Table 3 Summary of interviews’ emergent themes and relative frequency of discussion by topic

Gender transition

Transition occurs in stages but does not define womanhood

Financial barriers to medical transitioning

Use of lower-cost and non-prescribed medications

Taking on only small transition expenses

Waiting to “come out” until transition is completed

Limited access to gender affirming services

Employment

Termination due to disclosed transgender identity

No transition or full transition is most protective against job discrimination

Sex exchange as source of employment while gender transitioning

Challenges with name change and name preferences at work

Need for trans-sensitivity training for local employers

Higher pre-transition earning power

Housing

Useful to have trans-supportive housing

Difficulty accessing housing due to transgender identity

HIV services

Linking transition services to HIV testing/care

Concerns for trans discrimination by health care system

Discussing HIV prevention with sex partners

Effect of transition on sex partner accessibility and relationship