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Try out PMC Labs and tell us what you think. Learn More. An estimated indicate great diversity in sexual behavior and experiences. Implications for sexual health promotion, counseling, and medical care are addressed. Trans men may perceive a shift in sexual attraction toward men during transition or posttransition Bockting et al. Little information is available about the specific sexual practices of trans men who are gay or bisexual or men who have sex with men trans GB-MSM.
Most trans men do not have genital surgeries Bauer, ; Grant et al. Conclusions regarding HIV prevalence among trans men cannot be drawn from these data, as only one small study Chen et al. Twenty percent had not had sex with a partner in the same time period. In qualitative interviews Sevelius,trans MSM varied in the emphasis they placed on safer sex with paying partners. Additionally, a lack of relevant sexual health information and unfamiliarity with gay community sociosexual norms, customs, and risks Adams et al. A high prevalence of depressive symptomatology Reisner et al. While little research has explored sexual well-being among trans men, Bockting et al.
Among trans men, sexual satisfaction has been found to be inversely associated with depression Rotondi, Bauer, Scanlon, et al. To date, research with trans GB-MSM has largely been qualitative, focused on those who are currently sexually active with cis men, or descriptive of small convenience samples. Additionally, little research has been conducted with trans GB-MSM outside trans men nude the United States, including in Canada, where trans experiences may be different from those in the United States because of access to health care, human rights protections, and potentially greater social inclusion.
This article seeks to describe the experiences of trans GB-MSM in Ontario, Canada, related to sexual orientation identity and behavior, HIV-related sexual risk, sexual satisfaction, and psychosocial factors potentially associated with sexual risk taking.
The Trans PULSE team is built on a partnership between academic researchers, members of the trans community, and community-based organizations that are committed to improving the health of trans people. Survey data were collected through respondent-driven sampling RDS; Heckathorn, over a month period in — RDS is a tracked chain-referral method for recruitment and analysis that is deed to limit bias in studies of hidden populations, those for which a random sample cannot be obtained. These participants in turn could recruit up to three more and so on.
Recruitment patterns were tracked, and individual network sizes the of other eligible people known were assessed to allow for statistical analyses that adjust for known biases in network-based samples. The multimode survey was completed via Internet or trans men nude no participants chose a telephone interview option. The survey included items on health-related measures, including social determinants of health, psychosocial measures, health care experiences, and sexual health.
Participants were trans people age 16 and over who lived, worked, or received health care in Ontario. A total of participants were recruited, including trans men. In this analysis, trans men included those who identified as male or primarily masculine, as well as those who identified as gender fluid, bigender, or identified themselves in a similar way and who were ased a female sex at birth. All data were based on self-reported measures. Participants indicated their sexual orientation identity; past-year sex partners, partner s, and sexual behaviors; and histories of sex work and HIV testing.
Two sets of sexual behavior variables were coded, one to describe the broad range of sexual activities trans GB-MSM engage in and the second to capture HIV-and STI-related risk from a narrower range of activities. Sexual behaviors included oral, anal, and genital sex involving flesh genitals, silicone or latex, or fingers or hands.
Sexual satisfaction was measured using a subscale of the Multi-dimensional Sexual Self-Concept Questionnaire Snell, and was coded as low, moderate, or high, based on tertiles one third in each group for the entire sample all trans men and trans women participants. Statistics presented are thus population estimates for networked trans people in Ontario i. Ninety-five percent confidence intervals CI were calculated using a modified form of bootstrapping, with resampling based on recruitment chains Salganik, CI represent the range of plausible population estimates that are consistent with our data.
Table 1 presents estimates of sexual orientation among trans men in Ontario. Trans men identified across a full range of sexual orientation identities, with only about one third identifying as heterosexual or straight. As a group, trans men had cis and trans partners who identified as men, women, and genderqueer. A full range of experience was represented with regard to current relationship types, as well as partner s. Trans GB-MSM engaged in all types of sexual activity, including receptive genital sex, though proportions of persons engaging trans men nude high-risk activities were much lower.
The primary contributor to HIV risk was unprotected receptive genital sex. The survey found that In Table 3we present data on psychosocial trans men nude that may impact sexual risk taking. Based on coding by tertiles, trans GB-MSM did not differ from other groups of trans people in our study with regard to sexual satisfaction Rotondi, Bauer, Scanlon, et al. While 1 in 5 had high levels of sexual body image worries, about one half had low levels. The diversity of sexual orientation identities and past-year sexual partner genders belie the assumption that trans men transition to be heterosexual men.
Even many of those who were currently partnered with a woman did not identify as straight, and there were many who were attracted only to women sometimes only to cis women who still identified as queer. Approximately two thirds of trans men were classified as gay, bisexual, or MSM, in that they identified as gay, bisexual, pansexual, two-spirit, or queer and were not exclusively attracted to women; or they had had a cis or trans male sex partner in the past year.
Trans GB-MSM demonstrated a full range of experience with regard to current relationship types, as well as to the of past-year sexual partners. While not every trans man used all of his body parts for sexual activity, trans men as a group engaged in all types of activity, including receptive genital sex.
Even where flesh genitals were involved, condoms or other barriers may have been used. Thus, these sexual behaviors do not correspond directly to HIV-related risk; proportions engaging in high-risk activities were much lower.
The primary contributor to HIV risk was unprotected receptive genital sex, an activity some may assume trans men are unlikely to engage in. Most HIV-related sexual high risk related to having cis male partners, as exposure to ejaculate is required to qualify as high risk. For this reason, overall HIV-related sexual risk observed among trans men Bauer et al. It is important to note that self-reports of fluid exposure may underestimate actual risk, as trans men nude that involve exposure to pre-ejaculate or to small amounts of ejaculate may not be reported unless inquired about specifically Hoff et al.
A fair amount of research exists on trans men nude women who engage in sex work, but participation by trans men is infrequently acknowledged. However, the extent to which trans men are similar to trans women with regard to the frequency of sex work activities, or to the length of time spent in the trade, is unknown. Trans GB-MSM would likely differ from other trans men with respect to recent sex work involvement, given that involvement with the primarily male sex work clientele would result in classification as MSM.
It is unclear how this relates to HIV risk, as some of those who were not tested may have been at low or no risk of HIV. However, it is unlikely that such a high prevalence of never-testing is solely due to an absence of lifetime HIV risk. Given this low uptake of HIV testing, self-reported prevalence among Ontario trans men must be interpreted cautiously Bauer et al.
Seroprevalence cannot be estimated for trans men in Ontario, as HIV test site and surveillance data do not capture trans status. While trans GB-MSM were not notably different from other groups of trans people with regard to sexual satisfaction, a smaller proportion reported zero past-year sex partners, as compared to all trans men Bauer et al. The high proportion scored as having low body image worries suggests that many trans GB-MSM are not heavily impacted by trans-specific body image concerns in sexual situations; however, for 1 in 5 these concerns were major.
This is consistent with overall findings for trans men in Ontario Rotondi, Bauer, Scanlon, et al. However, this scale has not been validated for trans people, and given the extreme stresses trans people can be subject to, we believe that it is unlikely that a score above the cutoff indicates clinical depression. Nonetheless, a large proportion had scores that were well above 16, and this does indicate a high burden of depressive symptoms.
That an estimated However, there was no indication that trans GB-MSM are in any way protected relative to their trans peers. It is difficult to make comparisons between our and those from other regions or trans populations due to wide variation in sampling, survey items, and definitions of violence Stotzer, Other quantitative data regarding experiences of trans men nude violence among trans GB-MSM or Ontario trans men have not been published to date.
However, trans GB-MSM have described fearing transphobic violence, particularly related to disclosure of trans status in sexual situations Reisner et al. Such violence could potentially limit condom efficacy and agency in sexual encounters. Furthermore, experiences of trans-related violence in all areas of life may also contribute to HIV-related sexual risk behavior, as seen among some younger trans women Nuttbrock et al.
ly reported demographic estimates from Trans PULSE are similar to Ontario population estimates, highlighting the strength of our RDS method in reaching a broad sample of trans people across Ontario Bauer et al. In comparison to smaller studies that have explicitly recruited sexually active gay, bisexual, or queer-identified trans men in urban centers Myers et al.
It is important to note that while RDS has been demonstrated to produce statistically unbiased estimates Salganik,CI are wide. Therefore, point estimates should not be overinterpreted but considered in relation to the range of possible values represented by confidence intervals. Moreover, are generalizable only to trans people who are at least minimally networked, that is, those who know at least one other trans person.
This indicates that within assessment, counseling, medical, and individual health promotion settings, trans men should not be pd to be heterosexual. In fact, a more open sexuality may be the norm. Sexual health counseling and history taking should thus for a full range of possibilities, regardless of prior sexual history or relationship status.
Trans men's sexual health concerns are rarely made visible in gay men's sexual health work, yet trans GB-MSM already exist within gay men's communities, gay bathhouses, and gay men's bedrooms. Sexual health and HIV- and STI-related prevention and testing programs deed for gay and bisexual men need to incorporate trans men's issues and needs and to reflect the potential for gay or queer bodies to be trans bodies.
However, given that not all trans GB-MSM will have access to, choose to affiliate with, or get information through existing gay men's communities, it is also important that sexual health information and concerns be explicitly addressed in trans primary trans men nude and transition-related care settings. We note that it may not be possible to address these issues well in some assessment settings, particularly where approvals for hormones or surgeries are at stake and where legitimacy of transsexuality has historically been linked with post transition heterosexuality.
Academic knowledge in this area is in its early stages. Additional research is needed to explore how sexuality may vary among trans men with different histories and planned trajectories of medical and social transition. Moreover, relationship structures and characteristics of sexual partners of trans Trans men nude have not been described.
Future research could further explore the impact of transphobic violence on sexual risk-taking among trans GB-MSM and sexual health and well-being issues for trans men more broadly, not limited to HIV. The authors would like to recognize the leadership of our late friend and colleague Kyle Scanlon in promoting the sexual health of trans GB-MSM in Ontario.
The authors wish to acknowledge the 16 Community Engagement Team members and other contributors who worked hard to make the survey what it was, the 85 trans people and four allies who contributed to the first phase of the study that shaped this survey, and the trans people who shared their experiences through their survey participation. National Center for Biotechnology InformationU. The International Journal of Transgenderism. Int J Transgend.Trans men nude
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Sexual Health of Trans Men Who Are Gay, Bisexual, or Who Have Sex with Men: from Ontario, Canada