136 Chapter 7 the consequences of medical intervention, and to explore if starting PS, and later on GAMT, is indicated (Cohen-Kettenis, Steensma, & de Vries, 2011). It is therefore important to keep in mind that adolescents never ‘just’ start PS. Hence it might not be surprising that most adolescents did not use PS to further explore their gender identity since they had already done so before the decision to start PS was made. The diagnostic trajectory that transgender adolescents followed in Amsterdam and Leiden might have selected those adolescents that were very likely to continue with GAMT. Nevertheless, clinicians and, to a lesser extent, parents of adolescents who had discontinued treatment, considered the possibility of further exploration important. So most adolescents who had continued PS and started GAH did not, in retrospect, see PS as a way to extend the diagnostic phase, in contrast to the fact that it is an important reason noted in the international guidelines (Coleman et al., 2012; Hembree et al., 2017). However, this does not mean that PS is not a valuable medical intervention. In our study, for those who discontinued PS, it was a valuable intervention proving the importance of having ‘thinking time’. Furthermore, those who had continued PS and started GAH, acknowledged it had given their families time to adjust. Their clinicians reported the importance of having time to support further self-exploration and to prepare for treatment with irreversible effects. Additionally, the study of Brik and colleagues (2020) showed that several Dutch adolescents received mental health support from a local mental health professional or a psychologist of the treatment team of the gender identity clinic more frequently than minimally necessary by protocol during treatment with PS. This might support the idea that adolescents do use the period of PS as an extended diagnostic phase in which they further explore their gender identity and whether they want to continue with GAMT or not (Brik et al., 2020). If this results in a decision to pursue GAMT, adolescents might in hindsight not recognize that the period of PS was important in making this decision, even if in fact it was. The experiences of adolescents who had discontinued PS support this notion. Therefore, PS may expand the time of self-exploration even in those who feel certain about their gender trajectory and who will apply for further treatments later on. About half of the adolescents who proceeded with GAMT used the time they received PS to get used to living in the affirmed gender role, as described in the international guidelines (Coleman et al., 2012; Hembree et al., 2017). Worth mentioning is that most adolescents stated that particularly their parents and other relatives had to get used to them living in the affirmed gender role, which was confirmed by most parents. This aspect is mentioned in other studies too (Alegría, 2018), but not in the international guidelines (Hembree et al., 2017). All adolescents who proceeded with GAH, some of the adolescents who stopped PS, and about half of the parents stated that they saw the start with PS as the first step of the GAMT. Most clinicians recognize that many adolescents experience it as such. Sometimes