Context: Previous research indicates athletic trainers have a favorable view of treating transgender patients, yet do not feel competent in their patient care knowledge or abilities.

Objective: To gain more depth of information about athletic trainers' knowledge and experiences regarding the health care needs of transgender student-athletes.

Design: Sequential, explanatory mixed methods.

Setting: Individual, semi-structured follow-up interviews.

Participants: Fifteen athletic trainers who previously took part in a cross-sectional survey in April 2018 (male=8, female=7, age=24±2, years of experience=3±3).

Main Outcome Measure(s): The interviews were audio recorded and transcribed verbatim. Member checking was completed to ensure trustworthiness of the data. Next, the data were analyzed using a multi-phased process and a 3-member coding team following the consensual qualitative research tradition. The coding team analyzed the transcripts for domains and categories. The final consensus codebook and coded transcripts were audited by a member of the research team for credibility.

Results: Four main domains were identified: 1) perceived deficiencies, 2) misconceptions, 3) concerns, and 4) creating safety. Participants described knowledge deficiencies in themselves, health care providers within their unit, and providers able to provide safe transition care. Participants demonstrated misconceptions when characterizing the definitions of transgender and transitioning and when describing how the body responds to hormone replacement therapy. Participants expressed concern for the mental health and wellness, self-image of transgender student-athletes, and potential cost of transgender health care. However, participants also described efforts to create safety within their unit by validation, instilling trust, adjusting the physical environment, and by engaging in professional development to improve their knowledge.

Conclusions: Athletic trainers want to create a safe space for transgender student-athletes but lack the necessary knowledge to treat transgender patients. Professional resources to improve athletic trainer knowledge, skills, and abilities in caring for transgender patients are a continued need.

Key Points
  1. Athletic trainers continue to describe a lack of knowledge, despite efforts to engaging in professional development helping them create safety, in caring for transgender student-athletes.

  2. Specifically, athletic trainers demonstrate misconceptions when characterizing transgender and transitioning, as well as a misunderstanding of the physiological response to hormone replacement therapy.

  3. Athletic trainers are concerned for their transgender student-athletes, recognizing the potential damage an unsafe world can have on their self-image and mental health and wellness.

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