99 Medical decision‑making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians 5 However, the adolescents, parents and clinicians wondered to what extent an adolescent should and can be able to understand and appreciate some possible (long-term) consequences of the treatment. According to clinicians and parents, not being able to understand and appreciate the impact of the loss of fertility on one’s future life and relationships is inherent to an adolescent’s age and developmental stage. Some clinicians mentioned that even some adults are not able to understand and appreciate the impact of certain consequences of the treatment. Thus, one might question whether it is reasonable to expect adolescents to be able to understand and appreciate all possible consequences of medical treatment. Yet we often seem to assess adults’ MDC in these situations as ‘sufficient’, while we question that of adolescents. Infertility and concerns about (future) fertility may have a major negative impact on quality of life and mental health (Carter et al., 2010; Trent, Rich, Austin, & Gordon, 2003). Research focusing on survivors of paediatric cancer shows that plans of minors for future children may change over the years (Armuand et al., 2014; Stein et al., 2014). Although there is, as far as we know, no similar published data regarding transgender minors deciding on PS, data from a Dutch study with transgender adults shows that views regarding parenthood might change over time (Van Mello et al., 2022). Other research shows that vitality and self-perceived mental health status is significantly better among adult transmen with children than for those without (Wierckx et al., 2012). Offering the possibility of fertility preservation is therefore important. However, that in turn might bring its own difficulties. For example, the fertility preservation process might have a psychological impact on the adolescent and/or the parent(s), as mentioned by one of the parents in this study. In our clinical practice, all adolescents and their families are offered fertility counselling, but some families refuse because they consider even just the counselling too psychologically burdensome for their young child. Up until now little is known about the possible psychological impact of the procedures and the process of fertility preservation on transgender adolescents (Baram, Myers, Yee, & Librach, 2019). Further research regarding not only the benefit but also the possible harm of a fertility preservation process on transgender adolescents and their families would therefore be valuable (Baram et al., 2019; Chen & Simons, 2018). Besides, we recommend future research examining the impact of the loss of fertility later in the adolescents’ lives, and investigating the best way to communicate information regarding fertility (preservation) to these young adolescents. Of note, in the Netherlands fertility preservation continues to be a topic of conversation throughout the diagnostic and treatment phases, and in any case before decisions about GAH and surgery are made, since fertility preservation remains possible even after adolescents have started treatment with PS, for example, by temporarily interrupting treatment. Another aspect participants mentioned regarding assessing MDC to start PS was the parents’ role. Involvement and help of parents with regard to making medical decisions for