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Living in flux : risk, protective factors, and meaning-making in transmasculine experiences of substance use

Mills, Tyler James


Tyler James Mills


David R. R. Smith

Elizabeth (Senior lecturer in social work) Price


Transgender individuals are particularly vulnerable to issues such as poor mental health, social isolation, and gender-related discrimination and violence which may contribute to developing and sustaining substance use disorders (SUD). The problems faced by transmasculine individuals are compounded by a poor understanding of factors which contribute to SUD in this population. This thesis is a mixed-methods, longitudinal study which examines factors associated with high-risk substance use in the transmasculine community and explores their lived experiences of SUD.
The main study adopted a sequential, longitudinal, mixed-methods design. 105 transmasculine individuals participated and 13 individuals were invited for interviews. Correlational and multiple regression analyses were performed on variables of SUD, quality of life, gender minority stress, gender role conflict, psychopathological symptoms, and personality traits. ANOVAs were performed to explore change over time.
Quantitative analyses revealed that over half of the sample engaged in high-risk substance use, and this increased over time. Gender minority stress, psychopathological symptoms, and personality traits were all major contributors to high-risk substance use. Qualitative analyses indicated that difficulties accessing transition-related healthcare, transphobia, distress (in)tolerance, and navigating masculinities and social expectations were all associated with increased distress that led to increased substance use.
The impact of COVID-19 on transmasculine individuals was substantial, and substance use significantly increased during the pandemic. Participants felt anxious, isolated, and distressed by poor access to healthcare and reported using substances to cope with these issues.
Overall, the results imply that SUD is a critical issue in the transmasculine community. Factors which protect against SUD, psychological interventions to improve mental health and reduce substance use, and limitations of this study are discussed, and topics of future study are suggested.


Mills, T. J. (2022). Living in flux : risk, protective factors, and meaning-making in transmasculine experiences of substance use. (Thesis). University of Hull. Retrieved from

Thesis Type Thesis
Deposit Date Nov 29, 2022
Publicly Available Date Feb 24, 2023
Keywords Psychology
Public URL
Additional Information Department of Psychology, The University of Hull
Award Date Mar 1, 2022


Thesis (7.4 Mb)

Copyright Statement
© 2022 Mills, Tyler James. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

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