Table 2.

Higher Order Themes and Number of Line By Line Codes

Category	Higher Order Theme	Total Line by Line Codes	Line by Line Codes from Caregiver Interviews	Line by Line Codes from Youth Interviews
Societal Factors	Comparing experiences	60	53	7
	Gender norms	43	42	1
	Passing	19	11	8
	Societal views of LGBTQ issues	11	8	3
	Fitting in	9	8	1
	Social interactions	6	5	1
	Living as identified gender will be easier	5	4	1
	Religion	5	4	1
Barriers to envisioning a positive future	Discrimination	27	24	3
	Policies and rights	23	21	2
	Insurance and finances	21	17	4
	Romantic relationships – concerns	18	15	3
	Rejection	17	14	3
	Discrimination – bullying	14	14	0
	Discrimination – employment	11	7	4
	Legal issues (e.g., official documents)	10	7	3
	Perceived as unusual	7	7	0
	Barriers to gender affirming treatment	5	4	1
	Attractiveness	4	4	0
	Difficulty imagining youth's future	4	4	0
Advocacy	Activism	25	23	2
	Knowledge/education about transgender	14	14	0
	Helping others	12	11	1
Acceptance/support	Supportive communities – youth	31	28	3
	Supportive communities – caregivers/family	27	27	0
	Being a good caregiver	26	26	0
	Wanting the best for youth	25	25	0
	Acceptance-interpersonal	24	21	3
	Acceptance-broad	21	16	5
	Being a good caregiver – support	18	18	0
	Being a good caregiver – skills & preparation	15	15	0
	Being a good caregiver – protection	10	10	0
	Seeking support/resources	9	8	1
Mental health/emotions	Worry about safety – physical and emotional	48	46	2
	Emotions – fear	34	34	0
	General worry about future	31	30	1
	Mental health – happiness	22	21	1
	Emotions – positive	16	15	1
	Mental health	15	14	1
	Emotions – sadness/grief	14	14	0
	Emotions – anxiety	13	13	0
	Reassurance	12	12	0
	Comfort with body	11	11	0
	Emotions – hardship	10	10	0
	Mental health – suicidality	7	7	0
Relationships	Friendships	24	18	6
	Caregiver-child relationship	22	19	3
	Caregiver discordance or agreement	17	17	0
	Relationships with extended family	14	14	0
	Parent-parent relationship	5	5	0
	Effect of having transgender sibling	3	3	0
Approaching the adjustment	Uncertainty about the future	39	34	5
	Is my child really transgender?	36	34	2
	Planning/preparation	34	30	4
	Decision-making about being out	28	12	16
	Desire for certainty	14	14	0
	Perseverance/determination	6	4	2
	Avoidance of thinking about youth's future	5	5	0
	Going with the flow/being flexible	5	5	0
	Origin of being transgender	5	5	0
Expectations	Romantic relationships – expectations	35	23	12
	Expectations about coming out	31	20	11
	Self-sufficiency	30	30	0
	Ideal expectations for youth's future	29	24	5
	Societal views of LGBTQ issues – hopes for future	27	25	2
	General expectations about youth's/family's future	23	20	3
	Youth's future family	23	21	2
	Difficult future/challenges	19	18	1
	Normative expectations	15	15	0
	Sexual orientation – caregiver expectations	15	15	0
	Change in expectations	13	12	1
	Reproduction	10	9	1
	Positive effects of being transgender	6	3	3
	Transgender identity won't affect future	6	1	5
	Sexual activity	5	4	1
Identity	Authenticity	28	27	1
	Personality and behavior	23	23	0
	Desire to be another gender	19	18	1
	Names	17	14	3
	Transition process	17	13	4
	Sexual orientation – youth self-identification	10	6	4
	Emphasis on youth's transgender identity	8	3	5
	Genitals	8	8	0
	Self-fulfillment	8	8	0
	Fluidity of transgender identity	6	3	3
	Gender spectrum/genderqueer	4	4	0
	Maintaining attributes	4	4	0
Institutional factors	Camp	34	27	7
	School – pre-college	32	26	6
	Employment/career – youth, specific careers	30	14	16
	Employment/career – youth, work issues	28	16	12
	College	14		11
	Changing schools/moving cities	13	9	4
	Facilities (e.g., bathroom)	12	9	3
	Employment/career – caregiver	10	10	0
	College – housing	7	7	0
Health/Interventions	Gender affirming treatment – hormones	45	42	3
	Gender affirming treatment – surgery	37	27	10
	Gender affirming treatment – feelings	32	30	2
	Professional help	30	27	3
	Gender affirming treatment	13	12	1
	Puberty	9	9	0
	Health	5	5	0