104 Chapter 5 Therefore, we encourage prospective gathering of more qualitative data from adolescents who have not started PS yet, or receive PS but have not started treatment with GAH yet. Due to the small sample size, the non-participation rate and the skewed sex ratio, it is not completely certain if genuine saturation was reached. Non-participating adolescents who had discontinued treatment might have had other thoughts regarding the adolescents’ MDC compared to the adolescents that have been interviewed. We, therefore, encourage gathering more qualitative data from a larger sample with a more balanced sex ratio. CONCLUSION In conclusion, this study shows that adolescents, their parents, and clinicians take various aspects into account regarding the adolescent’s MDC. The four criteria one needs to fulfil to have MDC - understanding, appreciating, reasoning, and communicating a choice - were all, to a greater or lesser extent, mentioned as challenging by the participants, just as MDC being relative to a specific decision and context (Appelbaum & Grisso, 1988). Most adolescents, parents, and clinicians find understanding and appreciating what the treatment and its consequences entail, important for MDC. Nevertheless, even though most adolescents, both continuers and discontinuers, and parents felt they did not have a full understanding and appreciation of all consequences, they thought that they were able to make the decision to start PS. Parents’ support of their child was considered essential in the decision-making process. However, several parents and clinicians wondered to what extent they themselves, and adults in general, are able to understand and appreciate certain consequences, let alone adolescents. The results of the current study show that clinicians find MDC challenging to assess in a uniform way. Dissemination of knowledge and support concerning the assessment of MDC and encountered ethical dilemmas about transgender adolescents’ MDC is desirable in order for clinicians to support adolescents and parents in the decision-making process.
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