132 Chapter 7 “For me, it was not a period of reflection. [...] I have never really had any doubts about wanting to be a man or not.” - Interview with a transgirl who continued PS; age at start PS: 12.9; age at interview: 15.5 “It was not as if she thought: good, now I have time to carefully think things over. She had already done that thinking before the puberty suppressing treatment.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.9; age at interview: 17.8 Additionally, one transgirl that continued PS and one parent stated that, even though extra time to explore and overthink whether or not to pursue GAMT was not a reason for them to start PS, they were both glad that if her (the child’s) thoughts had changed, no irreversible changes would have taken place. “I liked the idea that the effects [of treatment with puberty suppression] were still reversible, even though I did not doubt her feelings, and did not think that it [stopping puberty suppressing treatment] would ever be necessary.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.0; age at interview: 18.1 Several clinicians stated that, at least in some situations, one of the reasons for them to let the adolescents start PS was to give the adolescents more time before deciding on GAMT. This time would allow them to further develop and become more autonomous. “You use it [puberty suppressing treatment] as a period for delay and respite so that you make the step to a more irreversible treatment with gender-affirming hormones, surgery etc. at a later moment, when you believe the adolescent is able to oversee all consequences [of the treatment].” - Focus group with clinicians “The adolescents become a bit more autonomous in that period between the ages of 13 and 16. During this period they become able to think a little more autonomously and [they] are a little less influenced by the environment. This happens very gradually, but it does make a difference.” - Focus group with clinicians Besides, the clinicians mentioned that in some cases, another reason to start PS was to allow themselves more time for the diagnostic assessment. While observing the adolescent’s development over time, the indication for further treatment might become more clear. The clinicians explained that additional diagnostic evaluation did not only concern the diagnosis gender dysphoria itself, but other aspects of the adolescents’ life too. “I think you also ‘buy’ time for the clinician to conduct a proper diagnostic evaluation.
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