Objective  To examine psychological characteristics and related behaviors among transgender (male-to-female, MTF) women.

  Methods  Using snowball sampling, we recruited 160 male adults (≥18) with the gender identity being opposite to their assigned sex and having sex with men in Shandong province for an anonymous face-to-face interview conducted from January 2016 to October 2017 with a self-designed questionnaire.

  Results  The age of the participants ranged from 19 to 44 years, with a median of 27 years. Of all the participants, 93.1% were Han people; 80.0% were unmarried; 83.1% had the education of senior high school and above; 74.4% were non-only-child; 74.4% expressed a male sexual orientation; 64.3% reported having unprotected receptive anal sex; and 16.3% reported having sex reassignment surgery. Among the participants, 51.2% reported a self-identified complete female psychological gender and 48.8% reported an uncertain psychological gender; there were significant differences between the two groups in marital status (P = 0.003), whether having a stable employment (P = 0.013), gender ratio for the people frequently contacted (P = 0.002), sexual orientation (P = 0.0001), pattern of dressing up when engaged in social activities (P = 0.0001), whether having sex with a female (P = 0.002), whether having commercial sex (P = 0.012), whether having gender reassignment surgery (P = 0.001), and whether experiencing violent or other types of abuse correlated with transgender identity (P = 0.004).

  Conclusion  There is a risk of human immunodeficiency virus (HIV) infection in MTF transgender women, especially in those with the identification of complete female psychological gender. The results indicate that intervention measures should be promoted among the population for the prevention of HIV infection.