Two sides of one disclosure: a dyadic qualitative study of sibling responses and transgender women’s lived experiences of family in Pakistan

Background Family rejection is a major contributor to poor mental health among transgender individuals. However, research often treats “family” as a single source of acceptance or rejection and focuses on transgender perspectives. The experiences of cisgender siblings and relatives remain overlooked, particularly alongside transgender individuals within the same relational context. In Pakistan, where the transgender community has legal recognition but faces social stigma, and where family honor (izzat) shapes kinship relations, the complexities of family responses remain insufficiently understood.Methods This qualitative study employed a dyadic design informed by Minority Stress Theory and Interpersonal Acceptance–Rejection Theory. Semi-structured interviews were conducted separately with transgender women and cisgender family members (siblings and parents) aware of their gender identity. Seven transgender women’s and seven family members’ accounts were analyzed using reflexive thematic analysis. Dyadic comparison examined similarities, differences, and tensions in shared experiences. Reporting followed COREQ guidelines.Results Five themes were developed. First, family operated as a gendered field of enforcement and protection, where fathers and brothers more frequently enforced masculinity through control and violence, while mothers and sisters provided emotional support constrained by social pressures. Second, rejection was framed around izzat, with relatives expressing transgender identity as sharmindagi (disgrace) or a danger to reputation and marriage prospects. Third, dyadic accounts revealed divergent interpretations: transgender women experienced concealment as rejection, while relatives described these as protection, grief, or difficulty adjusting. Fourth, mothers emerged as contested anchors whose support was genuine but limited by broader family expectations. Fifth, religion and community networks operated as a cross-cutting symbolic system.Conclusion Family responses toward transgender women in Pakistan cannot be understood as simply accepting or rejecting. They represent complex, gendered, honor-mediated negotiations in which individuals and relatives interpret the same experiences differently. Interventions should be culturally appropriate, gender-sensitive, and inclusive of siblings.