Constructing Gay Male Identity in a Multicultural Society: A Qualitative Grounded Theory Study in Malaysia

Malaysia is a multiethnic and multireligious country in Asia that provides a rich landscape for the study of intersectional influences on sexual identity development. This study adopted a constructivist grounded theory research design to explore sexual identity development in 36 Malaysian gay males of varying ethnicities and religious affiliations. We proposed a five-stage Systemic Interaction Model (SIM) that theorizes sexual identity development as a continuous process of gay men discovering and then cycling between refining and redefining their self-concept. The five SIM stages are as follows: (1) noticing same-sex attraction and gender nonconformity; (2) exploring, experimenting, and eradicating differences from among same-sex peers; (3) confirming sexual orientation as gay; (4) accepting sexual identity as gay and (5) negotiating social expectations and pursuing a perceived ideal gay life. The five-stage model details the intricate intersectional, intrapersonal and interpersonal processes of Malaysian gay men as they move from passive roles into active cultural agents, developing their sexual identity in the relational, closeknit and tight Malaysian society in the process. Implications for health professionals and policymakers were also discussed.


Introduction
Although several sexual identity development models of gay ethnic minorities have been proposed by scholars, they have been based on gay men living in Western societies. Research on sexual identity development among Asian gay men remains scarce (e.g., Bishop et al., 2020;Parmenter et al., 2020). Cass's (1979Cass's ( , 1984 homosexual identity formation model remains influential in Asia as the standard theory for gay identity development to-date (e.g., Ferdoush, 2016;Lim et al., 2021;Pijanowski, 2018).
More recently, research on sexual identity development has moved away from using stage models and focused on developing milestone models instead, with the aim of predicting the time, patterns and norms for a person to achieve certain sexual orientation identity milestones based on their respective demographic backgrounds (e.g., Bishop et al., 2022;Hall et al., 2021;Katz-Wise et al., 2017;Rendina et al., 2019). According to Hall et al. (2021) systematic review, milestone models typically investigate the sequence a gay man achieves certain milestones, as follows: (1) noticing same-sex attractions; (2) questioning their sexual orientation; (3) identifying as gay; (4) engaging in sexual activities; (5) coming out to others and (6) being in a romantic relationship. The reductionist nature of milestone models enhanced its universality in predicting the sequence and age when gay men may achieve certain common milestones (Charmaz, 2014). However, such impersonal and monolithic frameworks are less helpful for mental health clinicians where in-depth depictions of the gay man's intrapersonal, interpersonal processes and their dynamic interactions with their specific environments may better inform clinical decisions. Kenneady and Oswalt (2014) suggest that Cass's model may be generalized to other heteronormative societies because the theory was developed when Australians had a more prevailing homonegative attitude. However, Kennedy and Oswalt overlooked the fact that Cass's model was developed from individuals living in a loose cultural society, different from the relational collectivists living in a tight cultural society observed in many parts of Asia (Brewer & Chen, 2007;Gelfand et al., 2011Gelfand et al., , 2021. This cultural factor is a prelude to more factors argued in the following paragraphs which serve to underscore the need for developing an indigenous gay male identity developmental model in Asia. This paper will focus on the Malaysian context due to its unique multicultural landscape.

Socio-Political Characteristics of Malaysian Communities
Malays, Chinese and Indians are the three main ethnic groups co-existing in Malaysia. Chinese and Indian Malaysians maintain some affinity with their cultural origins from China and India. Malays are Muslims, Chinese are often Buddhists, Taoists or Christians and Indians are either Hindus or Christians (Ngim et al., 2013). Although non-Malays have religious freedom and are religiously diverse, Malays are defined as Muslim in the constitution and Islam is Malaysia's 1 3 official religion (Cheah & Singaravelu, 2017). Muslim Malaysians are also forbidden to leave or change their faith (Moustafa, 2014), and Islam is transmitted by bloodline or through conversion.
Homonegativity is highly prevalent in Malaysia. In a nationally representative study, most Malaysians endorsed a homonegative attitude and regarded heterosexuality as the only healthy expression of sexuality (Manalastas et al., 2017). Furthermore, Muslim and Christian Malaysians were found to be more homonegative than Buddhist and Hindu Malaysians (Foong et al., 2020). Homonegativity is further reflected in government administration and the dual-legal system (Singaravelu & Cheah, 2020). For example, the government established state-sponsored conversion therapy programs, publicly caned lesbians and enforced draconian laws on LGBTQ people (Human Rights Watch, 2021). The dual legal systemcivil law and Sharia law-criminalizes homosexual acts. Sections 377A and 377B of the Malaysian Penal Code and multiple components of the Sharia law frame same-sex sexual activities as 'unnatural' with legal consequences of fines, imprisonment and whippings (Singaravelu & Cheah, 2020). Shah (2020) provides an excellent account of the complexities around the privileges and vulnerabilities of living as a gay man in Malaysia. In particular, he highlights the immense pressures faced by the LGBTQ community as a consequence of the Sharia authorities' fascination with moral policing and persecution of that commmunity.
Most countries in Asia, including Malaysia, are deemed tight cultural societies (Gelfand et al., 2011(Gelfand et al., , 2021. These societies generally demand strong conformity and punish social deviance due to historical challenges in ecological and manmade threats. It differs from the loose societies found in most Western countries, which have a greater tolerance for deviance and more fluid social norms (Gelfand et al., 2011(Gelfand et al., , 2021. Moreover, relational collectivism takes precedence over individualism in tight societies, in which close relationships and kinships relationally define and structure one's self-concept. In contrast, the self-construal structure in individualism focuses on developing individuation and autonomy (Brewer & Chen, 2007).
As with many Asian societies, Malaysians endorse strong ties with their kinship networks (Ting & Sundararajan, 2018). Intergenerational co-residence remains common to pool resources (Yeung et al., 2018). Familism is advocated where family members' needs are prioritized over their individual needs (Kim, 2010). Filial duties in respecting and caring for parents are expected and practiced across the three ethnicities (Tan et al., 2019). Parents are culturally granted hierarchical power over their children, and an adult offspring is expected to enter into a heterosexual marriage (Zang, 2016), continue the blood lineage (Yeung et al., 2018) and bring honour to the family (Tan et al., 2019). In this closeknit, relational-based, tight and heterosexist society, some families would disown their gay children for violating social norms and shaming the family (Cheah & Singaravelu, 2017;Chua, 2019;Gelfand et al., 2021). Being disowned could destroy a gay man in this society and spell social death because his self-concept and important resources are closely linked with his close relationships (Yang & Kleinman, 2008).

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Constructing Gay Male Identity in a Multicultural Society:…

Research Aim
These ecological differences in family structure, political atmosphere and cultural values may shape a different trajectory for Asian gay men's sexual identity development in Malaysia from Alderson's (2003), Cass's (1979Cass's ( , 1984 or other sexual identity developmental models that have been based on dual-minority people (ethnic and sexual) adjusting to culturally Western societies. Therefore, we argue that developing an indigenous gay men's developmental model is imperative in ensuring its relevance when working with gay males in Malaysia. Specifically, we examined the process of MGM identifying as a gay person, their perception of the ideal state of sexual identity and how they resolve their identity conflicts.

Research Design and Procedure
This study employed Charmaz's constructivist grounded theory approach which is founded upon the interpretivist paradigm and emphasizes the use of reflexivity throughout the research (Charmaz, 2014;Rieger, 2019). It closely aligns with the research team's belief that reality is co-constructed from interactions between researcher and participants and the general applicability of this theory is conditional upon time and space (Charmaz, 2014). We followed the COREQ protocol in reporting qualitative analysis (Tong et al., 2007).
Semi-structured in-depth interviews were employed as the primary data collection strategy and anonymous feedback from the gay community on the proposed theory was incorporated for data triangulation. Four open-ended questions guided the interviews (see Supplementary Information (SI)). JWL and JWC, a male and female researcher respectively, conducted the interviews and analyzed the data. Reflexivity was maintained through memoing throughout the research process (Mills et al., 2006).
The data collection began after RSKT's institution granted ethics approval. Advertisements that described the research goals were placed in Malaysian-based LGBTQ-focused Facebook groups using the three major languages in Malaysia-English, Malay and Mandarin-to increase participant diversity. JWL, JWC and a Master-level student with prior engagement with the community and trained in qualitative interviewing skills, conducted the interviews in the participants' preferred language. All participants provided verbal consent and their identity was disguised with coded names. After the interview, each participant received RM10 (equivalent to USD 2.40) e-wallet code as a token of appreciation.

Participants
The first six participants were recruited using purposive sampling to maintain fidelity with grounded theory's simultaneous data collection and analysis process. The inclusion criteria were Malaysian citizens 18 years old and above and self-identified gay males born and raised in Malaysia. The exclusion criteria were non-Malaysians, transgenders or persons in distress. An initial theory was developed from the six participants' sharing, which prompted theoretical sampling of MGM from a specific religion, ethnicity and geolocation to reinforce the theory (Charmaz, 2014). The sampling stopped when participants' sharing no longer densifies the theory, indicating saturation (Charmaz, 2014). The final sample consisted of 36 Malaysian gay males (between ages 18 and 58, M = 30.3; SD = 8.9), representing Malaysia's diversity in religion and ethnicity (see Table 1 for demographic details).

Data Coding and Validation
Thirty-six semi-structured interviews ranging from 23 to 176 min each were conducted, totaling 46 h and 43 min. Recordings were transcribed according to the denaturalized method for grounded theory analysis (Davidson, 2009). All transcripts were coded separately by JWL and JWC in NVivo Version 12.6. The analysis followed constructivist grounded theory's three levels of coding-initial coding, focused coding, and theoretical coding (Charmaz, 2014). The constant comparison method was applied throughout the coding process, which generated a description of gay identity development's social processes (Kolb, 2012). JWL and JWC compared and discussed their coding results with RSKT until consensus on the theory was achieved (Syed & Nelson, 2015). Subsequently, the researchers actively conducted member checks with 10 local gay community members who anonymously expressed their resonance and feedback via Google Forms of the theory which was presented in a 20-min debriefing video (Birt et al., 2016;Charmaz, 2014).

Results
From the results of the theoretical coding, we propose a grounded theory-the Systemic Interaction Model (SIM), that theorizes MGM's sexual identity development as a continuous process of gay men discovering and cycling between refining and redefining their self-concept in relation to their ecology. SIM develops from gay men's purposeful social interactions to reduce psychosocial distress and improve their quality of life. Internal and external barriers could block identity development through self-suppression whereas internal and external facilitators could promote identity development through self-acceptance. A gay man may discontinue the identity development process when the suppression of any expression of same-sex attraction is perceived as the best choice.
Being gay is more than mere same-sex attraction for the participants. Their identity as gay men comprises of multiple-nuanced components that increase with complexity. The meaning of being gay expands over time through social interactions and numerous streams of identity processing could co-occur. The size of an onion growing from its bud increases with each new layer; similarly, gay identity becomes layered with richer details over time. For example, gay identity may expand from "I am 1 3 Constructing Gay Male Identity in a Multicultural Society:… As discovering, refining and redefining the self-concept are the core processes of sexual identity development, we see merit in grounding these dynamic and complex processes into a five-stage SIM that describes MGM's gay identity construction in different ecological systems across the lifespan (Bronfenbrenner, 1986) viz (1) noticing same-sex attraction and differences in gender expressions; (2) exploring, experimenting and eradicating differences from same-sex peers; (3) confirming sexual orientation as gay; (4) accepting sexual identity as gay and (5) negotiating social expectations and pursuing ideal gay life (see Fig. 1).
The participants' diverse backgrounds highlighted intersectional factors, such as ethnicity, culture, religious affiliation and geographical location, which may have influenced their identity development. Participants would have had to negotiate implicit and explicit religious, ethnic, social and cultural expectations from the contexts they socialized and assimilated to. SIM depicts the MGM's dynamic identity shaping processes as they interacted with their environment, moving from passive roles into active cultural agents over the five stages (See Fig. 2).

Stage 1: Noticing Same-Sex Attraction and Gender Nonconformity
Noticing same-sex attraction and gender nonconformity were prominent characteristics of this stage. While a few participants mentioned no difference in their gender expressions, masculinity or preferences in play toys compared to same-gender peers in childhood, most participants noticed they were comparatively feminine and preferred quiet activities over stereotypically boys' sports. For example, P14, a Malay Muslim shared that "I was never athletic…I was a boy who behaved like a girl… liking things that people will consider to be girly." The participants' peers, family members, schoolteachers or religious leaders in their microsystems actively enacted and socialized gender role expectations and showed their prejudice towards gay people (see Fig. 2). For example, their parents repeatedly yelled, punished or expressed disgust at their effeminate gaits and behaviors, which was their primary source of understanding of homosexuality. As nonconforming gender expressions are frequently perceived as 'gay,' most participants experienced bullying, name-calling and having slurs hurled at them for their gender nonconforming behavior which was distressing and traumatizing because they did not feel they had any control over their behaviors and mannerisms. The experience of P11, an ex-Muslim and now identifies as a non-religious Malay illustrates the intense anti-gay bullies that was traumatizing for him: "There was this time…I look at this boy… [and said] "Oh, he looks so cute…he looks handsome."…[then] there was this evening when I was in the class alone…he closed the door…as though he wanted to hit me with his belt…[he furiously asked] "Did you say that you like me? Are you saying that you are gay? Are you gay!!!???"'. Participants also felt physical attraction and affection for guys and, at a later age, sexual attraction to guys (also, see P01, P20, Stage 1, Table 2). For Table 2 provide participants' quotes corresponding to characteristics of each stage of the gay male's identity development example, they were attracted to male characters on TV or good-looking male classmates. P06, a Chinese Buddhist shared that "I thought it was normal to have these strong feelings towards boys…you try to do a lot of things…for the person…have really strong interest to know about the person…in the name of friendship, but back then I didn't have the awareness…I didn't know that is actually considered gay." Some participants felt natural and at ease about their same-sex attraction at this stage, believing it was "just a phase." At this stage, influence from their peers was significant. Some participants pursued girls to conform to social norms during puberty (see P10, P16, Stage 1, Table 2). Participants who watched heterosexual porn noticed their inclination to focus on the male character and eventually turned to watching gay porn. Participants became increasingly aware of and curious about their differences from their peers. This curiosity initiated their discovery of a potential new self-concept. Some variations of psychological formations existed among the participants. For instance, Christian, Catholic or Muslim participants who understood 'homosexuality' or 'gay' from their religious teachings began experiencing shame and guilt, which occurred more typically in the later stage (Stage 2) for the other participants. Participants who lived in rural areas, suffered from mental disorders or needed to care for family members with disabilities spent a longer time in Stage 1 until their situations changed. The process of gay men's development may temporarily stall upon encountering a new school and living environment. These observations reveal that gay identity development requires gay men's availability to engage in social interactions consciously and purposefully. In Stage 1, participants who experienced rape or parental divorce reported feeling confused and angry towards themselves and the rape or the divorce.

Stage 2: Exploring, Experimenting, and Eradicating Differences from Same-Sex Peers
Exploring, experimenting and eradicating same-sex attraction were prominent characteristics of this stage (see Stage 2, Table 2). Participants searched for information about their same-sex attraction as they entered adolescence. In a vacuum of information about homosexuality, participants understanding of the semantics of 'gay' and 'sissy' and their identification with it initiated a new self-concept as 'potentially gay.' This volatile state started the process of refining their self-concept. Some participants doubted the legitimacy of 'gay' and sought its validity. For example, it could be seen in P12, an Indian Bahai's surprise at learning about 'gay': "I read up about LGBT…I found a few groups online…I spoke to a lot of people there like, oh my God, this [gay] is a thing. People like me. It's a legit thing!!." Some participants searched professional sources (e.g., articles written by mental health professionals) that normalized their experience of being gay. However, learning about the different types of violence directed towards gay men in Malaysia and abroad, induced an intense fear in most participants and the need to take precautions for their own and immediate family members' safety if their sexual orientation was 'gay'. P05, a Chinese Taoist shared that "I feel that if I accidentally let people around me notice that [I am gay], it will turn into…some rumor that will not only affect me, but also my family members. After all, my sister is studying in the same school as I do." This fear marked the beginning of internalized homophobia. Concurrently, participants began experiencing a strong sense of shame, guilt and fear because 'gay' is negatively interpreted across ethnicity and in Christianity, Catholicism, and Islam. They felt they were unfaithful believers or unfilial children for bringing shame to the family (see P18, P02, Stage 2, Table 2). This was particularly true of Muslim participants. For example, P19, a Malay Muslim shared his share of fear and guilt when his father threatened to commit suicide: "[if] I found out that one of my kids are gay…I will kill myself because I failed to educate my kids. And because of that statement, until now, I feel like I don't have the courage…to come out of the closet." All participants feared being disowned by their families for being gay. These stressors caused participants to either anxiously get rid of their same-sex attraction, suppress their same-sex attraction, or 'correct' themselves by trying to 'be straight' through conversion therapy or dating girls (see P01, Stage 2, Table 2).
For example, P03, a Chinese Christian participant, attended conversion therapy and experimented with multiple self-correcting efforts to change his sexual orientation but to no avail. 'I became a lot more reckless with life…one of my friends… saw the way I just dashed across the road…[he said that] this is not a straight-thinking person anymore…Again, I always think of these people [American missionaries who provide conversion therapy] are very well-meaning because they were very good people…he's trained to make me feel comfortable…but the more he talks, the more you feel worse…I'll call my childhood best friend…and tell him I can't handle this anymore.' At this stage, media, religion and education systems influenced participants' identity development. They became increasingly aware of the public prejudice and discrimination against homosexuality (see Fig. 2). As participants suspected themselves as being 'potentially gay', some of them attempted to socialize more with self-identified LGBT people on social media to compare and contrast their characteristics and experiences to see if they could be explained by the term 'gay' (see P06, Stage 2, Table 2). Some participants purposely moved to a foreign country where nobody knows them to work or study to explore their same-sex attraction in a safer environment. Some participants experimented with same-sex sexual activities online or in-person to confirm their same-sex attraction. This loop of experimentation, suppression and self-examination unintentionally provided further evidence that distinguished their affection for and physical and sexual attraction towards males and females. Participants' evaluation as to whether they were gay or not marked the beginning of the next stage.

Stage 3: Confirming Sexual Orientation as Gay
Confirming and redefining sexual orientation as 'gay' were prominent characteristics of this stage. A few participants with less internalized homophobia were relieved to know they were gay while most participants were "forced" to come to the realization that they were gay. This realization redefined participants' self-concept from 'potentially gay' to a self-concept of undesirably being 'undeniably gay.' Some participants began to experience despair because their same-sex attraction persisted despite their numerous 'self-correcting' efforts. For example, P31, an ex-Hindu to Atheist Indian shared that "I try to watch a lot [of heterosexual porn], but it never really worked out…I always have to go back to gay porn…that made me feel even worse because I cannot be like everyone else. Even if you try, you're failing." Participants' internalized homophobia reached its peak in this stage because the anti-gay societal hostility had suddenly become a reality. For example, P02, a non-religious Chinese shared that "Once I found out, it dawned on me that, "Oh, I'm a gay guy, I like guys…also suddenly, it came to a realization that I couldn't tell anyone around me because…the treatment I was getting…like the bullying [I will get bullied] and then the fact that they [others] weren't really open [to accept gay]. I mean, Kelantan. Kelantan is not the most gay-friendly state ever." Their internalized homophobia enormously increased their wishes for self-suppression. They began labelling themselves as a "guilty sinner" (see P20, Stage 3, Table 2), a "child that brings shame to the family" (see P05, Stage 3, Table 2), or a person who "failed the cultural expectation for marriage and having a child" (see P18, Stage 3, Table 2). Their confirmation as 'gay' provoked overwhelming emotions in participants blended with shame, guilt and fear. Participants were confronted with a new understanding of living with a stigmatized identity and being discriminated against by the religious system, culture, laws and society (see Fig. 2). Participants eventually came to an internal recognition of themselves as 'gay' to reduce their psychological turmoil from living in denial despite their internalized homophobia.
Also at this stage, participants began exploring the gay community as gay men and having gay friends in their microsystem (see Fig. 2). They engaged in gay dating and evaluated their attractiveness within the gay community; participants who have had sexual experience began exploring sexual positions in sexual relationships (see P12, Stage 3, Table 2). These social interactions provided new information that probed gay men to refine and redefine more nuanced facets of their self-concept as gay men in same-sex relationships, level of same-sex attractiveness and through their sexual positions. Some participants began changing their way of life as they adjusted to gay cultural norms. For example, they broke up with a girlfriend, stopped attending anti-gay churches, tried same-sex casual sex or cheated in same-sex romantic relationships (see P36, P20, P15, Stage 3, Table 2). Although participants felt accepted by the gay community, the process of self-confirmation and adjusting to gay identity was mainly hidden from their families and close friends, leading them to feel guilty for living a 'double life.' These pent-up emotions led some participants to 'come out' to friends in spontaneous 'confessions'. For example, P29, an Indian Hindu shared that "It wasn't so much that I know my [gay] identity and I'm now going to tell you, it was like I can no longer hide [too stressful] this part of me, and therefore I have to tell you.' Friends' responses to the participants' 'coming out' significantly affected their self-acceptance and well-being. Gay-friendly and gay-neutral responses facilitated gay identity development whereas homonegative responses became barriers to self-acceptance. For example, P01, an indigenous Christian confessed his romantic feelings to a guy who belonged to a gang. The latter reacted 1 3 Constructing Gay Male Identity in a Multicultural Society:… violently at P01's confession which led to P01 to having persisting trust issues in interpersonal relationships.

Stage 4: Accepting Sexual Identity as Gay
Participants' increasing self-acceptance of their gay identity were prominent characteristics of this stage. Christian, Catholic and Muslim participants showed increased exploration of religious studies about homosexuality. This shows a cyclical process from the redefined 'undeniably gay' self-concept into a new refining process. Gay men either changed their religious interpretation of homosexuality or left their faith communities to reduce cognitive dissonance. For example, P20, a Chinese Christian shared that "If you really look into it, Bible didn't really explicitly say 'gay' is a sin…in Old Testament, they also talk about like, woman cannot talk in front of men…why all these stupid people don't talk about those verses?…so it really depends on what you want to believe." On the other hand, P28, a Malay Muslim shared that "I know God is not cruel. He doesn't create…human beings to…just be tormented for the rest of their lives…I think reading [academic writings of liberal Muslim scholars] and things like that really helped me in accepting who I am…I also haven't disregarded my values or religious values. It's like you are enjoying your life to the fullest." Notably, when P25 converted from a gay-neutral religion (Buddhism) into a homonegative religion (Christianity), he experienced decreased self-acceptance, a resurgence of self-doubt and guilt typical of MGM in the previous stage (Stage 3). This change showed that SIM is not a linear process. Participants who had 'come out' in Stage 3 began building a validating environment that facilitated self-acceptance. Their intention to further 'come out' in Stage 4 was relatively well-planned to increase self-congruence and was less guilt-driven. As participants transitioned into this stage, their internalized homophobia gradually decreased and they began to accept their femininity by internalizing social acceptance from peers and feeling less pressured to conform to gender roles (see P18, Stage 4, Table 2). At this point, their self-concept was redefined from a negative state to a positive one. However, they remained vigilant about the public's acceptance of their gender expression to stay safe (see P13, Stage 4, Table 2). Some differences were observed in the subjective experiences of the various ethnic groups. For example, Muslim gay men experienced elevated fear stemming from religious violations (e.g., persecution from religious authorities and legal repercussions). Indian participants from rural areas had to overcome additional negative stereotypes associated with crime and social class unique to their ethnic group.
Some participants started using sex to cope with their distress and connect with other gay men (see P08, Stage 4, Table 2). This coping mechanism further refined a nuanced facet in their self-concept that being 'gay is lonely'. P16, a Catholic, multiracial MGM, succinctly shared the stigma-induced stress. "Sex was the only positive, enjoyable thing about being gay because everything else [everyday anti-gay stigma, discrimination and constant vigilance on sexual identity management] was not fun." Over time, most participants shifted from sex-focused to relationship-focused interactions with other gay men as they craved deeper interpersonal connections (see P33, Stage 4, Table 2). This change in strategy is a continuation of the refinement process. Participants in a romantic relationship felt more secure in their relationship at this stage whereas unattached participants continued their search for a romantic partner. With increasing assimilation into the gay subculture, participants noticed the in-group competitiveness and discrimination within the gay community. Participants were discriminated against based on their ethnicity, skin color, physical attractiveness, body size, penis size, religion and perceived masculinity by other gay men. For example, P20, a Chinese Christian shared his encounters as such: "You are not handsome enough, you cannot join us, you cannot sit with us" whereas P24, an Indian Hindu, shared that "I'm just comparing the amount of people who have written in their [online gay dating] profile…[many of them have written] no Indian or Chinese, or only Malay or only Chinese, or no Indian, or just specifically no Indian at all." Similarly, P08, a Chinese Buddhist, recounted incidents when Malay gay men refused to engage in sexual intimacy with him because P08's religion and diet preferences were 'non-halal'; they believed he would contaminate them. The competitive environment in the gay community became increasingly unwelcoming for some participants as they craved deeper interpersonal connections. This process initiated another cycle of refining and redefining another component of their selfconcept with the gay community. Some participants distanced themselves from the gay community as they noticed increasing differences in their values on the casual sex culture, racial biases and in-group discrimination (see P17, Stage 4, Table 2). This process showed their shift from passive-receiving roles into active agents who decided and reconstructed their relationship with religion, gender role expectations, heterosexist norms, the gay community and gay cultural norms (see Fig. 2).

Stage 5: Negotiating Social Expectations and Pursuing Ideal Gay Life
Prominent characteristics in this stage were negotiating social expectations and the pursuit of an ideal gay life. Participants' internalized homophobia was also typically lower than in Stage 4. As participants matured into middle adulthood participants, they faced increasing pressure from their parents and extended families to get married. This was especially so for Malay-Muslim participants as their culture believes conversion from homosexuality to heterosexuality is possible. Malay-Muslim participants faced the additional pressure of having to produce offspring due to the belief that prayers from offspring are essential to the peace and wellbeing of the parents' souls and receiving forgiveness from God in the afterlife. These challenges placed further obstacles to gay men in refining and redefining their self-concept in that they would have to consider heterosexual marriage. The pressure to get married motivated some participants to form a support group with other gay men as a coping mechanism. For example, P19, a Malay Muslim shared that, "We do have this kind of conversation with my gay friends…do you still want to get married… some will say yes, some will say no…I purposely told him…if you are going to get married…maybe we can still be friends. But then I will monitor you [from having same-sex relationships]." Although Indian participants were aware that Indian wives frequently condoned their husband's same-sex sexual affairs, they preferred living congruently with their gay identity and would not consider heterosexual marriage. They either deflected their parents' expectations for heterosexual marriage by focusing on their careers and education or confronted their parents by coming out as gay (see P30, Stage 5, Table 2). Although participants believed that coming out to parents is crucial to being a completely authentic gay man, most decided to disclose their sexuality only after achieving financial independence. But a few felt it was unnecessary to tell and remained closeted despite attaining financial independence.
Partnered participants experienced increasing challenges in hiding their romantic relationships from others. They would socialize their close gay friends and partners into their microsystem (see Fig. 2) but they would camouflage and normalize their partners as their 'best friend' to justify their partners' frequent appearances on family occasions. For example, P05, a Chinese Taoist, shared that "I invited him [boyfriend] home, and [introduced him as the best friend] …I told him that, my parents were quite old. We should take this opportunity while they could still move around…we go overseas at least once a year, with my family members," whereas P19, a Malay Muslim, shared that,: "within the family we are like close friends… [when we went to his hometown], where the family is there, you can hang out more with the family because you…[are a] close friend." However, participants who had never dated stopped pursuing relationships and were resigned to their single status. In contrast, partnered participants decided whether they preferred a monogamous, open or polygamous relationship. Those in a committed relationship entertained the possibility of getting married and adopting children. Thus their self-concept was further refined and redefined based on their preferred relationship styles and the meaning and future of being gay. Regardless of their relationship status, most participants wanted to migrate to countries where gay marriage was legal (see P18, Stage 5, Table 2).
Some participants considered fulfilling their filial duties as sons through creative ways. Instead of producing offspring from a heterosexual marriage, they considered adopting a child and providing more care and financial compensation for their parents (see P25, Stage 5, Table 2). As P19, a Malay-Muslim participant said, "I told myself that I'm not going to get married; instead, I will be helping my parents with all those financial [supporting parents financially], like being a good son, taking care of them." A few participants decided to contribute to the gay community by promoting platforms that support or increase the community's visibility. They became more involved with LGBT-friendly NGOs, LGBT-related activism or raising awareness about gay marriage and conversion therapy bans. While some participants opted for this 'loud activism', many opted for 'soft activism' by sharing social media posts. For example, P09, a Chinese Buddhist, is a 'loud activist' and shared that, "I'm actually doing something about promoting LGBT equality…I feel I have…quite accepted myself." P11, an ex-Muslim who now views himself as a non-religious Malay, opted for soft activism: "I don't put like a rainbow flag or anything…but sometimes let's say…there's an interesting post about LGBT, I can share it without having any problem." Member check also confirmed that some MGMs believed that their sexual identity is a private matter and would not engage in gay pride activities. Most participants in this stage actively redefined their relationship with ethnocultural expectations, social stereotypes of being gay and heterosexist prejudice against gay men, and attempted to influence political and legal decisions through activism on various levels (see Fig. 2).

Discussion
The five-stage SIM was proposed to theorize MGM's sexual identity development as a continuous process of gay men discovering and then cycling between refining and redefining their self-concept through purposeful social interactions to reduce psychosocial distress and improve their quality of life. It illustrates the intricate intrapersonal and interpersonal processes of gay men developing at the intersection of their social identities.
The five stages were constructed based on the developmental experiences shared across 36 MGM's life experiences. For example, we noticed that participants in Stage 4 underwent the same struggle as those in Stage 3. Similar observations were also made of participants in Stage 5 and Stage 4. Therefore, we infer that if a participant develops his sexual identity at Stage 3, they should experience a similar developmental trajectory as participants in Stage 4. SIM could be interpreted and utilized not only as a lifespan theory but also as a nonlinear stage theory. While most MGM experienced Stage 2 during early adolescence, some MGM began Stage 2 only in young adulthood but progressed through the subsequent stages quickly. Furthermore, some MGM 'regressed' to an earlier stage when there was an ecological shift. The following paragraphs will discuss the research findings and their implications.

A New Gay Male Identity Model in an Islamic and Multicultural Context
SIM illustrates the challenges of MGM developing their sexual identity in a closeknit, relational and tight society that differs from previous gay identity development models. Hall et al. (2021, p. 7) systematic review suggested that gay men's identity development typically follows the sequence of (1) noticing queer attractions; (2) questioning one's sexual orientation; (3) self-identifying as gay; (4) engaging in sex; (5) coming out to others and (6) having a romantic relationship. Hall's model continues to reflect an individualist focus, with the gay man maturing with their partner as the new primary 'family' unit. In contrast, SIM has a relationalist focus where gay men prize and carefully manage their parent-child filial relationship, socialize and integrate their partners into a bigger nuclear family unit and their self-acceptance is relationally derived (Brewer & Chen, 2007). Further, the intersectional differences in their development are deeply influenced by their respective ethnic, class and religion.
For example, MGM carefully navigated their development to safeguard their immediate families from associated gay stigma. Correspondingly, they experienced guilt for hiding their sexual identity from friends which implied a failure in maintaining their relational role responsibilities in close relationships (Brewer & Chen, 2007). As such, peer acceptance served as a cornerstone for MGM to internalize and initiate self-acceptance of their gay identity while coming out to parents would make them a 'complete' gay person. These manifestations show that MGM's self-concept is relationally defined as they primarily depend on approval from significant others to bring about self-acceptance. Thus MGM's motivation differs from the motivation of western individualists to have their individual uniqueness affirmed upon coming out (e.g., Cass, 1979Cass, , 1984. The continuous presence of immediate family throughout the development process reflects the closeknit family structure commonly observed in most Asian countries (Raymo & Dong, 2020;Yeung et al., 2018). It suggests that this set of cultural complexities is not unique to MGM and that SIM may resonate with scholars and professionals who work with gay men in other parts Asia and find the model relevant to their practice.
SIM provides a new understanding of gay identity; it is not a static identity that stops developing after identity synthesis. Gay identity is multifaceted and continues to develop, refine and redefine across the lifespan with increasing complexity. This view helps to explain why some individuals may disidentify as being gay (Pinto et al., 2022). Furthermore, we found that the determiners in MGM's sexuality development is not limited to gender, ethnicity and social class (Shah, 2020) but also includes factors such as ethnic stereotypes, ethnocultural beliefs and expectations, religion, mental health status, geolocation, gender norm expectations and applicable legal systems. This finding echoes the critiques of stage models that variability exists in sexual orientation identity development (e.g., Bishop et al., 2022;Hall et al., 2021), and that these factors may help predict the time and pattern in sexual orientation identity development.
Contrary to Alderson's (2003) findings, we found that in a sexually conservative society like Malaysia, except for a minority of the participants, sexual activity is not a pre-requisite to knowing self as gay. Most MGM confirmed they were gay upon learning their preference for same-sex pornography materials and sexual fantasies.
Our findings concur with past research that sexual abuse confuses the survivor's beliefs about the origins of their homosexuality (Kiss et al., 2020). However, it may not be a determinant factor leading to homosexuality. Although participants who experienced same-sex sexual abuse, female-initiated sexual abuse or parental divorce suspected these factors made them gay, they shared the same themes in their subsequent developments with participants who were not sexually abused.
While the origins of participants' homosexuality was not the aim of this study, we made several observations that could shed light on the contribution of psychosocial factors to gay sexual identity development. Firstly, we found same-sex attraction naturally present in all participants, with some MGM experiencing it as early as five years old. It was not caused by adverse life experiences or social influences. In Malaysia, where homosexual expressions and role models were invisible during MGM's childhoods, this finding suggests nature's contribution towards sexual orientation. Secondly, results show that heterosexist society presents powerful barriers that block gay men from comprehending their differences from same-sex peers and they must consciously and purposefully interact with others to clarify, confirm and accept their same-sex attraction. This finding could help explain why some gay men only realize they are gay in adulthood while others have known it since childhood.

Implications for Policymakers
We recommend that Malaysian policymakers decriminalize same-sex sexual acts and gender nonconforming behavior. The strong heterosexist environment in Malaysia which may physically and psychologically hurt, socially and spiritually exclude, and legally persecute MGM, has caused enduring stress, fear, and anxiety in them (Shah, 2020). Research has shown that heterosexism could cause lead to internalized homophobia (Hatzenbuehler, 2016) and negatively affect gay men's mental and behavioral health, thereby increasing public health costs (Hatzenbuehler et al., 2017;Newcomb & Mustanski, 2010;Xu et al., 2017). By decriminalizing same-sex acts and gender nonconforming behavior, it would help to reduce potential gay brain drain (Suen & Chan, 2021) as mentioned by many participants in Stage 5. It would also help alleviate the never-ending fear faced by gay men as mentioned in Stage 4 (and in Shah, 2020). Malaysia could learn from neighboring Singapore, which has a similar Penal Code and multicultural composition to Malaysia, by decriminalizing same-sex acts.
Secondly, policymakers should ban conversion therapy and encourage gay-affirmative counselling. Our finding suggests that homosexuality has a natural element which disqualifies the underlying premise of conversion therapy that homosexuality is an illness, immoral and needs remediation. This false premise on homosexuality could also explain MGM's failure in eradicating their homosexuality in Stage 2 of SIM, and systematic reviews have drawn similar conclusions (American Psychological Association, 2009).

Implications for Mental, Behavioral, and Public Health Professionals (HP)
SIM showed the challenges that MGM faced throughout their sexual identity development. Nevertheless, our study shows that MGM had transformed from being submissive to becoming active agents over time and eventually extending their influence beyond their microsystem. This is because gay men are motivated to reduce psychosocial distress and improve their quality of life which puts them in a state of high self-acceptance, low self-suppression and overall better mental health. These efforts should be a reminder for HP to think beyond a deficit model and utilize SIM as a guide to incorporate gay men's strengths and resilience in overcoming their adversities in each stage of their sexual identity development.
HP should practice using a gay-affirmative framework, caution against conversion therapy and advocate for non-discrimination of homosexuals. Two MGM who attended conversion therapy experienced heightened suicidality and self-destructive tendencies when they failed to eradicate their same-sex attraction. Although they were delighted to meet other religious gay men, conversion therapy heightened their sense of helplessness. This finding suggests that association with other religious gay men could help religious MGM overcome their conflict with self-acceptance whereas conversion therapy could have adverse effects on their mental health. In this sense, HP may invite religious gay clients to explore religious verses or narratives for potential acceptance from their religion to facilitate self-acceptance (Shah, 2016(Shah, , 2021.
As MGM is primarily other-oriented in this relational-based society, culturally responsive therapists should be equipped with a relational lens to view and better understand the relational dynamics contributing to MGM's distresses. For example, MGM's internalized homophobia is fueled not only by the internalization of society's homonegative attitudes but as seen in SIM, is also driven by relational fear of inflicting associative gay stigma on those close to them. This relational fear has led to further self-hatred and worsening internalized homophobia. A culturally responsive therapist could frame these relational fears as culturally appropriate concerns in a tight, closeknit, relational, heterosexist society; acknowledge MGM's efforts in keeping themselves and their loved ones safe from homonegative threats; appreciate MGM's efforts in meeting their relational responsibilities as a son, brother or close friend and explore ways to address or reduce these relational concerns while affirming the client's gay identity. The therapist's validation and appreciation of MGM's efforts in fulfilling their responsibilities would help assuage their relational worries and nurture the therapeutic relationship.
Finally, the structured development of internalized homophobia across the stages and the purpose and patterns of same-sex sexual behavior detailed by SIM may interest HP's research and clinical work.

Limitations and Future Directions
SIM should be interpreted with the following cautions: (1) There may be a cohort effect as most participants were aged 45 and below (Lelutiu-Weinberger et al., 2013). (2) Participants' feedback suggested that Indian and Malay gay men who identified as 'bisexual' or were in a heterosexual marriage be not included in this study. (3) Although SIM was modelled in stages, not all MGM will reach Stage 5. Neither do we intend to frame it as the only healthy gay identity development. The fluidity of stages should be allowed and pathologizing the early stages should be avoided. Future research could explore multiethnic instead of monoethnic gay individuals' sexual identity development or verify SIM's usefulness and potential application for gay men in other parts of Asia.

Conclusion
This study aimed to construct an MGM sexual identity development model using a constructivist grounded theory approach (Charmaz, 2014). We proposed a fivestage Systemic Interaction Model (SIM) that theorizes sexual identity development as a continuous process of gay men discovering and then cycling between refining and redefining their self-concept. SIM details the intricate intersectional, intrapersonal and interpersonal processes of Asian gay men moving from passive roles into active cultural agents as they develop their sexual identity in Malaysia, a closeknit, relational and tight society-a different cultural context from previous gay identity development models. As this set of cultural complexities is not unique to MGM, scholars and professionals who work with gay men in multicultural and multireligious contexts could find SIM useful as it may more closely resemble the concerns and struggles health professionals see in their practice.
Funding Open Access funding enabled and organized by CAUL and its Member Institutions. This work was supported by Monash University, Malaysia campus under Project ID 22884.

Data Availability
The data generated during this study are not publicly available due to the highly sensitive nature of this topic but may be available from the corresponding author on reasonable request.

Conflict of interest
The authors have no relevant financial or non-financial conflict to disclose.
Ethical Approval Approval was obtained from the Monash University Human Research Ethics Committee. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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