138 Chapter 7 this is in line with the adolescent’s and parents’ wishes. On the other hand, one adolescent who discontinued PS recounted that before she started PS she did not think of PS as a way to gain extra time to think. However, during PS she realised that she could use this time to explore her wishes regarding GAMT and she ultimately decided not to continue with PS and GAMT. This may be true for other adolescents as well and should be kept in mind. So even for adolescents who grow up in a supportive and affirming environment, a period of pause can turn out to be beneficial and give them time to become better informed and more realistic about the future. Additionally, the results of this study show that PS serves functions not only for the transgender adolescents themselves, but also for their parents and other relatives, and for clinicians. Family support plays an important role in shaping the transgender adolescents’ health (Bouris et al., 2010). A review on this topic in sexual minorities found that, over time, parents generally become more accepting of their child (Rosario & Schrimshaw, 2013). Even though it is unknown whether these results may be generalized to transgender minors, giving parents and other relatives time to get used to their child’s new gender role might increase their acceptance (Katz-Wise, Rosario, & Tsappis, 2016). PS might play a role in this regard by providing ‘extra’ time before GAMT is started. Nevertheless, one may wonder how much priority this function should be given, for example, if the adolescent could be harmed by staying on PS for a longer time, but the parents on the other hand need more time to get used to their child living in the affirmed gender role. From an ethical point of view, clinicians should balance the interests not only of the adolescents but also of the parents, and guidelines should recognize that PS might enable others to get used to the identity and gender role of the adolescent. There are strengths and weaknesses to the present study. The qualitative nature of this study made it possible to find out, in depth, the ways in which transgender adolescents, their parents and clinicians think or feel about the function of PS. Another strength of this study is that adolescents who did continue with GAMT as well as adolescents who did not proceed with GAMT were interviewed. This allowed us to compare their considerations. Nevertheless, the retrospective nature of this study raises the possibility of recall bias and hindsight bias of the informants, and the first interview-question might appear to introduce bias, instead of being fully open-ended. In addition, it should be noted that the informants are recruited from two Dutch treatment teams which work according to the same treatment protocol where PS was required for all adolescents before any further affirming treatment was provided. Adolescents recruited from other gender identity clinics in other contexts might report a different function of PS. Therefore, we encourage prospective gathering of more qualitative data from adolescents who have not started PS yet or receive PS but have not started treatment with GAH yet, especially from other settings in other contexts, e.g., in clinics with a shorter history of providing care and in countries where less general knowledge on gender dysphoria/gender incongruence is available (e.g., Fortunato et al., 2020; Jokić-Begić et al., 2017; Shirdel-Havar, Steensma,
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