135 Perceptions on the function of puberty suppression of transgender adolescents who continued or discontinued treatment, their parents, and clinicians 7 “It is not as if we [clinicians] put them on some kind of train. Those children and adolescents are already on a train when they first visit the clinic and that makes steering the train more difficult.” - Focus group with clinicians DISCUSSION Comparing the considerations of transgender adolescents who had continued with GAH after PS, adolescents who had discontinued treatment with PS, their parents, and clinicians reveals that they do not all have the same views on the functions of PS. Nevertheless, there was one reason to start PS which all informants agreed upon: inhibition of the development of secondary sex characteristics. In addition, some clinicians mentioned that PS reduced distress not only in adolescents but also in parents. This distress experienced by parents because of the physical changes their children undergo has been described in other studies as well (Butler et al., 2019; Field & Mattson, 2016). Additionally, especially clinicians considered it important that adolescents mature a little further during the years they receive PS, and that, while they experience less distress due to the undesired development of their bodies, they may be better able to decide on whether or not to proceed with GAMT and carefully consider the consequences of their decision. This is in line with the reason for considering PS mentioned in other studies; namely, that clinicians try to find a balance between the distress in transgender adolescents and the potential long-term risks of the treatment (Butler et al., 2019). Most adolescents who continued with GAH, however, stated that they already knew they wanted to start GAMT after PS. The idea of PS as a way to ‘buy’ time to explore and decide whether or not to continue with GAMT was not endorsed by all informants. None of the adolescents who had started GAH after PS, nor their parents, saw this as a reason to start PS. Most stated that they did understand this rationale behind the treatment and that it might be relevant for other adolescents, but not for themselves, although several mentioned it was good that the effects of the treatment were reversible “just in case things would have changed.” By contrast, most adolescents who had discontinued PS, and their parents, stated that they did, either initially or eventually, see PS as a way to buy time to explore their options and consider the subsequent trajectory. For clinicians, this extra time for exploration was a function of and a reason to start PS too, although this depended on the case. The finding that most adolescents did not use PS for further exploration of their gender identity is of note, but not an unexpected finding. For example, follow-up studies have already shown that the vast majority of adolescents who start PS subsequently start GAMT (e.g., Brik et al., 2020; de Vries et al., 2011b; Wiepjes et al., 2019). In the Netherlands, adolescents follow a careful assessment consisting of several appointments over a longer period of time to find out if they meet the criteria of the diagnosis gender dysphoria, if they understand