131 Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians 7 “It sometimes happens that the parents are more stressed [than the adolescents themselves], [...] especially when it concerns younger adolescents [10/11 years old] […] I sometimes find that difficult, when I feel the parents push very hard [to start treatment with puberty suppression].” - Focus group with clinicians Theme 2: Providing more time to expand the diagnostic phase Three out of the six adolescents who had discontinued PS (group 1), and all four of their parents, stated that they had primarily used PS to gain more time to think about whether or not to proceed with GAMT without having to worry about the physical changes of their body. “It was a great relief; I did not have to worry about all that fuss [e.g., having my period and breast growth] but could simply think about who I am. To clarify things. [...] I became a woman, my breasts started to grow but I just did not want it. I simply needed a lot more time to think, because it was so unclear who I was and how I wanted to live my life.” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 12.1; age at discontinuation PS: 13.3; age at interview: 14.3 “When he was referred to the Amsterdam gender identity clinic he sometimes lived his life as a girl and sometimes as a boy; he was still searching and in doubt. In order to have more time, he started treatment with puberty suppression.” - Interview with a parent of an assigned male at birth who had discontinued PS; age at start PS: 15.9; age at discontinuation PS: 16.7; age at interview: 22.9 One adolescent from group 1 stated that she initially did not think of PS as a way to gain extra time to think, but during PS she realised that she could use this time to explore her wishes regarding GAMT. “When I started treatment with puberty suppression it really felt as the first step of the transition for me. After that, I would continue with testosterone treatment. [...] Only during the treatment with puberty suppression I realised, now I still have time to think [about whether I want to continue with the transition or not].” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 16.7; age at discontinuation PS: 17.0; age at interview: 19.5 On the other hand, none of the eight interviewed adolescents who had proceeded with GAH, and none of their parents, stated that more time to explore and decide whether or not to pursue GAMT was a function of PS for them. They mentioned that they were/ their child was already certain that they wanted to proceed with GAMT when starting PS. However, several of them stated that they could understand the rationale for other adolescents who might need this extra time to explore.
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