Experiences of Reproductive Health Among Transgender Men Following Surgical Gender Affirmation

Abstract

Genital reconstruction is a hallmark gender affirmation procedure for a distinct subset of transgender men that require physical congruence with their expressed gender identity. Those that proceed with genital reconstruction are faced with a particularly finite set of decisions related to their physical body and emotional well-being, including the concession of their child-bearing potential. Current literature lacks a focus on the long-term implications of such outcomes, as well as an emphasis on fertility, biological parentage and non-infectious reproductive health concerns. The complex personal impact of dramatic gender affirming procedures remains an extraordinarily unmet need and was the focus of this research. The purpose of this study was to explore the experiences of reproductive health among child-bearing aged transgender men who underwent sterilizing genital reconstruction as a critical step in their gender affirmation journeys. A qualitative descriptive methodology, rooted in a complex adaptive systems (CAS) framework, allowed the principal investigator (PI) to support an environment of open dialogue to capture the holism of participants’ stories which could otherwise be deprioritized in pursuit of a linear and deterministic approach to data collection. Ten participants were recruited through social media and a leading reconstructive surgical practice for transgender persons. Each participant completed semi-structured, one-on-one interviews using videoconferencing and demographic questionnaires. Inductive data analysis, including affective coding, revealed thematic and categorical relationships which added a deeper emotional dimension to the subjective coding techniques. Six overarching themes of Gender Experience, Gender Affirmation, Fertility Concerns, Emotional Experiences, Health Care Provider Interactions and Communication were found. In addition to informing the narrative about the patterns and beliefs about fertility preservation, this study also expressed additional subcategory findings including self-acceptance, discovering one’s gender identity, and the complex impact of health care provider (HCP) interactions on this phenomenon of interest. These findings underscored the vital interdependency of research and practice and highlight opportunities for real-time advancements, as well as future endeavors to advance science and the standard of care for transgender patients.