Growth into manhood: identity development among female-to-maletransgender youthLealah Pollockaand Stephen L. Eyreb*aJoint Medical Program, University of California, Berkeley and University of California,San Francisco, USA;bDepartment of Pediatrics, Division of Adolescent Medicine, University ofCalifornia, San Francisco, USA(Received 24 February 2011; final version received 25 October 2011)This study aims to understand the process by which female-to-male transgender youngpeople come to identify as transgender through in-depth interviews with 13 self-identified female-to-male transgender youth. A grounded theory was created of theprocess that young people go through in coming to identify as transgender. Weidentified three stages: (1) a growing sense of gender: school, puberty, sexuality andexposure to diverse gender options impact upon each young person’s sense of his owngender; (2) recognition of transgender identity: a young person experiences a growingsense of discomfort with his female birth gender and comes to recognise himself astransgender; and (3) social adjustment: after becoming aware of himself as transgender,a young person adapts to life as a male. Although individual experiences may vary,understanding the typical trajectory of the female-to-male transgender experience canhelp inform appropriate health care and support services.Keywords: adolescent; transgender; youth; identity; sexualityIntroductionThe term transgender refers to a range of identities that do not conform to conventionalnotions of male and female, broadly referring to individuals who do not identify as thegender they were assigned at birth. Transgender youth are an underserved, marginalised,largely invisible population (Israel and Tarver 1997; Lev 2004). Recent research hasbegun to define the extent of their medical and social service needs, but there has been verylittle attempt to understand their developmental trajectories or how they construct andunderstand their gender over time (Lombardi 2001; Grossman and D’augelli 2006). Thisstudy aims to understand how female-to-male transgender youth come to identify astransgender and how they are affected by developmental experiences through childhood,adolescence and early adulthood.Female-to-male invisibilityMany authors have noted that female-to-male youth (those assigned female sex at birthbut who identify as male) have a very different life experience from male-to-femaleyouth (those assigned male sex at birth but who identify as female) (Bornstein 1994;Feinberg 1996; Pazos 1999). Although there has been much written on the female-to-maleISSN 1369-1058 print/ISSN 1464-5351 onlineq 2011 Taylor & Francishttp://dx.doi.org/10.1080/13691058.2011.636072http://www.tandfonline.com*Corresponding author. Email: [email protected], Health & SexualityVol. 14, No. 2, February 2012, 209–222experience (Feinberg 1993; Green 1998; Burgess 1999; Pazos 1999; Ma’ayan 2003;Devor 2004; Diamond 2004), overall, female-to-males are less studied and less visiblethan male-to-females. Cromwell (1997) has provided an excellent cross-cultural andhistorical summary of ‘females who lived as men’, questioning why anthropological workhas given such little attention to female gender diversity. Writers theorise that this stemsfrom the general invisibility of women’s history and experiences, greater acceptance ofmasculine behaviour in women than of feminine behaviour in men, the assumption that allmasculine female-bodied individuals are lesbians and the tendency to attribute ‘male’ toan ambiguously gendered person (Bornstein 1994; Cromwell 1997, 2003; Devor 2004).While invisibility and ease of passing can provide a mantle of safety, it also prevents theneeds of female-to-males from being understood and addressed (Pazos 1999). InCromwell’s (1997) words, ‘ ... it is time to move beyond the androcentrism,phallocentrism, heterosexism, and homocentrism that have rendered, and continue torender, female gender diversity invisible’ (135).This study aims to add to the literature by specifically examining how a group offemale-to-male youth constructed their gender over time, how they came to identify astransgender and how experiences such as puberty, school and sexual interactions affectedtheir views of themselves and their gender. These issues are examined from theperspective of the young people themselves. The research questions the study sought toexplore were: (1) what is the process by which female-to-male youth come to identify astransgender and (2) what developmental events emerge as important to identitydevelopment and how do these events affect female-to-male youth?Theoretical frameworkThis study takes a feminist constructivist approach to gender identity development.Feminist and social theory reject the unilaterally predetermined model of identitydevelopment in favour of a constructivist model, wherein the construction of the self is areflexive process that occurs in the context of social interaction (Gecas 1982). Feministconstructivist theory posits that categories of gender identification and biological sex arediscursively created and reproduced as products of particular cultures in particularhistorical moments and that the traits we conceive of as masculine or feminine are sociallycompelled enactments of societal norms (Butler 1990). We are not interested in theaetiology or ‘truth’ of gender, but rather in how gender is experienced.MethodsIn-depth, open-ended qualitative interviews were conducted with a convenience sample of13 self-identified transgender youth, ages 18–23, who were born female but do notidentify as female.RecruitmentParticipants were recruited in a lesbian, gay, bisexual and transgender youth-oriented clinicin San Francisco, through flyers and direct recruitment by members of the youth advisoryboard of a community agency serving lesbian, gay, bisexual and transgender youth.Participants were offered US$20 cash for study participation. Written consent was obtainedfrom each participant. This study was approved by the UC Berkeley Committee for theProtection of Human Subjects. Interviews took place between January and July 2007.210 L. Pollock and S.L. EyreData collection and analysisData collection and analysis were iterative processes that occurred in parallel. Open-endedinterviews, ranging in duration from 35 minutes to 2 hours, were conducted with eachparticipant. The interview was largely unstructured, based on the following