Ranked motivations for medical gender affirmation among transgender men and women in Thailand: a cross-sectional descriptive study

Medical gender affirmation is influenced by psychological and social motivations, but evidence on these factors among transgender individuals in Thailand remains limited. This study examined motivation factors associated with medical gender affirmation among transgender men and transgender women in a Thai clinical sample. This cross-sectional descriptive study, conducted in Bangkok, Thailand, from 2021 to 2022, explored motivations for medical gender affirmation among 102 transgender men and 68 transgender women. Data on demographic profiles, medical gender affirmation history, and familial and environmental factors were collected. The participants were asked to rank three predetermined motivation factors for medical gender affirmation: (1) body self-perception, (2) gender-affirming behaviors, and (3) social recognition and relational belonging. Body-related distress was measured using a single-item five-point Likert scale. Group comparisons of demographic variables, motivation factors, and distress levels were analyzed via t -tests and chi-square tests, with statistical significance set at p < 0.05. Body self-perception was the strongest motivator for medical gender affirmation, especially among transgender men compared with transgender women (89.2% vs 70.6%, p = 0.004). Transgender men also reported significantly greater body-related distress ( p = 0.032). Compared with transgender men, transgender women initiated medical affirmation nearly a decade earlier (mean age 18.2 vs 27.1 years, p < 0.001) and were more likely to report supportive environments ( p = 0.031), although parental acceptance remained similarly limited in both groups (~ 40%). Surgical patterns differed, with transgender men more often undergoing top surgery (66.7% vs 30.9%, p < 0.0001) and transgender women more often undergoing bottom surgery-related procedures (39.7% vs 19.6%, p = 0.007). Body self-perception was the most common motivation among Thai transgender individuals. Transgender men reported greater distress and significantly later initiation of medical affirmation. Top surgery was more common among transgender men, whereas transgender women more often pursued bottom surgery.