Health care experiences

Anticipated stigma in health care was assessed via a six-item measure specifically developed for this study, given the lack of validated measures assessing anticipated health care stigma among TM individuals. After a review of the literature and existing measures, the research team developed this measure in collaboration with the community advisory board to capture self-efficacy (e.g., feel confident) in being treated with respect in health care settings, anticipated challenges and barriers to receiving health care, misgendering/mispronouning, gender identity disclosure, prior mistreatment experiences, and hearing about other people's mistreatment experiences.^8,35–37 The items were piloted as part of the survey to ensure clarity and minimize response errors. Measure items are given in Supplementary Table S1. Responses ranged from strongly disagree = 0 to strongly agree = 4. All items were summed to generate a score ranging from 0 to 24 (α = 0.80).

Participants were also asked if they had to educate their doctor or other provider regarding any topic to get appropriate care in their lifetime and if they had been refused treatment by a doctor or other provider in their lifetime (yes/no).⁸