Transmasculine individuals—those assigned female at birth whose gender identity aligns with or is expressed through masculinity—experience profound barriers to equitable healthcare, shaped by intersecting structural, societal, and institutional stigma. This three-paper critical qualitative dissertation investigates how stigma engenders medical mistrust, drives reliance on informal and community-based health information networks, and shapes the reception and effectiveness of public health messaging related to HIV prevention.The first paper, “Between agony and access: Intersectional stigma, medical trauma, and transmasculine health experiences in a structurally violent system,” employs reflexive thematic analysis of qualitative interviews with thirty transmasculine participants residing in an urban East Coast setting. The analysis produced six interconnected themes: (1) intersectionality magnifies medical trauma; (2) systemic marginalization in healthcare; (3) clinical encounters as sites of medical trauma; (4) protective mistrust and anticipatory healthcare avoidance; (5) clinical co-conspirators as allies and advocates; and (6) strategic responses and ‘performative pathology’ as adaptive survival. Findings illustrate how structural and interpersonal stigma shape healthcare interactions by fostering distrust, healthcare avoidance, and adaptive coping strategies. The study highlights the urgent need for systemic transformation towards affirming, trauma-informed, intersectionally competent healthcare practices and policies.

Building upon these insights, the second paper, ““Reddit is my doctor”: Transmasculine health literacy practices in community and digital contexts,” employs an integrated theoretical framework of Critical Health Literacy and the Gender Affirmation Framework. Through semi-structured interviews (n=30) with transmasculine individuals aged 22-34, the paper examines how participants proactively acquire, critically assess, and strategically deploy community-derived health information amid clinical mistrust and structural stigma. Reflexive thematic analysis generated four interconnected themes: (1) relational foundations emphasizing peer trust; (2) specialized experiential clinical knowledge guiding health decisions; (3) structured digital platforms facilitating access to gender-affirming knowledge; and (4) critical engagement through ethical dissemination and collective gatekeeping of information. Findings emphasize the necessity of integrating community-generated knowledge into formal healthcare education, practice, and policy. The third paper, ““We’re not even in the picture”: Transmasculine critiques and reimaginings of PrEP marketing,” employs an image elicitation approach within three focus groups (n=12) to analyze how transmasculine participants interpret existing PrEP advertisements. Reflexive thematic analysis informed by critical health literacy and intersectionality identified seven themes within two primary domains: critiques of existing marketing strategies and recommendations for community-driven campaigns. Participants rejected hypersexualized, cisnormative visuals and messaging that presumed prior PrEP knowledge, highlighting feelings of exclusion and tokenization. Conversely, ads depicting diverse bodies, relational intimacy, gender ambiguity, and educational clarity resonated strongly. Participants reframed HIV prevention as a collective, relational act emphasizing mutual responsibility, community solidarity, and shared care. They recommended community-authored campaigns to ensure authentic representation, participatory design, and meaningful inclusion of transmasculine experiences. Collectively, these papers offer a cohesive, theoretically grounded analysis of how transmasculine people navigate and resist healthcare systems that frequently marginalize or exclude them. Findings underscore actionable implications for social work, public health, clinical practice, and policy reform, advocating for structural transformation and transmasculine-led initiatives to advance health equity and gender justice.