Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals' ethical challenges and norms regarding decision-making in gender-affirming medical care.

"Declarations Ethics approval and consent to participateThe methods used to carry out the study followed the Declaration of Helsinki and all other relevant guidelines. We submitted the study protocol for review to an officially accredited IRB/REC, the Medical Ethics Committee of the Amsterdam UMC, location VUmc, which issued a declaration that under Dutch law, a full ethical review was not necessary (IRB00002991, April 21, 2020). We informed eligible respondents via e-mail about the study and their rights at least a week before the interview. We emphasized that participation in the study was voluntary and that participants could withdraw from the study at any moment. We provided the opportunity to ask questions and obtained written informed consent before the interview. We also obtained oral informed consent at the start of the interview after reiterating the study objectives and data management. Given the relatively small number of clinicians working in Dutch GAMC, privacy and anonymity were subject to concern. We preserved participant anonymity (and, by extension, that of their clients) in this writing by using pseudonyms. Furthermore, we omitted the locations of the participating institutions, some demographic characteristics such as age and gender, and specifics regarding cases or HCPs’ current positions. Consent for publicationNot applicable. Competing interestsNot applicable. Competing interests Not applicable."

"Funding Not applicable."