Background : In the U.S., the majority of research among transgender and non-binary populations is risk and deficit based and often focused on trans feminine adults and HIV. Little is known about the psychological processes of gender identity affirmation among transmasculine adolescents and young adults.
Methods : This is a secondary qualitative analysis of cross-sectional data collected in 2015 as part of the Affirming Voices for Action (AVA) project, a mixed-methods study whose primary focus was to examine barriers and facilitators to HIV prevention and care among transgender and non-binary adolescents and young adults ages 16-24 in 14 U.S. cities associated with the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN). This analysis is focused on the qualitative in-depth interviews of 29 adolescents and young adults from 12 cities who reported being assigned female sex at birth and who identify as male, men, transmen, or another transmasculine identity.
Results : Participants described self-affirmation as a complex, iterative process through which they gained confidence and self-assurance in their masculine gender identity or expression. The self-affirmation process discussed by participants included constructs of gender identity exploration, gender identity acceptance, and gender identity enactment. Engagement with these aspects of the self-affirmation process can result in positive self-image and promote resilience, allowing youth to know, be, and advocate for themselves.
Conclusions : Understanding self-affirmation processes, within the context of oppression and discrimination, has implications for clinical training and practice, program development and implementation, and continued research with transgender and non-binary youth. This qualitative analysis highlights the lived experiences of transmasculine youth and describes a crucial process of identity development among this population and includes the positive role of medical gender affirmation in transmasculine youth's ability to understand and express their gender identity.