Introduction: Restrictive masculinity norms (RMNs), characterized by emotional suppression, dominance, and risk-taking, have been linked to adverse health among cisgender heterosexual men. Little is known about how RMNs operate among sexual and gender minority (SGM) populations, particularly transgender young adults. Methods: Data were from the 2024 Rhode Island Young Adult Survey, a cross-sectional, web-based survey of adults aged 18-25 years. Analyses were restricted to SGM participants (n=438), with sub-analyses among transgender young adults (n=100). RMNs were measured using a 12-item questionnaire. Outcomes include alcohol use disorder (AUD), cannabis use disorder (CUD), heroin use, intimate partner violence (IPV), problematic pornography use, and problem gambling. Modified Poisson regressions with robust standard errors were used to assess main effects after adjusting for sex assigned at birth, transgender identity, age, race/ethnicity, and social status.
Results: Among SGM young adults, a one-unit increase in RMNs score was associated with increased risk of all outcomes [AUD: 1.13 (95%CI 1.08, 1.18); CUD: 1.03 (95%CI 1.01, 1.06); heroin use: 1.22 (95%CI 1.13, 1.31); IPV: 1.04 (95%CI 1.02, 1.06); problematic pornography use: 1.05 (95%CI 1.02, 1.09); problem gambling: 1.11 (95%CI 1.07, 1.15)]. Associations were consistently stronger among transgender young adults, including a markedly elevated risk for heroin use [4.91 (95%CI 3.30, 7.31)], while the association with CUD was not statistically significant.
Conclusions: RMNs are associated with adverse behavioral health among SGM young adults and exert a disproportionate impact on transgender individuals. Addressing RMNs may represent an important, modifiable pathway for reducing behavioral health inequities during young adulthood.
Keywords: restrictive masculinity; sexual and gender minorities; transgender; young adults.