133 Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians 7 In that period of time you [as the clinician] are able to follow the development of the adolescent. The information this provides may help create a better diagnostic image and arguments as to why you would or would not proceed to gender-affirming medical treatment. This [clarifying the diagnosis or these arguments] is often quite difficult when a child or adolescent is younger.” - Focus group with clinicians “Sometimes adolescents believe that starting [puberty suppressing] treatment fixes everything, which is not a realistic idea. The adolescents have to work on a number of other things [problems in their lives] too. We [the adolescent and clinician] have to actively make a plan how to deal with and solve these problems, because not all problems will just disappear into thin air.” - Focus group with clinicians Theme 3: Providing (more) time to get used to living in the affirmed gender role Half of the adolescents who proceeded with GAH after PS stated that the period on PS provided their parents and others in their environment time to get used to them living in the affirmed gender role. Most parents confirmed this. Only one adolescent stated that she herself used this period to get used to living in the affirmed gender role too, but the other seven adolescents did not. None of the adolescents who had discontinued PS, stated that they considered having time to get used to living in the affirmed gender role a function of PS for them and/or people in their environment. However, some clinicians did mention giving the adolescents the opportunity to get used to living in their new gender role and evaluating this experience with the adolescents as a function of PS. “The treatment with puberty suppression gave me and the people around me time to get used to me living as a girl. That was really essential, because if I had started with the female sex hormones straight away it might have been too much to get used to and my environment might not have understood [me living as a girl].” - Interview with a transgirl who continued PS; age at start PS: 12.9; age at interview: 17.8 “In the beginning, I found it quite difficult that I gave birth to a son who wanted to become a woman. We processed that in that period [when she was given treatment with puberty suppression].” - Interview with a parent of a transgirl who continued PS; age at start PS: 14.2; age at interview: 17.9 “They [the adolescents] have the opportunity to get used to living in the affirmed gender role and to find out for themselves what it is like.” - Focus group with clinicians
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