192 Chapter 10 show that inhibition of the development of secondary sex characteristics was an important function of the treatment for all participating transgender adolescents who proceeded with GAH after treatment with PS, the adolescents who discontinued treatment with PS, their parents, and clinicians (Coleman et al., 2022; Hembree et al., 2017; Vrouenraets et al, 2022b). Inhibition of the development of secondary sex characteristics will result in a more satisfactory physical appearance and congruent to the experienced gender for those who continue with GAMT. The second main reason to use PS mentioned in the established international transgender guidelines is to provide adolescents ‘extra’ time for exploration and considerations (Coleman et al., 2022; Hembree et al., 2017). In this regard, contrasting results emerged; on the one hand, most adolescents who proceeded with treatment with GAH did not experience the time on PS as an extended exploration phase (Vrouenraets et al., 2022b). Most of them saw PS as the first step of GAMT, even though some were glad that the effects of PS were reversible even if they did not expect to change their minds. This is in line with the results of one of our other studies (Brik et al., 2020). On the other hand, these same two studies also show results that endorse the use of PS to provide adolescents ‘extra’ time for exploration and considerations. As it turned out, most adolescents who discontinued treatment with PS did experience the time on PS as an extended exploration phase (Vrouenraets et al., 2022b). Furthermore, some transgender adolescents used the time on PS in order to get used to living in the affirmed gender role themselves, or used that time to let their parents get used to the situation and/or to accept the gender dysphoria (Brik et al., 2020; Vrouenraets et al., 2022b). Several parents endorse that they found the time their child was on PS helpful to adapt to their child’s new gender role (Vrouenraets et al., 2022b). Of note, the results of one of our studies show that about 10 percent of the adolescents who started GAH had used PS for longer (at least three months more) than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time (Brik et al., 2020). Examples of reasons for this prolonged use of PS were more time to decide about treatment with GAH, lack of parental support or acceptance of gender dysphoria, comorbidity such as depression or autism spectrum disorder, and further diagnostics by the clinicians of the treatment team (Brik et al., 2020). This supports the idea that the time on PS is used as an extended diagnostic phase where adolescents can further explore their gender identity and treatment wishes, and work on issues that might interfere with successful treatment. In addition, the period the adolescents were on PS also proved useful for several clinicians, providing them more time for diagnostic assessment (Brik et al., 2020; Vrouenraets et al., 2022b). The functions mentioned by the transgender adolescents, their parents, and clinicians are not all in line with the reasons to use PS as mentioned in the two established international transgender guidelines (Coleman et al., 2022; Hembree et al., 2017; Vrouenraets et al., 2022b). Results of our studies could be implemented in the guidelines, taking the different perceived functions and thoughts of the adolescents and their parents regarding PS into
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