Background : Substance use and sexual risk behaviors among transwomen have been investigated in the field of HIV prevention and care. However, very few studies have investigated health promotion and risk behaviors among transmen and gender non-binary persons. As the first phase of a large study aiming to longitudinally investigate the interaction of substance and hormone use and psychosocial factors among transwomen, transmen, and gender non-binary persons (TTGNP), this study aimed to describe substance and hormone use behaviors in relation to psychosocial factors among TTGNP based on qualitative methods.
Methods : A total of 61 TTGNP (self-identified TTGNP, age from 18 to 29 years, and residing in the San Francisco Bay area) were recruited based on purposive sampling and were interviewed using an interview guide with structured open-ended questions. The interviews were transcribed verbatim and coded and analyzed based on interpretative phenomenological analysis/grounded theory and thematic analysis. The interview took about an hour, on average. Participants were: Mean age= 24.4 years; 27.9% Caucasian, 16.4% African Americans, 14.7% Asians, 11.5% Latina/o, and 27.9% others; 86.9% U.S.-born; 79.5% single; 47.5% with at least some college; 32.0% reporting less than $10,000 annual income; 14.3% identified as gay or lesbian, 21.4% bisexual, 21.4% heterosexual, and 42.9% other.
Results : Preliminary analyses revealed eight domains: 1) Gender identity (early life and current experiences), 2) Discrimination/stigma related to gender/racial minority status/identity, 3) Socioeconomic status, 4) Mental health issues, 4) Substance use, 5) Hormone use (prescribed and non-prescribed hormone use), 6) Social support, 7) Health care access and experiences. Most participants started not conforming with one particular binary gender norm in early childhood. During the transitions, they often experienced rejection, isolation, and discrimination that increased minority stress and in turn, some started abusing substances and struggling with mental health problems. A participant abusing opiate stated: “you know…to escape, I guess. Yeah, a euphoric high. The same reason anyone does.” Non-prescribed hormone use was not prevalent, but some used them in combination with prescribed hormones to facilitate their envisioned body images. Although transgender health care is available in the Bay area, many expressed challenges to access physical and mental health services specific to TTGNP.
Conclusions : It is crucial to assure that TTGNP have access to safe and transgender and non-binary sensitive health care and social services. The qualitative interview data will be further explored interaction non-prescribed hormone and substance use behaviors in relation to health and mental health outcomes.