Real Talk: Honest Conversations Improve Healthcare Experiences for Transmasculine Individuals

By: Marcus O. Reed

Trans-men/Masculine Individuals Healthcare Needs & Challenges:

Road trips can be a gateway for discovery, offering opportunities to uncover information about fellow members of the communities that we’re a part of and the state of these communities as a whole. From June 9 to November 4 of 2023, Atlanta-based organization Game Changing Men (GCM) took to the road to learn about the sexual and reproductive health needs and challenges of Black/African American trans-men/masculine individuals throughout the Southeast. After visiting 11 cities across this region (10 states and Washington, DC), GCM weaved together the rich stories of these communities and developed five key takeaways:

1. Trans-men/masculine individuals engage in a range of sexual practices and behaviors

All trans-men/masculine individuals have unique and distinct identities. Therefore, the sexual practices and behaviors of this community will reflect this diversity. Maintaining the assumption that trans-men/masculine individuals have sex and behave the same way denies their individuality. It is important for providers to understand this because it helps ensure that trans-men/masculine individuals receive care that is tailored to their unique experiences and needs.

2. There are gaps in providers’ knowledge about the transmasculine community

Providers generally lack knowledge about the unique sexual and reproductive health needs of trans-men/masculine individuals. As a result, providers often assume a one-size-fits-all approach, ignoring the healthcare wants and needs of many trans-men/masculine individuals. This serves as a reminder that additional training and information about caring for this community effectively is crucial. After all, an informed provider is a responsible provider.

3. There are misconceptions in healthcare about trans-men/masculine individuals

Unfortunately, but not surprisingly, gaps in providers’ knowledge can result in misconceptions. Among the deeply problematic misconceptions some providers believe about trans-men/masculine individuals is the idea that trans-men/masculine individuals have a lower chance of acquiring HIV/STIs due to existing, false assumptions about trans-men/masculine individuals. For instance, some providers assume that trans-men/masculine individuals mainly have intimate relationships with cis-gender women which reduces their chance of acquiring HIV/STIs – despite knowing that  gender identities of trans-men/masculine individuals’ sexual partners vary, and aren’t exclusively cis-gender women. This inaccurate belief about the risks facing trans-men/masculine leads to poor usage of prevention services.

4. More inclusivity in medical settings is needed for trans-men/masculine individuals

Even though some trans-men/masculine individuals have pleasant experiences when seeking care, a fair amount of trans-men/masculine individuals don’t share this experience, and anticipate or deal with discrimination or discomfort in healthcare/medical spaces. Failure to provide trans-men/masculine individuals welcoming and identity-affirming spaces can discourage them from seeking care for the first time or again in the future.

5. Accessible healthcare is critical for trans-men/masculine individuals

A major barrier for trans-men/masculine individuals seeking care is finding services that are both accessible and located nearby. It is unreasonable to expect them to pursue and stay engaged in care if it requires traveling long distances or if the available services do not address their specific sexual and reproductive health needs. Similar to other communities, trans-men/masculine individuals desire care that is accessible and beneficial.

Recommendations To Improve Trans-men/Masculine Healthcare Experiences:

Overall, the insights gained from this tour revealed a broader message: changes in the healthcare field are urgently and desperately needed for trans-men/masculine individuals. With an understanding of some common issues shared by focus group participants, the next step in the conversation focuses on action—specifically, on practical and meaningful solutions to address these challenges. Following completion of the road trip, this list of concerns and facing trans-men/masculine individuals evolved into a list of thoughtful recommendations aimed at improving healthcare experiences for this community:

1. Adopt a status-neutral approach

Regardless of their HIV-status, all trans-men/masculine individuals deserve to receive respectful and comprehensive care. Providers that discriminate against trans-men/masculine individuals on the basis of their HIV-status stigmatizes them and imposes yet another barrier to seeking care. Providers must practice a status-neutral approach to ensure that trans-men/masculine individuals obtain wholistic care that meets their sexual and reproductive health needs.

2. Improve provider training

Even though knowledge gaps among providers exist, these knowledge gaps don’t have to persist. In fact, these knowledge gaps can be filled by providers practicing more “T.L.C.,” allowing them to better serve trans-men/masculine individuals. In this context, “T.L.C.” stands for train, listen, and correct. Formally train providers so they can learn more about this community; remind providers to actively listen to the wants and needs of this community instead of assuming what they are; and correct internal practices that don’t support appropriate, comprehensive, and accessible healthcare for trans-men/masculine individuals.

3. Make healthcare spaces more inclusive

Like other communities seeking healthcare, trans-men/masculine individuals want to receive care where they feel respected and seen. A key step to improving the healthcare experience of trans-men/masculine is creating identity-affirming and welcoming healthcare spaces that encourage them to return there. For example, having identity-affirming posters on the walls of these spaces and offering services that meet their specific needs are appealing ways to accomplish this goal and help them feel safe. As the late Maya Angelou once said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

4. Dedicate resources to benefit trans-men/masculine individuals

To give these recommendations real impact, it is essential to support them with funding, time, and other valuable resources. Bringing these ideas to life requires sustained and dedicated investment. Yes, it’s that cut and dry.

5. Connect with the transmasculine community continuously

In spite of GCM’s tremendous efforts to help improve the healthcare experience of trans-men/masculine individuals by conducting this impressive road trip, it’s still not enough. The changes listed  take time to be incorporated and implemented, however that won’t happen without being in constant communication with the transmasculine community to advance this work by incorporating their expertise and lived experiences.

Bearing all this information in mind, improving the healthcare experience of trans-men/masculine individuals in meeting their sexual and reproductive health needs is a joint effort between community especially trans-men/masculine individuals and organizations led by trans-men/transmasculine individuals, healthcare providers, and others who are dedicated to advancing health equity for under-represented communities. Though this discussion is major step in the right direction to ensure and provide trans-men/masculine appropriate, affirming, and accessible care, the conversation doesn’t end here, but in fact is the beginning of much larger one.

As we continue to move this conversation further along, join our Instagram Live discussion on November 16^th featuring global activist and recording artist 2AM Ricky, nationally known Ob-Gyn Dr. Betsy Collins, members of GCM, and other special guests and transmasculine individuals offering their firsthand experience addressing the healthcare needs of trans-men/masculine individuals. We look forward to seeing you there!

Please note that these takeaways and recommendations reflect the experiences of the Black trans-men/masculine individuals who participated in the Real Talk on the Road focus groups and shouldn’t be mistakenly perceived as the experiences of all Black trans-men/masculine individuals. This piece is intended to help voice their unique experiences, recognizing that this community is often overlooked, unheard or silenced.