This case report is not about a specific individual/couple/family but an existing phenomenon, Chinese gay males’ internalized sissyphobia (IS), explained as one’s fear or hatred of one’s and others’ effeminate verbal and non-verbal behaviors [1]. The number of Chinese gay men is approximately 27 million, living in Taiwan, mainland China, Hong Kong, Malaysia, Singapore, and other overseas countries [2]. That is, there is the necessity for discussion of this phenomenon. According to one of my previous studies, Chinese gay males learned the fear of effeminate behaviors from their families and societies where (a) a male’s social status is higher than a female’s; (b) a male’s role receives many more educational and financial resources and social powers; (c) a son’s children are much more important for a family than a daughter’s; and (d) a male’s masculine traits are rewarded, but feminine traits are punished [2]. Moreover, due to Confucianism and collectivism in Chinese societies, having a gay son is considered a disgrace; thus, gay sons usually work hard to make their parents feel honored. One such effort is to strengthen their masculinity in interpersonal interactions to reduce suspicion on the part of relatives or their parents’ friends about their homosexuality. All of these factors strengthen their IS. The phenomenon of IS is clearly related to anxiety disorders, where people feel fearful, worried, and nervous after unsure outcomes or in uncertain surroundings [3]. In other words, IS can be considered a type of anxiety for Chinese gay males, affecting their interpersonal interactions in the gay male community and in couple relationships. The gay male community typically includes groups of gay bears (heavy, hairy, and masculine), gay wolfs/hamadryads (muscular, fit, and hypermasculine), and monkeys/twinks (thin, hairless, youthful) [4]; overall, masculine traits are the mainstream attraction, giving a higher social status. That is, in order to being accepted in the community, people reject their effeminate behaviors or physical appearance and express prejudice against these characteristics in others. As a result, one cannot fully be one who really is in the gay male community and may fear possible punishment. In couple relationships, gay men with more masculine/ambitious traits usually dominate the relationship; that is, those with more effeminate traits have lower self-esteem and higher levels of worry and anxiety.

Generally, the Chinese gay male community is more diverse than Chinese societies in general. However, the discrimination and prejudice in the community due to sissyphobia are not less prevalent than in Chinese societies. Thus, a Chinese gay male who is effeminate, a dragqueen, or in the process of becoming a transgender woman will generally experience feelings of isolation or rejection in the community. Although some effeminate gay males have good social or interpersonal skills, their effeminate traits do not make them attractive or do not give them higher social status or access to resources in the community. Obviously, the presenting problems due to IS for individuals, couples, or the gay male community are not easy to resolve. The purpose of this case report is to invite more researchers, sociologists, psychologists, therapists, social workers, and activists who are interested in the population of Chinese gay males to deal with the presenting problems due to IS. As a couples and family therapist and an existentialist, I would like to work with masculine clients, who have IS, to help them accept effeminate traits in themselves and others and to deal with their fears of becoming effeminate and interacting with effeminate gay males, in order to create friendly, inclusive, and supportive surroundings for themselves, their partner in a relationship, and everyone in the gay male community. When working with effeminate gay male clients, I would like to gain their understanding about the formation of sissyphobia in the couple/ community relationship, reduce their self-blame and anxiety about their effeminate traits, accept who they are, and collaboratively work out some strategies to protect themselves in the couple/community relationship. The ideal picture is to reduce the negative influence due to IS on Chinese gay males, and to help them feel free in all relationships.