While cisgender males tend to adhere to hegemonic models of masculinity, trans men may express masculinity in different ways. These differences have clinical implications, and clinicians should be aware of them.
Many trans men participate in sport, including organized team and individual sports at high school and college levels. They also engage in sexual behaviors such as receptive genital sex.
Gender identity
Gender identity refers to a person’s internal sense of gender; it can be the same as or different from assigned sex at birth. Gender identity is less commonly known than sex, and some people may not understand the difference between the two. Those who believe that someone can be a different gender than their assigned sex at birth are more likely to have lower levels of education and to live in rural areas.
Overall, about half of adults say they think that society has gone too far or not far enough in its acceptance of transgender and nonbinary people. Opinions differ by demographic characteristics and partisanship. Young adults and those without a four-year college degree are more likely to say that society has not accepted transgender and nonbinary people far enough, while Republicans are more likely to say that society has gone too far.
Sexual orientation
Transgender men and women often experience a range of sexual orientations. They may be erotically attracted to the opposite biological sex—women to men or men to women—or they may be attracted to all genders. It can be difficult to determine their orientation without offending them or creating confusion.
Several studies have shown that transgender people’s sexual orientation is very fluid. One study found that a majority of transgender men and nonbinary individuals endorsed being attracted to more than one partner gender during their sexual lives (Fig. 2A).
Future research should assess sexual orientation using updated measures that are inclusive of transgender people’s varied identities and experiences, as well as their varying behaviors and attractions. These measures include plurisexuality, which enables people to identify as having sexual orientations involving any gender or a combination of genders, as well as bisexuality and asexuality. This is especially important given that many transgender people have reported shifts in sexual orientation during and after transition.
Health
Transgender men may have unique health needs, particularly gynecologic care. Some of these patients need pap smears, annual mammograms and other routine screenings. Those who have had top surgery for male-contoured chests may also need a breast exam to be familiar with their new anatomy.
Many of the participants in a study of gynecologic needs for transgender men reported difficulties receiving regular health care because they feared revealing their gender identity to their medical providers. The male/female boxes on the health intake forms and pronoun usage by medical staff were a major source of confusion and conflict.
Some transgender people may experience mental health conditions such as anxiety or depression at higher rates than their cisgender peers. It is important for them to find a mental health provider who is sensitive and comfortable working with transgender patients. This could include a transgender counselor or someone who is experienced in treating LGBTQ+ clients. Finding a therapist can be difficult, but it is possible to ask for referrals from trusted LGBTQ+ friends and family or a transgender support group.
Socialization
In this CI, participants described their experiences with transphobia and its repercussions on their lives. These repercussions included social isolation and family discord. They also included a lack of confidence in the health care system and an incentive to engage in unsafe self-care, such as using illegal networks to purchase hormones without a prescription.
Many of the participants in this CI lived in the South, a region known for its stereotypical views of masculinities and men. As such, they often felt pressure to perform stereotypical masculinities in their everyday lives. For example, one respondent said he felt that being a man meant taking care of his wife and children.
These responses indicate that the repercussions of transphobia may be more pronounced in rural settings than in urban ones. This is important because it may affect the outcomes of a transgender person’s life. In addition, it may affect their relationship with the wider LGBTQ community. This research contributes to nursing science by highlighting the need for increased support for transgender people.