Intersections and evolution of 'Butch-trans' categories in Puerto Rico: Needs and barriers of an invisible population.

Public health research among transgender populations globally has primarily focused on HIV/AIDS. However, trans men remain outside of this conceptual framework, with distinct but overlapping social contexts and needs. In Puerto Rico (PR), the trans men population has remained largely hidden within the 'butch' lesbian community. The objective of this article is to document the identity construction of trans men and 'buchas' (local term to refer to butch lesbians) in PR and its relation to their bodily practices and overall health. We conducted an exploratory qualitative study with 29 trans men and buchas based on ethnographic observation, focus groups, audio-recorded in-depth interviews, and critical discourse analysis. Findings emphasise two domains to be addressed by health policies and initiatives: (1) bodily representations and gender performance, and (2) the meanings of female biological processes. This small-scale ethnographic study represents an initial step towards understanding the social context of this 'invisible' community and significant implications for their health and well-being. We provide several recommendations to address public health concerns of this understudied, marginalised community.