178 Chapter 9 Till now, at the gender identity clinic, it is not standard to involve patients in MCD sessions. However, participation of patients themselves in MCD sessions might bring to light new viewpoints on the moral issue at hand. The participation of transgender people’s own practical experiences and normative considerations can then be taken into account and might stimulate reflection and deepen decision-making processes even more. This could also enlarge the understanding of each other’s perspectives on good care. Therefore, participation of transgender people seen in the clinic and/or from the community at large in MCD sessions would be a great next step. The current study showed that most team members at the gender identity clinics in the Netherlands have positive experiences with MCD. Other studies show that MCD is also considered valuable by professionals in other branches of care, both in the Netherlands and internationally (de Snoo-Trimp et al., 2020). However, we cannot assume that MCD is appreciated by transgender clinicians outside the Netherlands. Therefore, we would encourage the collection of more qualitative and quantitative data on how gender identity clinics in other countries experience CES and MCD. It would be worthwhile to explore what kind of support CES in general and MCD in particular can offer in other countries. A European study on the experiences of MCD and their outcomes highlights considerable differences in Europe, regarding the experiences with MCD outcomes and the rating of various MCD outcomes in terms of their importance to clinicians (Svantesson et al., 2019). An international study focusing specifically on the relevance of CES in transgender care would show us whether there are cultural differences regarding: (1) the types of moral challenges transgender teams from other countries are confronted with; (2) how these challenges are framed; and (3) how the teams deal with these moral challenges. STRENGTHS AND LIMITATIONS The present study had strengths and weaknesses. The mixed methods nature of this study enabled us to find out, in depth, how professionals who provide care for transgender adolescents in the Netherlands evaluated MCD. The qualitative data and quantitative data were mutually supportive. Furthermore, the diversity of the MCD participants enabled us to record a wide variety of clinicians’ experiences and considerations. Nevertheless, the participants in this study were solely from gender identity clinics in the Netherlands. Besides, only six members of the Amsterdam and Leiden teams were interviewed individually, in order to reduce the burden on the clinicians. Despite the small number of interviewees, we believe that due to our careful selection of participants our study results reflect the views of a representative group.