Strategies Used By Transmasculine Adults to Resist and Reduce the Impact of Structural Violence in Healthcare

Background and Purpose:

Transgender and gender-diverse people face notable risks for stigma, a process that enacts violence on trans people through stereotyping and social rejection. Transgender stigma is theorized as occurring at the structural, interpersonal, and individual levels, including in healthcare. Transmasculine adults are documented as experiencing unique barriers in healthcare, such as a lack of gynecological care and sex education that reflect their needs and bodies. National surveys have indicated that transmen may be more likely than transwomen to delay needed medical care due to financial costs or stigma.

While the occurrence of stigma is well-documented, there is a need for research into the actions that can be taken to counteract such violence in healthcare—particularly at a structural level—including actions taken by transmasculine patients. The research question of this qualitative study is: What strategies do transmasculine adults use to resist and reduce the impact of transgender structural stigma in healthcare?

Methods:

For this qualitative study, semi-structured interviews took place with 25 transmasculine adults, aged 18 or older, in one Mid-Atlantic city. Participants were recruited via flyers in the city’s LGBT health center, announcements at trans support groups, and word-of-mouth. Each interview lasted between 45-180 minutes. Interviews elicited detailed narratives, including stories about family and intimate relationships to experiences accessing healthcare.

Using thematic analysis, a team of three researchers analyzed the interview data, coding meaning units in response to the a priori research question. Codes and over-arching themes were discussed between the researchers until consensus was reached, and then the final codebook was created. The first author then reviewed the data to link meaning units to codes.

Average participant age was 33 (range 20-57). Half of the sample was White, 25% were Black/African American, and 25% were multiracial. Most had some college education.

 

Results:

We identified eight themes in the data related to resisting and reducing structural stigma in healthcare: (a) using social support for help navigating the healthcare system (e.g., gathers information from peers, seeks emotional support); (b) acting to improve the healthcare system for trans patients at large; (c) persistence/works within the existing healthcare system to meet health needs (e.g., identifies ways to get medical needs covered by insurance); (d) finds knowledgeable and sensitive providers; (e) self-advocates; (f) strategically discloses trans identity to facilitate better healthcare; (g) health literacy (gathers information and research and uses to inform healthcare interactions); and (h) avoids mainstream healthcare (e.g., asks friends with medical training for advice/care, self-manages care). Our analysis includes discussion of how intersectionality and privilege play important roles in what strategies are used or available to transmasculine participants.

Conclusions and Implications:

This study highlights how transmasculine adults have navigated an incredibly violent and cisnormative healthcare system by disrupting the status quo, advocating, persisting, and creating trans-centered social networks for emotional care, health literacy, and meeting health needs. The discussion will highlight how these strategies challenge violent norms in healthcare and connect to broader efforts of resistance in a political climate of heightened transphobia in the U.S.