130 Chapter 7 The clinicians stated that almost all adolescents suffer from (the anticipation of) the development of secondary sex characteristics. For almost all clinicians, halting the development of the physical changes, and thereby reducing this suffering, were the main reasons to start PS. Clinicians hoped that the treatment would improve the adolescents’ functioning now and later in life, and reduce the distress caused by the developing body to create time and rest for further exploration enabling a healthy psychological adolescent development. “The main reasons [to start treatment with puberty suppression] are to reduce suffering and stress. An additional reason, to a variable degree [depending on the degree of development of secondary sex characteristics], is suppressing the development of physical changes.” - Focus group with clinicians “As far as I’m concerned, one of the reasons [to start treatment with puberty suppression] is to make the adolescent feel a little better at that moment, because you stop the puberty that the adolescent simply does not want.” - Focus group with clinicians Besides, most clinicians and one adolescent stated that the adolescents might be better able to decide whether or not to proceed with GAH when, through PS, they no longer suffer from the development of secondary sex characteristics and other physical developments that come with puberty. “Once the adolescent is less stressed [about the development of the secondary sex characteristics] the adolescent is sometimes better able to judge if proceeding with gender-affirming hormones is really desired.” - Focus group with clinicians “The treatment with puberty suppression gave me more peace of mind, [...] it opened up my tunnel vision and helped me see more possibilities in terms of gender identity and everything. So, yes, it has helped me with the search for who I am.” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 15.5; age at discontinuation PS: 16.6; age at interview: 17.0 In addition, clinicians mentioned that the distress that adolescents and parents experience because of (the anticipation of) the development of secondary sex characteristics made them feel pressured to treat the adolescents. “The treatment with puberty suppression gives [the adolescent] a kind of rest because the adolescent’s agony [caused by the development of the secondary sex characteristics] is relieved. Additionally, the agony itself may put pressure on the decision-making for both the adolescent and the clinician involved.” - Focus group with clinicians
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