Shape-Shifting, Mistrust, and Medical Trauma: How Structural and Intersectional Stigma Impact Health Engagement Among Transmasculine Individuals

Background and Purpose:
Transmasculine individuals assigned female at birth (AFAB) encounter persistent stigma and structural exclusion in healthcare, contributing to widespread medical mistrust and trauma. Guided by the Gender Affirmation Framework and theories of intersectional stigma, this study explores how transmasculine individuals navigate health systems marked by cisnormativity, racism, ableism, and other intersecting oppressions. The study investigates how stigma-related experiences shape engagement with care, contribute to trauma and mistrust, and lead to alternative strategies for managing health needs—including informal information networks and strategic self-presentation.

Methods:
This qualitative study draws on three focus groups and thirty interviews with transmasculine, nonbinary, and gender-diverse AFAB individuals in the greater Philadelphia region. Participants were recruited through community networks and trans-affirming organizations. Data collection included in-depth discussion of healthcare experiences, stigma-related stressors, and health information-seeking practices. Transcripts were analyzed using reflexive thematic analysis. The Gender Affirmation Framework and Critical Health Literacy informed the analytic approach.

Results:
Participants described enduring forms of structural stigma—such as gendered medical forms, exclusionary insurance codes, and physical environments like “women’s health” clinics—that reinforced anticipatory stigma and discouraged care-seeking. Intersectional stigma amplified these dynamics for participants who are multiply marginalized (i.e. race, class, body size, or disability). Medical trauma was a recurring theme, with participants reporting misgendering, sexual objectification, pathologization, and invasive questioning—especially in reproductive and sexual health contexts. This trauma contributed to pervasive medical mistrust and healthcare avoidance. To navigate hostile systems, participants employed “shape-shifting” strategies, including performative pathology (exaggerating distress to access care), binary conformity (downplaying queerness), and reliance on “clinical co-conspirators”—affirming providers who discreetly bypassed restrictive protocols to meet care needs. While these tactics sometimes improved access, they often came at an emotional cost. Participants also described turning to peer networks and online forums to access, vet, and disseminate health information in lieu of institutional support.

Conclusions and Implications:
Findings illustrate how intersecting forms of stigma produce lasting medical trauma and mistrust among transmasculine people, contributing to reduced engagement with preventive care and disproportionate reliance on informal networks. For social work research and practice, these results underscore the need for trauma-informed, trans-affirming models that recognize and address structural stigma. Policies must center trans leadership in designing care systems, revise gatekeeping protocols for gender-affirming interventions, and support clinical partnerships that uphold bodily autonomy. Social workers are well-positioned to advocate for structural reforms and promote collaborative models of care that recognize identity-based harm and restore trust through affirming, community-led solutions.