115 Trajectories of adolescents treated with gonadotropin‑releasing hormone analogues for gender dysphoria 6 RESULTS During the study period, 143 adolescents started treatment with GnRHa (38 transgirls, 105 transboys). Median age at the start of treatment was 15.0 years (range, 11.1-18.6 years) in transgirls and 16.1 years (range, 10.1-17.9 years) in transboys. Of these adolescents, 125 (87%, 36 transgirls, 89 transboys) subsequently started treatment with GAH after 1.0 (0.5-3.8) and 0.8 (0.3-3.7) years of treatment with GnRHa (figure 3). Median age at the start of GAH was 16.2 years (range, 14.5-18.6 years) in transgirls and 17.1 years (range, 14.9-18.8 years) in transboys. Five adolescents who used GnRHa had not started GAH at the time of data collection, because they were not yet eligible for this treatment due to their age. At the time of data collection, they had used GnRHa for a median duration of 2.1 years (1.6-2.8). Six adolescents had been referred to a gender identity clinic elsewhere for further treatment. One of these was 17 years old and eligible for GAH but initially indicated he needed more time to decide about testosterone treatment and subsequently stated that he wished to delay the start of this treatment until after his school examinations. The other five were not eligible yet due to their age at the time of referral. Nine had discontinued treatment with GnRHa (see below), one of whom restarted GnRHa after five months. This individual and two others subsequently started treatment with GAH (figure 3). Figure 3. Flow chart showing the trajectories of adolescents who started treatment with gonadotropin-releasing hormone analogues (GnRHa) GAH refers to treatment with gender-affirming hormones; GAMT refers to gender-affirming medical treatment; GnRHa refers to treatment with gonadotropin-releasing hormone analogues. n = 143 Started GnRHa Stopped GnRHa Too young to start GAH Referred to elsewhere Prolonged GnRHa n= 125 Start GAH Continued GnRHa n = 1 Start GAH at adult gender identity clinic n= 5 No wish for GAMT 105 19 1 restarted 134 9 6 1 5 1 20 1