Understanding the role of gender congruence and affirming care in trans men's body image and quality of life.

Background: Trans men face unique challenges related to gender congruence, body satisfaction, and quality of life (QoL). While research highlights the importance of these factors for transgender and gender-diverse (TGD) individuals, little is known about how they intersect to influence specific QoL domains (e.g. physiological, psychological, social, and environmental) for trans men. Understanding these relationships is critical to developing interventions that support their well-being. Method: This cross-sectional study recruited 166 trans men aged 18-30 from Global North countries with universal healthcare systems. Participants completed measures of gender congruence, body satisfaction, and QoL. A serial mediation model tested the associations between these constructs, controlling for age and satisfaction with gender transition. Exploratory analyses examined the role of gender-affirming care (e.g. hormones, chest surgery) in these relationships. Results: Gender congruence was positively associated with body satisfaction and QoL across physiological, psychological, and environmental domains but not social QoL. Body satisfaction was associated with physiological and psychological QoL but not social or environmental QoL. Gender congruence indirectly influenced QoL through body satisfaction in specific domains. Gender-affirming care improved gender congruence and indirectly enhanced body satisfaction. Conclusions: Findings underscore the importance of gender congruence in shaping body satisfaction and QoL for trans men, highlighting its mediating role in the benefits of gender-affirming care. Interventions should prioritize fostering gender congruence and addressing body image concerns to enhance trans men's well-being across multiple life domains.