119 Trajectories of adolescents treated with gonadotropin‑releasing hormone analogues for gender dysphoria 6 Vrouenraets et al., 2015). Whether or not treatment with GnRHa influenced gender identity development cannot be concluded from the current study due to its observational nature. The study does show that gender identity development was not suppressed in all, as a few adolescents discontinued GnRHa because they no longer experienced gender dysphoria, but it is unknown if gender dysphoria would have subsided in more adolescents in the absence of treatment with GnRHa. For one adolescent, the experience of falling in love made him doubt whether he was transgender. This is in line with previous findings that the first romantic experiences and the awareness of one’s sexual attraction play an important role in the resolution of gender dysphoria in adolescents (Steensma et al., 2011). This emphasizes the importance of this topic in the diagnostic evaluation. However, some adolescents may not have had any romantic or sexual experiences, especially if they present at an early age. In addition, transgender adolescents were shown to be less experienced, both sexually and romantically, compared to peers from the general population (Bungener, Steensma, Cohen-Kettenis, & de Vries, 2017). Treatment with GnRHa prevents the physical changes of puberty and is known to negatively affect sexual desire (Plosker & Brogden, 1994). PS might thus decrease the chances of adolescents having romantic and sexual experiences which might in turn influence gender identity development (Korte et al., 2008). This was not true for the adolescent in the current study who fell in love while using GnRHa and then decided to discontinue treatment, but it is uncertain if more adolescents would have had such experiences if they had not used GnRHa. Two individuals who discontinued GnRHa indicated that they did not feel either male or female. A non-binary gender identity appears to be becoming more common among adolescents presenting at gender identity clinics (Butler, De Graaf, Wren, & Carmichael, 2018). For these adolescents, it may be more difficult to find out and understand their own gender identity and it is unclear what constitutes optimal care for this group. Experienced side effects played a role in the decision to discontinue treatment with GnRHa in three adolescents. However, for none of the adolescents who stopped GnRHa in the current study, were potential long-term side effects a reason to decline or discontinue treatment with GnRHa. Lack of information about long-term effects of GnRHa use was not considered an important problem by interviewed adolescents with gender dysphoria in the study by Vrouenraets and colleagues (2016), but is seen as a major problem by many professionals (Vrouenraets et al., 2015). In the current study, 13 adolescents who were eligible for treatment with GAH used GnRHa monotherapy for longer than the minimum time required by protocol for reasons other than logistics. During this time, they received mental health support from a local MHP