Table 1 Coding Scheme: Main themes, sub-themes and inclusion/exclusion criteria

1. Health Care\Barriers/Needs

  Non-TG specific health barriers/needs

1.A

a) Mental Health

b) Preventative Health Services

  TG-specific health barriers/needs

1.B

a) Medical transition

Gender identity disorder as a pathology under 2.C

b) Hormone therapy

c) Surgery

d) Standards of care

e) Gender identity diagnosis

2. Other Barriers

  Socio-Demographic

2.A

a) Housing

b) Geographic location

c) Transportation

d) Financial

  Clinical Encounter Barriers for TG

2.B

a) Access to care

References to navigating health care system coded below under 6.A

b) Health insurance

c) TG-doctor-patient encounters

d) Lack of available information

  Other Barriers

2.C

a) Violence/abuse/safety

Other issues related to safety of school environment coded under #3

b) Discrimination

c) Stigma

d) Employment

e) Government issued identification

f) Legal/arrest

g) Bathroom access

h) Education

i) Substance abuse

3. Social and Family Support

 Family

3.A

a) Family composition/structure

b) Parental support

c) Lack of family support

d) Parental Consent

 Print and Social Media

3.B

a) Films, TV specials, internet, etc.

 School

3.C

a) References to school environment

Education as barrier coded above in 2.C

4. Community-Based Institutions and Resources

 Community-based health and social support services

4.A

a) Community-based events, services, support groups

b) References to specific organizations

5. Recommendations: Characteristics of Excellent Care

 Provider Education (staff specific)

5.A

a) Cultural competency training and TG awareness and education for all staff

Direct references to cultural competency and providers

 Clinical Environment

5.B

a) Welcoming environment

b) References to supportive environment

c) List of resources available for patients

 Approaches to TG Care

5.C

a) Psycho-social approaches to care that may include risk reduction models, peer-to-peer, mobile testing, holistic approach/comprehensive care, involving TGs in the delivery of services

6. Health Care System

 Difficulties Navigating Health Care System

6.A

a) References to challenges navigating the system

7. Personal Experiences

 Role of Personal Experiences Shaping TG Advocacy/Research

7.A

a) Includes references to TG self-identification

8. Other Issues

 Research/lack of on TG

8.A

References to need or lack of research on TG

 Complex Identities & Diversity of TG

8.B

Includes references to multiple identities

 Resilience of TG Youth

8.C

References to TG youth being resilient in face of challenges

 Advocacy

8.D

Specific references to advocacy, leadership development, legislation/policy

Community-based social services are coded under 4.A

 Characteristics of Clients Served

8.E

Description of clients served at participant’s institution

Diversity of TG in general is coded under 8.B

 Differences in Care Needs between Adults and Youth

8.F

Description of ways in which care needs or care services differ for youth vs. adults

 Great Example

8.G

Examples, stories about TG youth that would be ideal to highlight in paper

 Other

8.H

May include: a) Mistrust of doctors by TG Community b) Jail/Prison