TPC-Journal-Vol 11-Issue-4

446 The Professional Counselor | Volume 11, Issue 4 Analysis The researchers used line-by-line coding of interview data and continuously compared new codes with those of previous interviews. Microsoft Excel software (version 16.44) was used for keeping track of the coding matrix. The coding matrix was reworked until a core theoretical category emerged that explained the underlying concepts inherent in the process under examination. Trustworthiness In qualitative research, a study’s rigor is typically measured by trustworthiness, or the consistency of the results with the data collected (Merriam & Tisdell, 2016). To support this process, we used a variety of strategies, including triangulation, member checks, and reflexivity (Corbin & Strauss, 2015; Creswell, 2013; Merriam & Tisdell, 2016). Triangulation was accomplished by the recruitment of two study auditors who conducted blind coding of data samples and reviewed the study design, procedures, and process of theory integration for accuracy (Creswell, 2013). Reflexivity involves the “critical self-reflection of the researcher regarding assumptions, worldview, biases, theoretical orientation and relationship to the study that may affect the investigation” (Merriam & Tisdell, 2016, p. 256). The first author and lead researcher, Charles F. Shepard, identifies as a White, cisgender, straight, middle-aged man who has lived his entire life in the Southeastern United States. He has been married for more than 14 years, and he is the father of two young children who were assigned female at birth. Shepard’s interest in the present topic is rooted in personal, academic, and professional experiences with conscience conflicts during the past three decades. The second author, Darius A. Green, served as an auditor and identifies as a Black, cisgender, straight, young adult man who has lived predominantly in the Southeastern United States. Green is a doctoral-level counselor educator who has conducted research and provided counseling with underrepresented populations. The third author, Karli M. Fleitas, served as the second auditor and identifies as a Japanese American, cisgender, straight, young adult woman who has lived predominantly in the Southeastern United States. Fleitas is a doctoral student in a counselor education program accredited by the Council for Accreditation of Counseling and Related Educational Programs who has clinical experience working with LGBTQ+ clients as well as certification with respect to diversity, equity, and inclusion practices. The fourth author, Debbie C. Sturm, served as the chairperson of Shepard’s dissertation committee and provided guidance to the research and reporting processes. Sturm identifies as a White, cisgender, straight, middle-aged woman who has lived between the Northeastern and Southeastern regions of the United States. She has conducted and supervised previous research relevant to LGBTQ+ concerns. We considered our identities and backgrounds throughout for their potential effect on the data collection and analysis processes. Results The major findings of this study included inhibitors and contributors to consent as well as a central theme, specifically how participants combined contributing factors to overcome inhibiting factors of the consent-giving process. Inhibitors to Consent Participants identified five major inhibitors to giving consent: (a) lack of knowledge and awareness of issues and concerns related to TGD identity, (b) fear, (c) doubt, (d) grief over a lost parenting narrative, and (e) rejection from healthcare providers (or payors) and parenting partners. To a lesser degree, lack of access to affirming care due to residential location and the cost of treatments were cited as notable experiences of participants.