“The most important thing is that my parents have accepted me, it does not matter what society says”: Our Health Matters Report on Family Experiences

Authors: Aakanshya Aryal, Sahil Jamal Siddiqui, Vihaan Vee, Niyor, Heather Santos, Ayden Scheim


The world can say, ‘if you don’t get support from your family, then why should we support you?’. The world can start from family. If your parents are with you, then it isn’t an issue whether friends, girlfriends, or boyfriends are with you or not.


Our Health Matters

Our Health Matters is a community-based participatory research study of trans men’s and transmasculine people’s health in India. The study uses qualitative (in-depth interviews) and quantitative (survey) methods to explore and bring attention to transmasculine people’s experiences in society and how they impact our health and well-being.The project is led by an all-transmasculine Steering Committee and a team of trans and non-trans researchers from Drexel University (Philadelphia, USA), the Population Council (New Delhi), and other organizations in India, Canada, and the USA. Project partners include TWEET Foundation and Transmen Collective. Click here for more information about the study team.


Background

Family support plays an important role for trans and non-binary people of all ages. Family support can help protect one against the negative impacts of social stigma and positively impacts overall health and well-being. For example, studies conducted among trans adults and young people in North America have found that gender-related family support is related to higher levels of resilience, better mental health, and higher quality of life.1,2 In contrast, gender-related discrimination from families is related to increased psychological distress.1

Few studies have explored family experiences of trans people in India. A recent qualitative study focusing on trans men in India found that participants began to experience family pressure to conform to their assigned gender role in adolescence, and often had to conceal their gender identity at home, leading to stress.3 Most faced negative reactions when they disclosed their gender identity, sometimes including verbal or physical violence. Due to lack of family support, misgendering, and lack of freedom in their daily lives, some participants left the family home or used alcohol or drugs to cope. However, a few participants reported that some family members reacted positively to their disclosure, or that their families became more accepting over time. Research with trans women in India has also highlighted the complexity of family experiences. For example, some described receiving conditional acceptance from parents, who privately accepted their gender identity but placed restrictions on interactions with transgender peers or neighbors, wearing preferred clothing outside of the home, or accessing medical gender transition.4

This report focuses on experiences of family support and rejection among trans men and transmasculine people who participated in interviews as part of Our Health Matters, a community-based research study.


Who did we speak to?

We spoke to 40 trans men who ranged in age from 20-50 (average= 28) and lived in 10 states in India. Participants self-identified with varying socio-economic, caste, and religious backgrounds. All interviews were conducted in Hindi or Marathi.

How did we collect and analyze our data?

In the first phase of Our Health Matters, in-depth interviews were conducted by peer researchers (trans men) via telephone or video conference in July and August 2021, following a semi-structured interview guide. The interviews were audio-recorded, transcribed, and then translated to English. The interview guide focused on family experiences, social and community support, experiences of discrimination and safety, mental health, and access to health care.

The interview transcripts were analyzed by four team members with previous experience in qualitative data analysis. Steering Committee members participated in interpreting the data and writing this report. To provide additional context, we provide some available demographic details (age, location, religion, caste) for each participant quoted.


What did we find?

Summary

Participants had diverse experiences with their families during childhood, when disclosing their trans identities, and after socially and/or medically transitioning. Although we present results about acceptance and rejection separately in this report, participants often experienced shifts in family support over time: 

Initially, they were very much accepting of it. I have always wanted to change my gender, they always said that you are free, whatever you want to do, so they were accepting of it. However, when I started to transition, and changes started to happen, they didn’t understand the intensity of changes that I was going through and they started neglecting me and I did not get the support I needed at that time. (23, Hyderabad, Hindu)

My family didn’t like it.…It took me two years to make them understand. Two years later they said yes to me. Now I have the full support of my father, mother, and my married sister. (25, Mumbai, Hindu, OBC)

In addition, participants expressed varying levels of support from different family members such as parents, siblings, and relatives:

My elder sister is like my mother to me. She understood all of this. “I will support you in whatever you do next,” she said. (28, Bhandra, Hindu, OBC)

I have an uncle who has supported me with surgery. (45, Mumbai, Hindu, OBC)

In this report, we describe how family acceptance and rejection were experienced by participants and how the same impacted their well-being. Expressions of family acceptance included not interfering with gender expression (e.g., choice of clothing), assistance with accessing or recovering from medical procedures, and affirmation of the participant’s identity, chosen name, and pronouns. Expressions of family rejection included pressure to maintain a feminine gender expression or to get married, attempts at “conversion therapy”, or being forced to leave the family home to transition. Some participants were not free to express their gender or transition because of restrictions placed on them as people labeled female at birth. While family rejection had very negative impacts on participants, family support improved their mental health and facilitated acceptance from relatives and the wider community. 

Finally, based on these findings, we make recommendations for future research and programs to increase family support for trans men and transmasculine people in India.

Family Acceptance

Some families demonstrated acceptance by actively supporting their transmasculine relative’s gender expression (e.g., clothes, hairstyle) or by not interfering with their choices. These family members accepted the participants just as they are, often since childhood. In some cases, family members showed quiet acceptance by not questioning changes in the participant’s gender expression. 

They never told me to wear girls’ clothes or play girls’ games and never stopped me. They let me keep my hairstyle as per my wish. (23, Delhi, Hindu, OBC)

Moreover, our father also understood that I did not like to live in a girl’s way anymore. I had long hair before. I got my hair cut on my birthday. Nobody asked why I cut my hair. (25, Kanpur, Hindu)

Family members also showed acceptance by trying to use correct names, pronouns, and titles. In some cases, family members were initially hesitant but started using correct names, pronouns, and titles over time.

They try to speak with me as a boy. Trying it slowly. (30, Mumbai, Hindu, OBC)

My brother accepted me so much. He started calling me brother from then on. (23, Mumbai, Christian)

Assistance with the transition process was an important form of family support.  Some families provided financial help, while others who were not in a position to give money showed their support by providing care and being physically present for medical procedures. Participants expressed a particular appreciation for this type of support.

I just told her that I am going to do this, then my mother said, “It is your life, you know how you want to live. It all depends on you.” So she told me that I should call her when I have an operation, and she will come. (24, Delhi, Hindu)

When I started my hormone therapy, I became very sick and lost my appetite. My parents took good care of me and supported me a lot. They said they couldn’t support me financially, but they will be by my side. And I can do whatever I want to. (22, Jamshedpur, Hindu)

Some parents expressed pride in their transmasculine children and were happy to see them thrive after beginning to transition. 

Mother tells me that whatever I am happy with, they are also happy with. Papa also used to say, ‘I have a girl’, but now he sees me as a boy, and tells me that I am his son. (30, Nagpur, Hindu, OBC)

My mother has told all of our relatives what I have done. My mom is proud of me. My mother says, “my child did not run away like other children. Didn’t do any wrong.” (20, Mumbai, Hindu, ST)

Family Rejection

Family members often pressured or forced participants to follow social expectations for people labeled female at birth, including dressing in a feminine manner, staying home, and marrying a cisgender (non-trans) man. This pressure began in childhood but continued into adulthood for some participants. Participants struggled with not being able to live their lives in the way they desired and with feeling constantly pressured by family members. 

Those moments were very tough for me, because there was family pressure on me to get married and I had just gone through a breakup. (50, Gauhati)

They think of me as a girl and girls are not supposed to go out. Girls should put on makeup and they should not wear clothes as I do. I cannot live my life the way I want to so I am a bit disturbed and try to control my feelings so that they do not one day cause an outburst. (29, Lucknow, Hindu)

Some participants had to leave their family homes in order to start their transition process due to family members denying their gender identities or refusing to accept their transition. In other cases, participant’s families did not entirely oppose their transition but refused to provide financial support, even if they were financially able to do so.

Don’t stay here and do whatever you want to do [they said]. You have to leave the village…You go out, do your best, use your money, but don’t stay here and do it. If you want to go bald, go out of town and do it. (25, Washim, Hindu, OBC)

When I started treatment, my family could have provided support, but I took care of everything. They are with me but they have a condition that ‘whatever you spend is on your own’. (25, Mumbai, Hindu, OBC)

A few participants felt that becoming financially independent might change their family’s response. They shared that becoming independent would enable them to bear all the costs of transition and potentially lead to greater family support.

 I told them about the surgery, but they are not ready for that as every parent fears for their child. Right now, they are not supporting it, and maybe in the future, if I become independent, they will support me. (23, Delhi, Hindu, OBC)

Some participants were taken by their families for “conversion therapy” in which doctors or religious/spiritual healers attempted to change their gender identity or convince them to identify with their gender assigned at birth.  In some cases, family members forcefully tried to make the participants take hormones or other medications. One participant highlighted being kicked out of the house when nothing changed after the family took him for conversion therapy .

My family forcibly tried to make me live like a girl and forced me to take medicine for about 4 to 5 months. (22, Jamshedpur, Hindu)

They took me to a psychiatrist around 2 to 3 km away from my house for my treatment. After listening to my case, the doctor’s reaction was very weird and negative. He told them that I was mentally sick and should be given female hormones to cure my problem. (22, Jamshedpur)

When I told them, they thought I was possessed by a ghost, and took me to Baba (magician). Nothing happened there. We went to Brahmin (priest) later, nothing happened there. I was beaten a little after that. Bored, they finally kicked me out of the house. (20, Mumbai, Hindu, ST)

Fear of rejection and stigmatization from other family members, relatives, and society led some family members to reject the transmasculine person in public, even if they were accepting in private. These family members were concerned about how they would be treated if they openly accepted the participant’s gender identity or transition. One participant described avoiding family events because of the pain caused by being misgendered.

 My parents tried to convince me to stop being like this and said that we are very poor people and explained this to my elder sisters and brother-in-law. No one will understand [they said]. (22, Jamshedpur, Hindu)

When someone new visits, my family members will call me a girl and tell them I am their daughter. I feel very bad when they look at me and I am mentally disturbed, so I walk away. I don’t like it. If there is an event in our family, I avoid it. They have accepted me, but they do not accept me in front of other people. (26, Mumbai, Hindu)

Some participants faced verbal abuse or physical violence at the hands of family members when they disclosed their gender identity or attempted to express their gender on their own terms. 

Once I tried to speak to my father, but he also responded in the same way. He told me that, are you out of your mind? And he behaved a bit violently. My father started saying, “Get out from here. I have always provided you with everything as per your requirement. I don’t know what else you want from us.” He said all these things by shouting. (23, Bijnor, Hindu, OBC)

When I used to wear shirts and pants, they would hit and scold me. I have had a lot of beatings, and I got so strong and adamant that I would not care if anyone hit me anymore. (40, Nagpur)

Impacts of family acceptance and rejection

Family acceptance had a positive impact on transmasculine persons’ mental health and well-being, made the transition process easier, and led to greater acceptance from their relatives and the wider society. Conversely, family rejection led to stigmatization and rejection from others and had a negative impact on overall health and well-being. 

Participants expressed that support from one’s own family is key to broader acceptance from relatives and society:

When I found out about myself, everyone gave me a lot of support. After the transition, my family and villagers wouldn’t let me feel that what I have done is different. Everyone speaks with the same respect as before. Giving me more respect than before. So, I didn’t get a negative response. Initially, there was a bit of an argument when the surgery was done but I didn’t have any problems as my parents were supporting me. (23, Mumbai, Hindu, OBC)

If your parents don’t accept you, then what are you going to do about society? They will say that your parents do not support you. Why do you expect support from us when the people who gave birth to you do not support you? This leads to mental stress. Sometimes I remember not getting a good night’s sleep.” (29, Nagpur, Hindu, SC)

As the participant above notes, family rejection can be extremely stressful. On the other hand, family acceptance led to better mental health and well-being. Participants shared that family support gave them the strength to deal with the stigma they faced from the wider society and helped them to navigate the transition process. 

The most important thing for me is that my parents have accepted me, it does not matter to me what society says. My depression has reduced a lot due to my parents’ acceptance. I am still taking medicine, but I no longer have severe depression. (23, Delhi, Student, Muslim)

My mother and my sister supported me in this. I was very sad and lonely, then my sisters came to me and sat along with me. They tried to distract me from this and ask me to play, to exercise, and to dance. Gradually I felt an improvement in myself. Then I started meditation and it helped me a lot.” (23, Churu)

My number two brother was very supportive. He helped me a lot when I started the transition. He said, do it, I am with you. (36, Pune, Hindu, ST)

Strategies used by transmasculine people to gain family support

Participants shared some of the strategies they personally used that helped them to gain acceptance from their family members. Some educated their families about transgender people and the transition process by showing them online videos. This helped family members to better understand transgender identities and transition processes.

When I completed the 10th standard, I told them back home and showed them videos about transgender people. They watched videos and said all right. (25, Mumbai, Hindu, OBC)

When I told my family that I wanted to change and do surgery, their response was neither negative nor positive. They feel shocked and ask if this happens? So I told them this could happen, and I showed them a YouTube video of surgery and the people who did this. I made myself comfortable with family members and made them positive about my decision. (26, Thane, Hindu, OBC)

In addition to online videos, some participants received help from trans peers who explained the transition process to their family members. Communicating directly with trans peers helped them to understand transition procedures and address their safety concerns.

I have one old friend who had a small surgery. I asked him to come home and meet my parents. Afterward mother said ok. She spoke with our family doctor and they also said ok. There is not any problem with health. Afterward, the family gave permission. (26, Thane, Hindu, OBC)

Another participant shared that professional counseling for his parents led them to accept him and assist in affirming his gender: 

The doctor talked to my parents for half an hour to one hour and explained about this, after that when they came out, they first took me to the salon, and got my hair cut. (26, Kashmir, Muslim)

Participants highlighted the importance of open communication among family members to facilitate support and acceptance over the long term. Participants highlighted that it is not always easy for parents to understand and accept them, so communication is key for both transmasculine people and their parents.

 I think it is a big responsibility of parents to understand their children. When parents need to explain something to their children they should explain and when they want to ask something, they should also ask. (27, Delhi, Hindu)


Conclusion and Recommendations

The findings in this report support previous research indicating that family support and acceptance are critical for trans and non-binary people’s well-being at every stage of life. They also highlight unique aspects of the family experiences of trans men and transmasculine people in India, as compared to their peers in other countries. Specifically, a recurring sentiment expressed was that family acceptance was the most important factor for participants’ well-being and ability to move forward in life, reflecting the central societal importance of parents, families, and relatives. Conversely, a lack of family support hindered transmasculine people’s ability to express their gender or transition, even as adults. This may reflect the ways that the choices and opportunities of transmasculine people are constrained by patriarchal gender norms impacting children labeled as girls at birth. 

We also found that participants were resilient and creative in finding strategies to gain family support and access transition care, if they needed it. In addition to the educational and communication strategies described in the previous section, participants made recommendations for social policies and programs that could increase family acceptance for transmasculine people in India. 

RECOMMENDATIONS
Participants suggested that many people don’t understand the meaning of being trans. Therefore, education and awareness about transgender persons is critical:

We also need to give support and try from outside because they don’t know about transmen.
It is our responsibility to explain them.
Some parents don’t understand, but mine support me.” (26, Thane, Hindu, OBC)

Awareness should be created for that first.
It should start from your home.” (28, Mumbai, Hindu, SC)
Participants expressed that along with advocacy by themselves and trans peers, access to counseling for family members is important.

Along with our counselling, there should be counselling of parents too
so that they do not harass their children so much,
not kill them or make them leave the house,
or have to commit suicide.” (40, Nagpur, Hindu)

Research on transmasculine health is scarce in India, particularly research that takes a community-based approach. Our Health Matters is an attempt to fill this gap and provide relevant information to promote transmasculine health. Through this research, we examined the experiences of trans men with disclosing their gender identities and navigating transition processes with their families. To identify ideal strategies to increase family acceptance, qualitative research to understand the perspective of cisgender (non-trans) family members would be quite valuable.

Some resources for family education and support:
Orinam: a bilingual website (Tamil and English) associated with Chennai-based social-supports-arts-advocacy group Orinam. The website features videos, blogs, poems and podcasts by members of LGBT community along with information on alternate sexualities and gender identities.
Sweekar – The Rainbow Parents : A group formed by parents of LGBTQ+ community to advocate for the community and facilitate acceptance.

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2Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 53(6), 791–793. doi:10.1016/j.jadohealth.2013.07.019

3Chakrapani V, Scheim AI, Newman PA, et al. Affirming and negotiating gender in family and social spaces: Stigma, mental health and resilience among transmasculine people in India. Cult Health Sex. Published online April 13, 2021:1-17. doi:10.1080/13691058.2021.1901991

4Chakrapani V, Dhall P. (2011). Family Acceptance among Self-identified Men who have Sex with Men (MSM) and Transgender People in India.