overlooked population who likely experience unique developmental tasks related to the intersection of socially stigmatized sexual orientation and gender identities. This study explores sexual orientation and gender identity development among a sample of young adult TMSM.

Methods: The analysis is part of a larger study adapting a group-based behavioral HIV prevention intervention for young adult TMSM aged 18-29 years old. Participants were recruited via online, clinic, and venue-based sampling conducted in Boston, MA. Study staff conducted 18 baseline visits, which included a quantitative closed-ended survey, HIV and STI testing, and a qualitative interview. The mean age of the sample was 24.3; 23.5% identify as People of Color and 76.5% as White. Building upon Life History Calendar methods adapted for qualitative research, participants were asked to construct a personal history timeline, identifying milestones in the development of their sexuality and gender identity. A staff member trained in the personal history timeline method conducted all 18 interviews. The interviews were transcribed, and transcripts reviewed for errors and omissions. Study staff conducted content analysis and open coding, and developed a thematic codebook. Transcripts were then organized according to each code in Dedoose, and assessed for inter-rater reliability. The coders wrote reflexive memos to facilitate ongoing reexamination and discussion among the study team to allow for theorizing and making interconnections between research questions, coding categories, and raw data.

Results: The results provide an understanding of the ways in which young adult TMSM construct and make meaning of their gender transition and affirmation experiences. Among the emergent themes were: early childhood gender memories; coming out and transition processes; family rejection and support; patterns and changes in sexual attractions and reconceptualization of sexual orientation; partners’ affirmation of gender identity; influence of transmasculine role models and/or media representations. Conflations of gender identity and sexual orientation contributed participants’ confusion about how to reconcile sexual attraction with gender identity. Many participants discussed fear of losing support from lesbian and/or feminist communities and invisibility within communities of gay men.

Conclusions and Implications: By identifying several themes related to sexual and gender identity development among young adult TMSM, this study combats invisibility and contributes to a better understanding of the diverse experiences of this community. Implications for future research, interventions, and clinical care to increase support for young adult transgender men will be discussed.