Masculinity performed by transgender men: qualitative evidence and metasynthesis

Experiência da masculinidade performada por homens transgêneros: evidências qualitativas e metassíntese

Abstract

Masculinity is a construct associated with cisgender men; however, transgender men also perform masculinities. This study aimed to synthesize, analyze, and reinterpret the findings of primary qualitative studies about transgender men’s experience of masculinity. The research question developed through the SPIDER strategy was: What is the qualitative evidence of masculinity performed by transgender men? Eighteen studies involving over 200 transgender men between the ages of 19 and 65 were selected. Three descriptive themes emerged: “Bodily performance of masculinity,” “Social performances of masculinity,” and “Sexualities.” Analytical themes were generated: “The appearance of masculinity” and “Far beyond appearance”. The results point to complementary experiences of masculinity: concerning physical appearance and body modifications; and the practices contesting the hegemonic masculinity standard. The experience of masculinities is outlined by body changes, culminating in the passability and social recognition of the transgender man.

Keywords
Gender identity; Masculinity; Transgender persons; Transsexuality

Resumo

A masculinidade é um constructo associado aos homens cisgêneros; entretanto, homens transgêneros também performam masculinidades. O objetivo deste estudo foi sintetizar, analisar e reinterpretar os achados dos estudos qualitativos primários acerca da experiência da masculinidade de homens transgêneros. A questão de pesquisa, desenvolvida por meio da estratégia SPIDER, foi: Quais são as evidências qualitativas da experiência da masculinidade performada por homens transgêneros? Foram selecionados 18 estudos que envolveram mais de 200 homens transgêneros com idades entre 19 e 65 anos. Emergiram três temas descritivos: “Performances corporais da masculinidade”, “Performances sociais da masculinidade” e “Sexualidades”. Foram gerados os temas analíticos: “A aparência da masculinidade” e “Muito além da aparência”. Os resultados apontam para experiências de masculinidade complementares: relativas à aparência física e às modificações corporais e às práticas contestadoras do padrão de masculinidade hegemônica. A vivência das masculinidades é delineada pelas alterações corporais, culminando na passabilidade e no reconhecimento social do homem transgênero.

Palavras-chave
Identidade de gênero; Masculinidade; Pessoas transgênero; Transexualidade

Masculinity is a sociocultural construct that refers to the expected roles those male individuals should play (Formiga & Camino, 2001). Hegemonic masculinity describes the normatization of masculinity and its constant reference to an (unattainable) pattern of practices that “[…] incorporate the most honorable way of being a man” (Connell & Messerschmidt, 2013, p. 245), evoking notions of power, legitimacy and privilege (Baptista-Silva et al., 2017; Halberstam, 1998).

The concept of performativity, proposed by Butler (2018/1990), designates the production of social patterns of identities and practices based on the man/woman binarism and on the differentiation of bodies. Therefore, masculinity presents itself as a performative effect experienced by the subject as a natural identity, although it is not. The transgender male population (set of subjects who do not identify themselves with the female gender assigned at birth and their corresponding performances) uses biomedical technologies (Santos et al., 2019) and adopts performative components of masculinity that give subjects an appearance ideally attributed to men, allowing them to present a social passability. This phenomenon is understood as the ability of the individual to be visibly recognized as belonging to the gender with which he/she identifies, in this case, the male gender (Cunha, 2019; Almeida, 2012).

In a systematic review of the process of social construction of masculinities (Martins & Nascimento, 2020) it is observed that only cisgender men were considered, which suggests that transgender men tend to be excluded. It is necessary to adjust the focus of attention to this segment of the LGBTQIA+ population in order to understand their specificities and have a broader look at masculinities, incorporating divergent and non-hegemonic perspectives. Systematic reviews dedicated to the transmale population are mostly in reference to health (Gatos, 2018; Sbragia & Vottero, 2019; Stephenson et al., 2017).

After conducting a non-systematic search, it was found that the scientific literature does not present reviews specifically referring to masculinities performed by transgender men. Considering this gap, the purpose of this meta-synthesis was to synthesize, analyze and reinterpret the results of primary qualitative scientific studies on the experience of masculinity performed by trans men.

Method

Postulated by Sandelowski and Barroso (2003, 2006), metasynthesis is a type of systematic review of the analysis of qualitative studies that consists of an interpretive integration of primary qualitative studies, which allows building new interpretations of research results, offering an integrated description of an event or experience. Primary studies correspond to original investigations that report first-hand research results, obtained based on the application of scientific methods.

In order to properly operationalize the meta-synthesis, the reference of Sandelowski and Barroso (2006) was adopted; they propose six systematic steps: definition of the research question, parameters and search strategy; retrieval of qualitative evidence through systematic searches in databases; selection of articles to be analyzed; methodological evaluation of selected studies; extraction and analysis of data from the articles; elaboration and presentation of a qualitative synthesis. The purpose at the end of the process is to create a new analysis, based on the integration of the primary qualitative findings.

The guiding question of the meta-synthesis was developed using the SPIDER (acronym for Sample, Phenomenon of Interest, Design, Evaluation, and Research Type) strategy and was formulated as follows: Which are the qualitative evidences of masculinity experience performed by transgender men? Inclusion criteria were exclusively primary qualitative studies; addressing issues related to masculinity by transgender men. Exclusion criteria included quantitative or mixed designs, secondary studies, gray literature, theoretical studies, themes or population divergent from the research focus.

Searches were conducted in March 2020 and there was no time limitation because of the reduced number of studies addressing this topic. The construction of the search strategy was also based on SPIDER, and was designed to identify qualitative studies through the combination of descriptors, which include synonyms and keywords, interconnected by the Boolean operators AND and OR (Methley et al., 2014) ) (Table 1).

Table 1
SPIDER search strategy in MEDLINE/PubMed database

Sample (S)	“Transgender Persons/classification”[Mesh] OR “Transgender Persons/history”[Mesh] OR “Transgender Persons/psychology”[Mesh] OR “Transgender Persons/statistics and numerical data”[Mesh] OR “Person, Transgender” OR “Persons, Transgender” OR “Transgender Person” OR “Transgenders” OR “Transgender” OR “Transgendered Persons” OR “Person, Transgendered” OR “Persons, Transgendered” OR “Transgendered Person” OR “Two-Spirit Persons” OR “Person, Two-Spirit” OR “Persons, Two-Spirit” OR “Two Spirit Persons” OR “Two-Spirit Person” OR “Transsexual Persons” OR “Person, Transsexual” OR “Persons, Transsexual” OR “Transsexual Person” OR “Transexuals” OR “Transexual” OR “Transmasculine” OR “Sexual and Gender Minorities/classification”[Mesh] OR “Sexual and Gender Minorities/education”[Mesh] OR “Sexual and Gender Minorities/history”[Mesh] OR “Sexual and Gender Minorities/psychology”[Mesh] OR “Sexual and Gender Minorities/statistics and numerical data”[Mesh] OR “Dissident, Sexual” OR “Dissidents, Sexual” OR “Sexual Dissident” OR “Sexual Minorities” OR “Minorities, Sexual” OR “Minority, Sexual” OR “Sexual Minority” OR “Gender Minorities” OR “Gender Minority” OR “Minorities, Gender” OR “Minority, Gender” OR “Intersex Persons/statistics and numerical data”[Mesh] OR “Intersex Person” OR “Person, Intersex” OR “Persons, Intersex” OR “Transsexualism/classification”[Mesh] OR “Transsexualism/ethnology”[Mesh] OR “Transsexualism/etiology”[Mesh] OR “Transsexualism/history”[Mesh] OR “Transsexualism/psychology”[Mesh] OR “Transsexualism/statistics and numerical data”[Mesh] OR “Transgenderism”
Phenomenon of Interest ( Pi)	“Masculinity/history”[Mesh] OR “Social Behavior/analysis”[Mesh] OR “Social Behavior/classification”[Mesh] OR “Social Behavior/ethics”[Mesh] OR “Social Behavior/ethnology”[Mesh] OR “Social Behavior/etiology”[Mesh] OR “Social Behavior/history”[Mesh] OR “Social Behavior/psychology”[Mesh] OR “Social Behavior/statistics and numerical data”[Mesh] OR “Behavior, Social” OR “Behaviors, Social” OR “Social Behaviors” OR “Social Identification”[Mesh] OR “Social Identity” OR “Identities, Social” OR “Identity, Social” OR “Social Identities” OR “Identification, Social” OR “Identifications, Social” OR “Social Identifications” OR “Group Identification” OR “Group Identifications” OR “Identification, Group” OR “Identifications, Group” OR “Social Stigma”[Mesh] OR “Social Stigmas” OR “Stigmas, Social” OR “Stigma, Social” OR “Stereotyping”[Mesh] OR “Stigmatization” OR “Gender Identity/history”[Mesh] OR “Gender Identity/psychology”[Mesh] OR “Gender Identities” OR “Identity, Gender” OR “Sex Role” OR “Role, Sex” OR “Roles, Sex” OR “Sex Roles” OR “Gender Role” OR “Gender Roles” OR “Roles, Gender” OR “Gender” OR “Men’s Role” OR “Role, Men’s” OR “Roles, Men’s” OR “Man’s Role” OR “Role, Man’s”
Design (D)	“Focus Groups”[Mesh] OR “Focus Group” OR “Group, Focus” OR “Anthropology, Medical”[Mesh] OR “Medical Anthropology” OR “Grounded Theory”[Mesh] OR “Theory, Grounded” OR Culture OR “Thematic synthesis” OR “Hermeneutics”[Mesh] OR Hermeneutic OR Ethnographic OR “ethnographic research” OR Phenomenology OR “phenomenological research” OR Narrative OR “Interviews as Topic”[Mesh] OR Interviewers OR Interviewer OR Interviewees OR “Group Interviews” OR “Group Interview” OR “Interview, Group” OR “Interviews, Group” OR “in-depth interview” OR “qualitative interview” OR “content analysis” OR “semantic analysis”
Evaluation (E)	“Experience” OR “Experiences” OR “Sense” OR “Senses” OR “Meaning” OR “Meanings” OR “Life Change Events”[Mesh] OR “Event, Life Change” OR “Events, Life Change” OR “Life Change Event” OR “Life Experiences” OR “Experience, Life” OR “Experiences, Life” OR “Life Experience” OR “perspective” OR “perspectives” OR “Subjectivities”
Research Type (R)	“Qualitative Research”[Mesh] OR “Research, Qualitative” OR “Qualitative studies” OR “Qualitative” OR “Empirical Research”[Mesh] OR “Research, Empirical”

Two independent reviewers (LCB; ECG-R) performed systematic literature searches in seven databases as follows: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), Latin American and Caribbean Literature in Health Sciences (Lilacs), American Psychological Association Databases (PsychINFO), Medical Literature Analysis and Retrieval System Online (Medline/PubMed), SciVerse Scopus and Web of Science.

The selection of studies was performed using the Rayyan Intelligent Systematic Review^® software from Qatar (Ouzzani et al., 2016). The Kappa Test, which result (0.89) indicates that there was an almost perfect agreement between the two evaluators (Viera & Garrett, 2005), validated the final selection of articles. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guide was used to report the essential elements that should make up a synthesis of qualitative evidence (Tong et al., 2012).

The flowchart (Figure 1) of search and selection of articles followed the recommendations contained in the PRISMA guidelines (Moher et al., 2009). Out of the 1359 studies identified, 207 were excluded because they were duplicates. The remaining 1152 articles had their titles, abstracts read independently by the evaluators, and 1130 references were excluded, in accordance with the inclusion and exclusion criteria. In this computation, references that added more than one exclusion criterion were counted more times. The remaining 22 articles were read in full. At this stage, four more studies were excluded: one article of document analysis, an undergraduate course conclusion work, a study carried out with another population and another that did not portray masculinity. Thus, the research corpus ended up with 18 articles.

Figure 1
Flowchart of the search and selection process of meta-synthesis articles, according to PRISMA guidelines

Results

Two independent reviewers based on the Critical Appraisal Skills Program (Critical Appraisal Skills Program, 2018) instrument and proved to be adequate verified the methodological quality of the studies. Out of the articles reviewed, 10 met all criteria, six studies met nine criteria, one study included eight items and another study included six items. According to Sandelowski and Barroso (2006) recommendations no article was excluded based on this quality assessment, because it is understood that, when excluding qualitative studies due to inadequacies in the research reports or due to methodological problems identified by the reviewers, there is a risk of eliminating studies with findings that can be valuable for clinical practice, which are not necessarily invalidated by their potential limitations (Table 2).

Table 2
Quality assessment of selected articles according to the Critical Appraisal Skills Program

Questions (CASP)	Reference Article
	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18
1. Was there a clear statement of the aims of the research?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
2. Is a qualitative methodology appropriate?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
3. Was there a search design appropriate to address the aims of the research?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
4.. Was the recruitment strategy appropriate to the aims of the research?	✓	✓	✓	✓	✓	?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	?
5....Were the data collected in a way that addressed the research issue?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	?
6.. Has the relationship between researcher and participants been adequately considered?	✓	✓	?	✓	✓	?	✓	✓	⬛	✓	✓	✓	✓	✓	?	✓	✓	?
7. Have ethical issues been taken into consideration?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	?	✓	✓	✓	✓	✓	✓
8. Was the data analysis sufficiently rigorous?	✓	✓	✓	?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	?	?
9. Is there a clear statement of findings?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
10. How valuable is the research?	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓

• Note: Yes ✓; No ⬛; Can’t Tell ?. CASP: Critical Appraisal Skills Program. References: 1: Klein et al. (2019); 2: Martin and Coolhart (2019); 3: Klein et al. (2018); 4: Sousa and Iriart (2018); 5: Tree-McGrath et al. (2018); 6: González-González et al. (2018); 7: Hoffkling et al. (2017); 8: Johnson et al. (2020); 9: Peitzmeier et al. (2017); 10: Armuand et al. (2017); 11: Azul (2016); 12: Brown et al. (2016); 13: MacDonald et al. (2016); 14: Ramos-Pibernus et al. (2016); 15: Safavifar et al. (2016); 16: Budge et al. (2015); 17: Williams et al. (2013); 18: Bento (2012).
  Source: Critical Appraisal Skills Program (2018).

Regarding the studies’ country of origin, 10 originated in the United States, two in Brazil and the rest in Australia, Spain, Sweden, Iran, Canada and Puerto Rico each with one report. The design of the studies were varied. The investigations were based on Exploratory Research, Case Studies, Grounded Theory, Social Constructionism and Ethnography; 11 were presented only as qualitative studies.

Regarding the data collection methods used in the studies, semi-structured interviews, in-depth interviews, video diary and data collection, mixed methods were used, combining: interviews and field notes, semi-structured interviews and reflective diary, ethnographic observations, focus groups and individual semi-structured interviews and, finally, participant observation and semi-structured interviews.

As for data analysis, the studies employed thematic content analysis, qualitative content analysis, Consensual Qualitative Research, Grounded Theory data analysis, narrative and transfeminist approach, Interpretive Phenomenological Analysis (IPA), interpretive description, critical analysis of the discourse, Foucaultian discourse analysis, interpretive anthropology, deductive-inductive approach and inductive coding. Two articles did not specify the framework adopted for data analysis. The detailed characterization of the studies is presented in Table 3.

Table 3
Characterization of articles included in metasynthesis (n = 18)

Author, year and country	Objective	Research design, data collection and analysis	Participants / Age	Main Results
Klein et al. (2019) United States	Explore the social, hormonal and athletic experiences of a trans-athlete during his gender transition	Case study; Formal and informal interviews; Narrative and transfeminism approach	n = 1; 20 years	Hormone administration can influence the mental and emotional state of the trans athlete. Providing social support and having financial resources during the transition are critical
Martin & Coolhart (2019) United States	Understand how trans-male people of different sexual identities experience their sexual experiences, despite their bodily dysphoria	Qualitative research; Semi structured interview; Interpretive Phenomenological Analysis (IPA)	n = 10; 39.7 years average	Gender identity affirmation of sexual partners can contribute to more satisfying sexual experiences
Klein et al. (2018) United States	To investigate what physical changes occur during the first year of testosterone therapy in a trans athlete and how the hormone affects their athletic performance	Case study; Video diary; Narrative and transfeminism approach	n = 1; 20 years	The physical changes observed with the regular use of testosterone were facial enhancement, hair, body fat redistribution, emotional or mood disturbances, physical training and effects on sport performance
Sousa & Iriart (2018) Brazil	Discuss the health needs and demands of trans men	Qualitative research; Participant observation and semi-structured interviews; interpretive anthropology	n = 10; 20 to 43 years	Health demands are related to de-pathologizing, body modification and outpatient care
Tree-McGrath et al. (2018) United States	Investigate positive and negative aspects of sexuality and sexual development for trans MSM in relation to their gender affirmation	Qualitative research; Semi structured interview; Grounded Theory data analysis	n = 16; age group not informed	Affirmation of gender provided greater confidence and openness to explore sexual interests
González-González et al. (2018) Spain	Understanding the experience of undergoing surgical procedures for sex reassignment	Qualitative research; Semi-structured interview and reflective diary; unspecified analysis	n = 7; 21 to 47 years	Factors influencing body modification: need to accept one’s own body, relationship with family, social environment and partner, organization of services and economic aspects
Hoffkling et al. (2017) United States	Identifying the needs of transgender men that emerge in the family planning process and during the postpartum period	Semi structured interview; Grounded Theory data analysis	n = 10; age group not informed	Participants prioritized transition versus reproduction. Physicians’ guidance was essential to foster safety
Johnson et al. (2020) United States	Identify the determinants of performing routine tests to detect cervical cancer in transgender men	Exploratory research; Semi structured interview; Deductive-Inductive Approach	n = 20; 33-year average	Main factors identified health professionals and organizations. Previous negative experiences, issues of gender identity and socioeconomic status were reported
Peitzmeier et al. (2017) United States	Examine the factors influencing Pap smear testing among trans-male individuals	Qualitative research; In-depth interview; Grounded Theory data analysis	n = 32; 21 to 64 years	Main factors identified identity negotiation, doctor and health plan. The degree of distress triggered by the exam ranged from “routine” atraumatic
Armuand et al. (2017) Sweden	Evaluate how trans men experience Fertility Preservation (FP), aiming at the cryopreservation of oocytes in a pilot program, developed within a university hospital program	Qualitative research; field interviews and notes; Thematic content analysis	n = 15; 19 to 35 years	Importance of professionals’ manifestation of sensitivity during the performance of FP procedures, medical knowledge, use of neutral language and the proper pronoun
Azul (2016) Australia	Explore aspects related to the trans-male gender and vocal situation of these individuals	Social constructionist; Semi-structured interviews; Deductive-Inductive Approaches	n = 14; 29.6-year average	It is a heterogeneous population with regard to aspects related to gender and their vocal situations
Brown et al. (2016) United States	To broaden the understanding of the experiences lived by adult trans men (FTM), with the aim of informing clinical practice and research	Qualitative research; Semi structured interview; Consensual Qualitative Survey (CQR)	n = 11; 22 to 40 years	Participants credit their satisfaction with post-transition life to their positive self-identity and the way men express their concerns about acquired privilege and claim to be attracted to women
MacDonald et al. (2016) Canada	Establish a body of knowledge about trans male individuals and their lactation and breastfeeding experiences	Qualitative research; Semi-structured interviews; interpretive description	n = 22; 24 to 50 years	Most participants chose to breastfeed, while some could not due to their physical or mental health. Healthcare professionals need to be knowledgeable about lactation and breast care after masculinizing mammoplasty and binder use before pregnancy, during pregnancy, postpartum and after
Ramos-Pibernus et al. (2016) Puerto Rico	Document identity constructions of trans men and buchasª	Exploratory research; Ethnographic observations, focus groups, and in-depth semi-structured individual interviews; critical discourse analysis	n = not informed; age group not informed	Two domains addressed by health policies and initiatives are emphasized: (1) body representations and gender performance, and (2) meanings of female biological processes
Safavifar et al. (2016) Iran	Understanding aspects of the religious experience of trans men after undergoing sex reassignment surgery	Qualitative research; In-depth interviews; Qualitative content analysis	n = 7; 22 to 29 years	The confluence of aspects of religious experience with spirituality comprised the central experiences of the participants. This is closely related to concepts such as secularism, stigma and technocracy
Budge et al. (2015) United States	Examine how gender socialization can affect trans men’s positive experiences and emotions	Qualitative research; Semi-structured interviews; Grounded Theory data analysis	n = 11; 20 to 49 years	Gender-specific experiences refer to a sense of brotherhood, enthusiasm related to taking testosterone, authentic pride in identifying as a man, and happiness related to others using the correct gender language
Williams et al. (2013) United States	Investigate the ways in which a group of people who have moved away from a given gender identity may come to experience another gender identity and how this is incorporated into sexuality	Qualitative research; Semi-structured interviews; inductive coding	n = 25; 20 to 65 years	The results show the link between gender and sexuality because of the bodywork that trans men do and the history and geographical situations in which they find themselves
Bento (2012) Brazil	Pointing out how a given concept of gender can make multiple expressions of gender visible and present narratives of trans men and trans womenª about their sexual experiences	Ethnography; In-depth open interviews; Foucaultian Discourse Analysis	n = 3; group age not informed	Trans experiences reveal the traces of truths constructed for gender, for sexualities and subjectivities. There is no typical sexual identity for trans people

• Note:
• ^ª
  Analyzed only the narratives of transgender men.

The synthesis of the results of qualitative studies followed the approach of thematic synthesis (Thomas & Harden, 2008). This approach is a process divided into three phases proposed for the identification and development of themes, covering: first step, free coding, line by line, of the results of primary studies and creation of “free codes”; second step, the organization of these “free codes” in related areas to build descriptive themes; and third step, the development of analytical themes (Thomas & Harden, 2008). The QDA Miner Lite software was used to facilitate management and codification of the studies.

The 18 articles were published between 2012 and 2019 and totaled about 214 participants. Two studies addressed the same subject and one publication did not indicate the number of participants. The age of the studies, participants ranged between 19 and 65 years. Based on content analysis, 43 free codes were created related to three descriptive themes, which in turn gave rise to two analytical themes. The authors of this meta-synthesis freely translated all excerpts from texts in Portuguese or Spanish.

Discussion

Descriptive theme 1: masculinity bodily performances

This descriptive theme consisted of seven codes: genitals (12 articles), breasts (9 articles), testosterone (7 articles), increased body and facial hair (5 articles), voice thickening (4 articles), clothing (3 articles) and muscle mass gain (3 articles).

The genitals represent a particular challenge, as they appear in a diversity of experiences: from subjects who do not experience discomfort or “problem” with their female genitals – “I decided very early on, when I realized I was transsexual, that I wouldn’t get myself that immense hatred that many have toward their female parts” (Armuand et al., 2017, p. 388) – even those who feel extremely uncomfortable with this part of the body – “[…] it is hard to undergo a procedure that reminds me of the body part I hate the most” (Johnson et al., 2020, p. 4).

However, the breasts are the part considered by transgender men as the body component that connects them most to the female body and, therefore, they most want to eliminate, due to the extreme discomfort the breasts cause and because breasts prevent their figures from being socially read and allocated as masculine: “We call breasts invaders. Because it is something that is not part of us [...] even if society would accept a man with... breasts, for us this would not be the ideal figure” (Sousa & Iriart, 2018, p. 7).

Study participants reported adherence to bodily aspects socially classified as masculine based on performances such as haircuts and clothing. The starting point of the social transition for most transgender men is the haircut: “I cut my hair shorter and started to transition” (Ramos-Pibernus et al., 2016, p. 974). Clothing is also one of the most used markers by transgender men to express their masculinity, understanding that culturally masculine clothing would help them to be understood as men in the eyes of other men: “Nowadays, I buy pants in women’s department stores because they fit me, but I prefer to buy in the men’s area. I also wear male underwear” (Ramos-Pibernus et al., 2016, p. 974).

The use of testosterone is perceived as the main resource for the transition of transgender men who understand that this is the way they value to express their body masculinity and which ensures increased passability, as one participant puts it: “You know, when taking testosterone you mean wanting the body to be more manly” (Armuand, 2017, p. 387). One of the participants commented that, despite making regular use of hormones, he would have preferred not to use them for the sake of being legitimized as a man (Sousa & Iriart, 2018, p. 6): “For you to be a man, you don’t need to take hormone. You take hormones if you’re fit, if your body is fit to receive them”.

One of the expected results of hormonization is the deepening of the voice. Hormone use enhances a masculine look through voice change, muscle development and body fat redistribution. Low timbre is valued as a way of expressing a certain ideal of body masculinity: “[My] voice is definitely a lot thicker now, so that’s amazing” (Klein et al., 2018, p. 561).

The construction of a muscular body is highly valued and desired by some transgender men, who are sensitive to the reading of the culture that identifies a correspondence between the bulky/stiffened body tone and masculinity that is socially attributed to men: “I did eight hours of physical exercise per day” (Bento, 2012, p. 2661). Another highly desired result is the growth of body hair, especially facial hair, which is associated with male morphology:

How is this at the moment? [Are you attributed male gender by others?] P2: Actually, it is always the case, but I am still scared it may not work some day; this is why I attach a beard to my face every day

(Azul, 2016, p. 679).

One can perceive that masculinity performed by transgender men owes much to the construction of a body compliant to what they believe to be a prototype (actually, stereotype) of the individual with masculine attributes. It is observed in most transgender men a search for the reproduction of certain homogeneous characteristics, having found only one excerpt of speech that represents an exception.: “I’m never gonna be what I see, what I really want and so I’m always gonna have this acceptance; this is what I’m gonna get and I have to be happy with that, but I’m no longer as uncomfortable” (Budge et al., 2015, p. 418).

Descriptive theme 2: social performance of masculinity

This descriptive category refers to the social order instruments that will consolidate, challenge or affirm the transgender men’s male identity. It refers to established gender norms (8), social recognition (7) and the socialization process (2).

Socially established gender norms are used as a guide for identifying the masculinity of a transgender man, who will seek to strictly comply with them in order to be legitimized and avoid having his masculinity challenged. This happens, for example, with an eventual pregnancy, a process so atavistically understood as exclusive to the woman that it is not possible to conceive or assimilate the possibility of a pregnant man: “People could not process my masculine appearance with pregnancy […]. How can [this cashier] think that I’m male when I’m eight-and-a-half months pregnant?” (Hoffkling et al., 2017, p. 10). Gender norms also affect other bodily characteristics, such as the presence of breasts, which are automatically associated with the female body: “I really like to swim and I felt really vulnerable whenever I would go swimming, like everyone is seeing me as a woman when I go swimming” (MacDonald et al., 2016, p. 14).

The “socialization” code refers to dissimilar education that involves boys and girls in childhood, shaping different worldviews (Martínez-Guzmán, & Íñiguez-Rueda, 2017). This makes them reflect on male privileges, but at the same time, they can choose not to condone male and misogynistic attitudes and behavior: “A lot of misogyny or sexualization or degradation of women comes up among them. It’s hard for me to hear that because I know what it feels like. I’ve been in that position” (Klein et al., 2019, p. 633).

Social recognition works as a legitimization from the other: “[...] I often got gendered male, and I always felt validated and good about [that]” (Tree-McGrath et al., 2018, p. 6). Being recognized and having their male identity validated is extremely important for these subjects to feel empowered in the face of challenging situations that, as a rule, they will have to face, especially given the gender norms that prevent them from being read in this way. Respect for the social name and the use of pronouns aligned with what is socially prescribed to refer to the male gender – are requirements considered essential for the legitimization of the transgender man’s male identity:

If my stepmother was sending me a card or talking to me, she would say ‘he’ or ‘son.’ [...] And the other day, she said ‘[John], you’re a really good man.’ And man, that just […] I was flying high all night

(Budge et al., 2015, p. 421).

Descriptive theme 3: sexualities

The most reiterated theme in this category was the transgender men’s sexual attraction and the need to define their sexuality based on this attraction, which also involves defining themselves with regard to gender, as Bryan states: “The most common question was ‘oh you’re not gay?’ I would say ‘no I identify myself as a male and generally when you think of a guy who likes women, you don’t think lesbian” (Klein et al., 2019, p. 631).

Another participant, Adam, completes this reasoning by arguing that, as a man, he believes he should not have a relationship with a lesbian woman: “I don’t want to be with a lesbian because they have to be with [me] a man” (Martin & Coolhart, 2019, p. 11). These statements indicate that these transgender men are afraid of being identified as women in their intimate relationships, which excludes the possibility of a relationship with a lesbian woman. From this reflection, we understand that, in order to enhance their identification with the male gender, these individuals enhance the precepts of heteronormativity, when they claim to be heterosexual.

Transgender men may eventually identify themselves as homosexuals, based on their male identity: “I’ve always really enjoyed gay male attention because it’s men that, like, not only do they see me as a guy, but they see me as a hot guy. So, it feels good” (Tree-McGrath et al, 2018, p. 6). These statements indicate that sexuality connects the subject’s identification with the validation that one seeks to obtain from the other’s perception, which corroborates the social component of sexuality (Soares et al., 2011).

Furthermore, the sexual act itself is framed by the heteronormative gender norms that guide their masculinity – “[…] sensation around my front hole can remind me of […] sex I had as a woman” (Williams et al., 2013, p. 728). Early in his transition, Kevin assumed a physical position exclusively on top of the woman during sexual intercourse; currently, he manages to lay beneath the woman without feeling less of a man, because “it doesn’t make me less of a man anymore” (Williams et al., 2013, p. 733).

From the analysis of the results, the following analytical themes emerged “The appearance of masculinity” and “Far beyond appearance”.

Analytical theme 1: the appearance of masculinity

This analytical theme was developed from the integration of the descriptive themes and emerged quite clearly and prominently in the studies, as all the selected articles point out that the experience of masculinity goes beyond the material body of the subjects in different ways. It is understood that this way of living masculinity is primarily anchored in the subject’s physical appearance. Appearance is interpreted as an exterior aspect that makes masculinity visible, both for the subject performing it and for others, based on the construction of an image ideally designated as masculine by cisgender subjects. This body structuring is due to the absence of breasts (Brown et al., 2016; González-González et al., 2018; Klein et al., 2018, 2019; MacDonald et al., 2016; Martin & Coolhart, 2019; Peitzmeier et al., 2017; Sousa & Iriart, 2018; Safavifar et al., 2016); short haircut (Klein et al., 2018, 2019; Martin & Coolhart, 2019; Ramos-Pibernus et al., 2016), deep voice (Azul, 2016; Budge et al., 2015; Klein et al., 2018; Martin & Coolhart, 2019), sober clothing (Klein et al., 2019; Martin & Coolhart, 2019; Ramos-Pibernus et al., 2016), presence of facial hair (Azul, 2016; Klein et al., 2018; Martin & Coolhart, 2019) and prominent muscles (Bento, 2012; Klein et al., 2018; Ramos-Pibernus et al., 2016). Such attributes have the function of materializing and making palpable the concept of masculinity, which is initially immaterial, that is, it is not essentially linked to corporality, but rather to performance and representation.

Some articles report situations in which some transgender men in certain circumstances (Hoffkling et al., 2017; MacDonald et al., 2016) suspend these gender norms, as with the experience of pregnancy and breastfeeding. Despite resisting the binary and transgressing the system a second time, as soon as possible transgender men choose to return to gender norms through the use of binder (binding that flattens the breasts), application of testosterone and performing a masculinizing mammoplasty after breast-feeding (MacDonald et al., 2016).

Analyzing the masculinity experienced by transgender men, this corresponds, at least in terms of appearance, to hegemonic masculinity (Connell & Messerschmidt, 2013) and to the gender norms established for cisgender men – people who identify themselves as men and were so designated at birth on account of their genitals. In this sense, we propose the concept of conditioned transgression to elucidate this movement carried out by transgender men. Transgression refers to the action of transgressing, infringing, violating a norm, subverting a precept. It goes back to the action that these subjects practice by infringing the norm of socially imposed cisgenderness, which results in the reaction of making transgender subjects unintelligible and abject. Conditioned refers to something that has been subjected to certain conditions; it is something that is established by binding, dependent. It refers to the process by which transgender men, as well as cisgender men, are conditioned to gender norms that will define what a man is and how he should present himself, in reference to male performativity.

Analytical theme 2: far beyond appearance

It is understood that masculinity is also anchored in sexual practices, especially when subjects do not interpret their actions through gendered and heteronormative performances. Masculinity is anchored in the subject’s self-identification, that is, in the understanding he produces about himself, based on what he understands himself to be and how he wants to position himself, regardless of external influences. Some identify themselves simply as men: “I identify myself as a male. So I would appreciate it if you could please refer to me as Bryan, or if you’re going to talk about me to somebody else, please use male pronouns” (Klein et al., 2019, p. 631). While others refer to themselves as transsexual or transgender men: “I feel good about being like, “Hey, I am transgendered [sic] and I don’t care if you care about that or not. If you have a problem with it then that’s your problem, it’s not my problem” (Budge et al., 2015, p. 416).

Transgender men understand that cis men exhibit behaviors and attitudes in order to prove themselves men because of gender stereotyping. Study participants report that they question such heteronormative practices; for example, Kevin claims he will not adopt these same behaviors to validate his masculinity: “[...] guys think I’m just another guy and they can tell rape jokes around me and I’m not ok with that you know. Like that’s just not ok” (Brown et al., 2016, p. 28). They also reflect on the privileges they acquired with passability: “I just want to solve my problem and get my male passability, you know, like, so that I don’t suffer anymore? […] I don’t want just that. I want everyone to have the right to walk without fear” (Sousa & Iriart, 2018, p. 7).

Going back to the experience of masculinity, as it is performed by transgender men, as a process intrinsically related to bodily changes and physical appearance, we propose the original concept of conditioned transgression, which allows us to think that, just like cisgender men, these subjects condition their performativities based on the norms of how a man is, or how he should be (Butler, 2018/1990). Specifically, regarding transgender men, the process of mimicking male gender markers ensures certain security in terms of protection against possible manifestations of transphobia, favoring social recognition and respect via passability (Cunha, 2019). Alluding to issues other than the materiality of this masculinity representation, transgender men are able to carry out a movement that challenges hegemonic masculinity based on binary logic, in the sense that they build masculinity without its major symbol – the phallus. In addition, they constitute themselves as being men even having breasts, or possibly being pregnant or breastfeeding, understanding themselves as homosexual (when they choose another man as an object of desire) and, especially, from the non-agreement with values, attitudes and behaviors that maintain the subordinate position of women in the patriarchal system (Halberstam, 1998).

In short, at first glance transmasculinity is experienced homogeneously and essentially through appearance and bodily materiality. However, from other vertices of analysis, we can see the orchestration of several other experiences that question the performance of masculinities. It is understood that the transition process is far from being restricted to external changes, on the surface of the body; it also reaches especially, subjectivity, with the transformation (“turn key”) of a conception of life and a vision of the world. This allows us to conclude that there is no single experience of masculinity that can be generalized covering all transgender men, as we must always talk about masculinities in the plural.

Conclusion

Returning to the research question, it was possible to understand that the form of expression most explored by studies in relation to the performativity of masculinities is centered on appearance. Through bodily changes, transgender men seek to perform the male gender and achieve passability, aiming to obtain social legitimacy. The synthesis of primary studies allowed the construction of an integrating concept of the experience of masculinity performed by transgender men: conditioned transgression, which circumscribes the transgression of the cisgender normative that aligns “sex-gender-desire”. The construct describes this transgressive device as a movement limited to performativities in order to gain social acceptance. Other experiences of masculinities performance were also evidenced, which point to possible transformations of the atavistic patriarchal heritage that sustains gender inequality, such as the rejection of the male discourse that disqualifies women. This finding suggests that transgender men can, within certain limits, escape certain injunctions and refuse certain privileges granted to cisgender men.

We understand that masculinity, in addition to appearance, can be identified and recognized through self-determination as a transgender man, or simply a man; it can also be performed through the non-agreement with misogynistic, homophobic and transphobic behaviors, which sustain the prestige hierarchy of the gender and maintain the subordination of women; and also through the movement challenging hegemonic masculinity, which occurs through processes such as pregnancy, breastfeeding and definition of masculinity/being a man without the presence of the phallus, sometimes with breasts in a body read as male.

In preparing this meta-synthesis, we came across some limitations, such as the existence of few studies produced in Latin American countries, making impossible to compare results with the qualitative findings obtained in underdeveloped countries. The studies assessed do not establish masculinity as experienced by transgender men as being the focus of investigation or deal with this issue in a secondary or tangential way. We suggest that future studies address this gap and that masculinities assume a leading role in the research agenda of Latin American countries, including Brazil, in order to understand the masculinities experienced by transgender men in different cultures and societies. We also found a lack of studies on transgender masculinities in children and adolescents. Addressing these themes can contribute to shed light on crucial contemporary issues regarding the adoption of masculine performances and conceptions in the early stages of emotional development.

How to cite this article

• Boffi, L. C., Guijarro-Rodrigues, E. C., & Santos, M. A. (2022). Experience of masculinity performed by transgender men: qualitative evidence and metasynthesis. Estudos de Psicologia (Campinas), 39, e200221. https://doi.org/10.1590/1982-0275202239e200221
• Support: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) (Process nº 88887.600239/2021-00). Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (Scientific Productivity Scholarship, Category 1A).
• Article based on the master’s dissertation of L.C.BOFFI, entitled “Tornando-se homem: processos de agenciamento de corporalidades de homens trans: Contribuições para o campo emergente das transmasculinidades”. Universidade de São Paulo, 2022.

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Publication Dates

• Publication in this collection
  28 Oct 2022
• Date of issue
  2022

History

• Received
  16 Oct 2020
• Reviewed
  16 Apr 2021
• Accepted
  14 Oct 2021