What a boy wants: Transgender men's hidden tran/scripts about the nonprescription use of gender-affirming hormones in mainland China

Taking gender-affirming hormones (GAH) without medical supervision can be dangerous and even deadly. This is the first study to investigate the non prescribed GAH use behavior among transgender men in mainland China in response to the public health threat. We collected data through interviewing Chinese transgender men and mining information from their commonly-used social medial platforms with Natural Language Process (NLP) of Artificial Intelligence (AI). The motivation, means to obtain, and outcomes of their nonprescription GAH use were examined. We found that transgender men in mainland China resort to the non prescribed GAH use because they have been denied the access to prescribed GAH due to barriers produced by ant-trans stigma as the structural determinant. A conceptual framework was developed to illustrate how transgender stigma has discriminated Chinese transgender men at health policy and institutional levels and shaped Chinese transmen's nonprescription GAH use behavior. The parent-child relationship, laden with the Confucian value of filial piety, was highlighted as the cultural gatekeeper for transgender stigma to reinforce cisnormativity and prevent Chinese transgender men from obtaining prescribed GAH they need. This framework also sheds light into how these transgender men have strived to communicate with their self-created coded language to counter stigmatizing discourse on their sexual and gender identities to make life livable in a transphobic society. Our work would lay a foundation for understanding how transgender stigma is locally produced in mainland China and contributes to the denial of Chinese transgender men's access to fundamental health services as human beings, and advocate for effective intervention.