134 Chapter 7 For the other half of the adolescents who proceeded with GAH, and their parents the period on PS was not a period to get used to living in the affirmed gender role. One parent even stated that the period on PS took too long for them. “We never had to get used to anything because it had always been like this since his childhood; he looked like a boy since he was five years old, he played with other boys, and presented himself as a boy.” - Interview with a parent of a transboy who continued PS; age at start PS: 12.9; age at interview: 15.5 “Of course it was a period in which we as parents could get used to it [our child presenting herself as a girl], but I did not need four years [to get used to it] [...] it could have been shorter because it was already clear to us and we had known for a long time [about the gender non-conforming feelings of our child].” - Interview with a parent of a transboy who continued PS; age at start PS: 11.9; age at interview: 18.5 Theme 4: The ‘first step’ of the gender-affirming medical treatment All adolescents who proceeded with GAH stated that they viewed the start of PS as the first step in their trajectory of GAMT. Two adolescents who did not proceed with GAH stated this too. About half of the interviewed parents said they saw starting PS as the first step. “For me it really was like the beginning of becoming a man because you need to have puberty suppression before you can start treatment with gender-affirming hormones.” - Interview with a transboy who continued PS; age at start PS: 12.9; age at interview: 15.5 “The most important reason to start with puberty suppressing treatment was to subsequently start with male sex hormones.” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 17.0; age at discontinuation PS: 17.9; age at interview: 27.8 The clinicians acknowledged that most adolescents view the start with PS as the first step of the GAMT. Most clinicians stated that they had the feeling that some adolescents who presented at the gender identity clinic only had one goal in mind: GAMT. The metaphor of a train was used; some children and adolescents seem to be on a moving train with GAMT as their final destination from the moment of the first visit to the gender identity clinic. Some clinicians had the feeling that they needed to slow down some of these trains to make sure that each step was carefully considered.
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