Abstract

Gender dysphoria can manifest in self-harm behaviors, suicidal ideation, and depression. Affirming interventions such as puberty blocking, hormone therapy, and surgery help reduce gender dysphoria. Physical activity is also useful for depression, anxiety, and body image. Trans men have documented their use of exercise on social media; however, the role of exercise in gender affirmation has not been explored clinically. The purpose of this study was to examine the transformative nature of resistance training in trans males and to assess the relationship between muscular fitness and gender dysphoria. This mixed-methods, case-series study followed three participants over a twelve-week supervised resistance training program. A phenomenological approach was used to explore the participants’ experience of physical and/or emotional change. Surveys assessed body image, body surveillance, and trans congruence. Standard fitness and body composition measures were taken pre, mid, and post intervention. Individual interviews were conducted concurrently. Greater muscle mass and lower body fat were strongly associated with better body image throughout the intervention, as was upper body strength. However, muscle mass, body fat, and strength were not consistently associated with trans congruence. The qualitative themes exemplified challenges and motivations for resistance training. Aspects of the training, heart rate monitors, mirrors, and the presence of others increased anxiety. Yet, participants reported benefits such as ease with daily tasks and improved strength. The relationship between gender dysphoria and resistance training is complex and takes place within the socially constructed gender norms. More research is needed to establish best practices for exercise programs that minimize harm and promote fitness.