100 Chapter 5 minors is important, just as most adolescents, both continuers and discontinuers, parents, and clinicians mentioned, and as stated in laws and in international guidelines on care for transgender children and adolescents (Coleman et al., 2012; Vrouenraets et al., 2015). Additionally, the clinicians in this study said that, besides the adolescents and parents, they themselves took part in the decision-making process too. None of the adolescents and parents did not mention this. For patient-centred care shared decision-making (SDM) is considered essential and it is recommended by paediatric regulatory organizations (Barry & Edgman-Levitan, 2012; Harrison, Canadian Paediatric Society, & Bioethics Committee, 2004). The SDM approach in general care is evidence-based and promotes collaboration between patients, family members, and clinicians when making a decision regarding health care (Boland et al., 2019). Patients, family members, and clinicians can deliberately decide about the best treatment plan by exchanging information about the treatment’s evidence (options, benefits, and risks) and the patient’s and family’s preferences (Légaré et al., 2011). In SDM the patient’s expertise and values are considered along with empirical medical information, and the decision-making responsibilities of the patient, family members, and clinicians are balanced (Makoul & Clayman, 2006; Crickard, O’Brien, Rapp, & Holmes, 2010; Langer & Jensen-Doss, 2018). Although little is known about SDM in the context of PS in transgender adolescents, research shows that SDM can support decisions about GAH treatment for transgender adolescents when integrating into practice the following five conditions: open communication, role agreement, supportive relationships, agreement about the decision, and sufficient time (Clark, Virani, Marshall, & Saewyc, 2021). Research shows that among other things the use of information-sharing techniques that are age-appropriate, breaking down a decision into smaller choices, and asking direct and simple questions all promote adolescents’ ability to participate in medical discussion (Michaud, Blum, Benaroyo, Zermatten, & Baltag, 2015). Future research examining how transgender adolescents can best be involved in the decision-making process regarding PS is recommended. Additionally, it is notable that most adolescents who proceeded to GAH after PS, and parents mentioned that they did not feel they had a choice whether or not to start the treatment with PS. By contrast, none of the adolescents who discontinued PS or their parents explicitly stated having no choice. It is noteworthy that, most adolescents, continuers and discontinuers, and their parents mentioned not really taking the treatment’s possible negative consequences into consideration. This, even though most adolescents, parents, and clinicians stated that understanding the treatment and its consequences should be considered when assessing adolescents’ MDC. Apparently, the possible negative consequences of the treatment do not outweigh the burden of the adolescents’ gender incongruent feelings. One could therefore question whether
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