Masculine identity development and health behaviors in transmasculine individuals: A theory of gender and health

Masculinity is a driving factor in health behaviors of cisgender men; however, there is little research about conceptualizations of masculinity and their impact on health behaviors among transmasculine populations. This study sought to construct a theoretical framework for masculine identity development in transmasculine individuals in the United States, and the impact this process has on their health behaviors, specifically alcohol and tobacco use. Twenty-four in-depth interviews were conducted as part of the Masculinity and Self-Conceptualization Study (MASCS). We analyzed the data using grounded theory. Transmasculine individuals iteratively drafted, questioned, and revised their masculinity. Alcohol and tobacco and other harmful health behaviors associated with traditional masculinity were often featured in early drafts of masculine identity as tools of gender affirmation. As participants grew into their masculinity and began being affirmed in their gender through legal, social, or medical means, their reliance on negative health behaviors as a gender affirmation tool often decreased. Harmful health behaviors such as alcohol and tobacco use featured prominently into early transition or masculine identity adoption for many transmasculine individuals in this study, and they frequently conceptualized engaging with alcohol and tobacco as a behavior that allowed them to access masculinity. Substance use interventions for transmasculine individuals should move away from a framework that focuses on alcohol, tobacco, and other negative health behaviors solely as a coping mechanism for cissexist stigma and trauma, toward a framework that supports transmasculine individuals in strengthening alternative tools to explore and affirm gender to prevent and reduce substance use. The Masculine Identity Development framework has the potential to be applied to other negative health behaviors and can identify the associations between adopted masculine characteristics and negative health outcomes.