{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T14:36:48Z","timestamp":1770820608288,"version":"3.50.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T00:00:00Z","timestamp":1615248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"crossref","award":["D43TW010565"],"award-info":[{"award-number":["D43TW010565"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Providence\/Boston Centre for AIDS Research","award":["P30AI042853"],"award-info":[{"award-number":["P30AI042853"]}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R36DA048682"],"award-info":[{"award-number":["R36DA048682"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["T32AI102623"],"award-info":[{"award-number":["T32AI102623"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["Health Policy Research Scholars"],"award-info":[{"award-number":["Health Policy Research Scholars"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001117","name":"amfAR, The Foundation for AIDS Research","doi-asserted-by":"publisher","award":["Public Policy Fellow"],"award-info":[{"award-number":["Public Policy Fellow"]}],"id":[{"id":"10.13039\/100001117","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>For transgender people, reaching transgender (trans)-specific developmental milestones, including recognizing and expressing one\u2019s identity, plays an integral role in overall health, wellbeing, and the pursuit of gender affirmation. Yet trans people continue to face minority stressors, including structural violence (i.e., discrimination, violence, and stigma), which may interfere with the achievement of these milestones. Among trans women specifically, however, potential associations between gender developmental milestones and structural violence are not well characterized in the literature. In a sample of Filipinx (i.e., an inclusive term for describing non-binary genders in the Philippines) trans women who are sexually active with men (trans-WSM), we thus sought to: (a) describe the mean ages at which gender developmental milestones occur and (b) examine the associations between structural violence and mean ages at which at which Filipinx trans-WSM experience trans-specific developmental milestones.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using data from Project #ParaSaAtin, an online survey of Filipinx trans-WSM (n = 139), we mapped age-estimates per trans-specific milestones and then tested whether structural violence is associated with the mean age at which trans women experience trans-specific developmental milestones.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, participants who reported higher levels of discrimination, stigma, and violence also experienced a later age for nearly each milestone (i.e., initial self-awareness of transfeminine identity, transfeminine expression in private, transfeminine expression in public, first consensual oral\/vaginal\/anal sex with a cisgender male partner, first consensual oral\/vaginal\/anal sex with a cisgender male partner as a trans women, and hormone integration) (all p-values &lt;0.05). Of note, the single exception to this pattern was the non-significant association between stigma and initial disclosure of transfeminine identification to another person.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Results are consistent with psychological literature outlining a temporal sequence of developmental milestones among young trans-WSM. For young trans-WSM in the Philippines, data from this study demonstrate significant associations between structural violence and the achievement of developmental milestones. These findings highlight the need for trauma-informed, strengths-based programming and institutional policies that measure and mitigate anti-trans violence.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248248","type":"journal-article","created":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T18:27:12Z","timestamp":1615314432000},"page":"e0248248","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Transgender-specific developmental milestones and associated experiences of violence, discrimination, and stigma among Filipinx transgender women who are sexually active with men"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-8198","authenticated-orcid":true,"given":"Arjee J.","family":"Restar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron S.","family":"Breslow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma Irene","family":"Quilantang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Sison","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3026-5275","authenticated-orcid":true,"given":"Amiel Nazer","family":"Bermudez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maylin","family":"Palatino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Adia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Cu-Uvin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Don","family":"Operario","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Nazareno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,9]]},"reference":[{"key":"pone.0248248.ref001","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ssresearch.2018.04.006","article-title":"Educational attainment of transgender adults: Does the timing of transgender identity milestones matter?","volume":"74","author":"L Wilkinson","year":"2018","journal-title":"Soc Sci Res"},{"issue":"1","key":"pone.0248248.ref002","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1089\/trgh.2019.0008","article-title":"Developmental Milestones in Young Transgender Women in Two American Cities: Results from a Racially and Ethnically Diverse Sample","volume":"4","author":"A Restar","year":"2019","journal-title":"Transgender Health"},{"key":"pone.0248248.ref003","article-title":"Gender-concordant identity documents and mental health among transgender adults in the USA: a cross-sectional study","author":"AI Scheim","year":"2020","journal-title":"The Lancet Public Health"},{"issue":"3","key":"pone.0248248.ref004","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1037\/sgd0000171","article-title":"The role of gender affirmation in psychological well-being among transgender women","volume":"3","author":"TR Glynn","year":"2016","journal-title":"Psychology of Sexual Orientation and Gender Diversity"},{"key":"pone.0248248.ref005","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.socscimed.2015.11.010","article-title":"Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions","volume":"147","author":"JMW Hughto","year":"2015","journal-title":"Social science & medicine"},{"key":"pone.0248248.ref006","first-page":"0886260520967126","article-title":"Come out, get out: relations among sexual minority identification, microaggressions, and retention in higher education","volume":"2020","author":"PR Crane","journal-title":"Journal of interpersonal violence"},{"key":"pone.0248248.ref007","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511793264","volume-title":"Fitting in, standing out: Navigating the social challenges of high school to get an education","author":"R Crosnoe","year":"2011"},{"issue":"3","key":"pone.0248248.ref008","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1177\/002234336900600301","article-title":"Peace Research","volume":"6","author":"P Violence","year":"1969","journal-title":"Journal of Peace Research"},{"issue":"7","key":"pone.0248248.ref009","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002463","article-title":"Using structural equation modelling to characterise multilevel socioecological predictors and mediators of condom use among transgender women and cisgender men who have sex with men in the Philippines","volume":"5","author":"A Restar","year":"2020","journal-title":"BMJ Glob Health"},{"issue":"3","key":"pone.0248248.ref010","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.avb.2009.01.006","article-title":"Violence against transgender people: A review of United States data","volume":"14","author":"RL Stotzer","year":"2009","journal-title":"Aggression and Violent Behavior"},{"issue":"4","key":"pone.0248248.ref011","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1089\/lgbt.2014.0106","article-title":"Stigmatization and mental health in a diverse sample of transgender women","volume":"2","author":"M-F Yang","year":"2015","journal-title":"LGBT health"},{"issue":"4","key":"pone.0248248.ref012","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1007\/s10508-017-1143-x","article-title":"Structural inequities and social networks impact hormone use and misuse among transgender women in Los Angeles County","volume":"47","author":"K Clark","year":"2018","journal-title":"Archives of sexual behavior"},{"issue":"3","key":"pone.0248248.ref013","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/08964289.2015.1028322","article-title":"Individual-and structural-level risk factors for suicide attempts among transgender adults","volume":"41","author":"A Perez-Brumer","year":"2015","journal-title":"Behavioral Medicine"},{"issue":"1","key":"pone.0248248.ref014","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/0967828X9500300104","article-title":"Transgender men and homosexuality in the Southern Philippines: Ethnicity, political violence and the protocols of engendered sexualities amongst the Muslim Tausug and Sama","volume":"3","author":"M Johnson","year":"1995","journal-title":"South East Asia Research"},{"key":"pone.0248248.ref015","volume-title":"Globalization and discriminatory practices against trans-women in the Philippines","author":"NA Joseph","year":"2012"},{"issue":"1","key":"pone.0248248.ref016","first-page":"67","article-title":"Structural-systemic-cultural violence against LGBTQs in the Philippines","volume":"2","author":"B Amoroto","year":"2016","journal-title":"Journal of Human Rights and Peace Studies"},{"key":"pone.0248248.ref017","doi-asserted-by":"crossref","unstructured":"Restar AJ, Adia A, Nazareno J, Hernandez L, Sandfort T, Lurie M, et al. Barriers and facilitators to uptake of condoms among Filipinx transgender women and cisgender men who have sex with men: A situated socio-ecological perspective. Global Public Health. 2019:1\u201312.","DOI":"10.1080\/17441692.2019.1679218"},{"issue":"3","key":"pone.0248248.ref018","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s10935-018-0508-9","article-title":"Protective factors among transgender and gender variant youth: A systematic review by socioecological level","volume":"39","author":"MM Johns","year":"2018","journal-title":"The journal of primary prevention"},{"issue":"3","key":"pone.0248248.ref019","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1521\/aeap.2020.32.3.212","article-title":"Characterizing PrEP Awareness and Interest Among Filipina Transgender Women","volume":"32","author":"AJ Restar","year":"2020","journal-title":"AIDS Education and Prevention"},{"issue":"1","key":"pone.0248248.ref020","doi-asserted-by":"crossref","first-page":"1236511","DOI":"10.1080\/23311886.2016.1236511","article-title":"Gender inequality: Nonbinary transgender people in the workplace","volume":"2","author":"S Davidson","year":"2016","journal-title":"Cogent Social Sciences"},{"key":"pone.0248248.ref021","first-page":"0886260518760018","article-title":"Identity abuse as a tactic of violence in LGBTQ communities: Initial validation of the identity abuse measure","author":"JM Woulfe","year":"2018","journal-title":"Journal of interpersonal violence"},{"issue":"7\u20138","key":"pone.0248248.ref022","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s11199-005-7140-x","article-title":"The development and validation of the genderism and transphobia scale","volume":"53","author":"DB Hill","year":"2005","journal-title":"Sex roles"},{"key":"pone.0248248.ref023","unstructured":"StataCorp. StataSE 16.1 [computer software]. StataCorp College Station, TX; 2019."},{"issue":"2","key":"pone.0248248.ref024","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/cdep.12268","article-title":"Early findings from the transyouth project: Gender development in transgender children","volume":"12","author":"KR Olson","year":"2018","journal-title":"Child Development Perspectives"},{"key":"pone.0248248.ref025","unstructured":"An act prohibiting discrimination on the basis of sexual orientation and gender identity or expression (SOGIE) and providing penalties, (2019)."},{"key":"pone.0248248.ref026","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2307\/2648286","article-title":"Gender differences in the timing of first intercourse: data from 14 countries","author":"S Singh","year":"2000","journal-title":"International Family Planning Perspectives"},{"issue":"1","key":"pone.0248248.ref027","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1089\/trgh.2017.0028","article-title":"Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults","volume":"2","author":"N Beckwith","year":"2017","journal-title":"Transgender health"},{"issue":"5","key":"pone.0248248.ref028","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/fampra\/cmx119","article-title":"Primary care providers\u2019 willingness to continue gender-affirming hormone therapy for transgender patients","volume":"35","author":"DA Shires","year":"2018","journal-title":"Family practice"},{"issue":"3\u20134","key":"pone.0248248.ref029","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1080\/08964289.2020.1725414","article-title":"The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US","volume":"46","author":"C Lelutiu-Weinberger","year":"2020","journal-title":"Behavioral Medicine"},{"issue":"1","key":"pone.0248248.ref030","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1080\/15538605.2014.853638","article-title":"Disclosure of transgender identity and status in the context of friendship","volume":"8","author":"MP Galupo","year":"2014","journal-title":"Journal of LGBT Issues in Counseling"},{"issue":"11\u201312","key":"pone.0248248.ref031","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s11199-012-0216-5","article-title":"Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color","volume":"68","author":"JM Sevelius","year":"2013","journal-title":"Sex roles"},{"key":"pone.0248248.ref032","unstructured":"Xavier J. Passing as privilege. Part Two of a Series on Transfeminism. 1999."},{"key":"pone.0248248.ref033","unstructured":"Goffman E. Stigma: Notes on the management of spoiled identity: Simon and Schuster; 2009."},{"issue":"2","key":"pone.0248248.ref034","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.jadohealth.2019.02.018","article-title":". \u201cI Couldn\u2019t See a Downside\u201d: Decision-Making About Gender-Affirming Hormone Therapy","volume":"65","author":"T Daley","year":"2019","journal-title":"Journal of Adolescent Health"},{"issue":"1","key":"pone.0248248.ref035","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12160-013-9565-8","article-title":"Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus","volume":"47","author":"JM Sevelius","year":"2014","journal-title":"Annals of Behavioral Medicine"},{"issue":"1","key":"pone.0248248.ref036","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s13178-017-0295-8","article-title":"Barriers to gender-affirming care for transgender and gender nonconforming individuals","volume":"15","author":"JA Puckett","year":"2018","journal-title":"Sexuality Research and Social Policy"},{"issue":"10","key":"pone.0248248.ref037","doi-asserted-by":"crossref","first-page":"e030464","DOI":"10.1136\/bmjopen-2019-030464","article-title":"Hormone use among Nepali transgender women: a qualitative study","volume":"9","author":"PR Regmi","year":"2019","journal-title":"BMJ open"},{"issue":"1","key":"pone.0248248.ref038","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/19317611.2013.829152","article-title":"The use of hormone therapy in the male-to-female transgender population: issues for consideration in Thailand","volume":"26","author":"K Humphries-Waa","year":"2014","journal-title":"International Journal of Sexual Health"},{"issue":"10042","key":"pone.0248248.ref039","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S0140-6736(16)00684-X","article-title":"Global health burden and needs of transgender populations: a review","volume":"388","author":"SL Reisner","year":"2016","journal-title":"The Lancet"},{"key":"pone.0248248.ref040","doi-asserted-by":"crossref","unstructured":"Bumanglag KC. Enhancing HIV\/AIDS surveillance in the Philippines to ensure the transgender Population\u2019s visibility. American Public Health Association; 2018.","DOI":"10.2105\/AJPH.2017.304158"},{"key":"pone.0248248.ref041","doi-asserted-by":"crossref","DOI":"10.4324\/9781003084778","volume-title":"Beauty and power: Transgendering and cultural transformation in the southern","author":"M Johnson","year":"2020"},{"issue":"4","key":"pone.0248248.ref042","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1525\/ae.1998.25.4.695","article-title":"Global Desirings and Translocal Loves: Transgendering and Same-Sex Sexualities in the Southern Philippines","volume":"25","author":"M Johnson","year":"1998","journal-title":"American ethnologist"},{"key":"pone.0248248.ref043","first-page":"1","article-title":"Social and medical gender affirmation experiences are inversely associated with mental health problems in a US non-probability sample of transgender adults","author":"JM Hughto","year":"2020","journal-title":"Archives of sexual behavior"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T18:28:15Z","timestamp":1615314495000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0248248"}},"subtitle":[],"editor":[{"given":"Amy Michelle","family":"DeBaets","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,9]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0248248","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,9]]}}}