197 General discussion 10 (Dauwerse et al., 2014; Molewijk et al., 2008a). MCD is a facilitator-led, collective moral inquiry by clinicians that focuses on a concrete moral question connected to a real clinical case (Dauwerse et al., 2014; Stolper et al., 2016). In order to evaluate the usefulness of MCD in dealing with ethical and moral challenges in the multidisciplinary clinical treatment for transgender minors we conducted a mixed methods evaluation study (Vrouenraets et al., 2020). The results of this study showed that the participants of this study widely felt that MCD helped them to more effectively deal with ethical and moral challenges. They reported that MCD improved the mutual understanding, respect, and communication among their team members. They also stated that MCD strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the participants were critical of the length of time spent discussing individual cases was excessive, some felt that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process (Vrouenraets et al., 2020). Some of these limitations were also mentioned in another study regarding the use of MCD in transgender care (Hartman et al., 2018). During MCD, the professionals’ knowledge and reasoning are included, yet MCD makes (possible conflicts of) underlying norms and values explicit. Furthermore, it gives suggestions how to deal with possible uncertainty or disagreement within a team. As such, MCD can be seen as an additional tool that can be used in complex cases. This finding is in line with results of other studies describing the use of MCD in transgender care (e.g. Gerritse et al., 2018; Hartman et al., 2018). However, future research focussing on the actual contribution of MCD to the improvement of quality of care of transgender minors is recommended. Finally, it would be worthwhile studying the involvement of transgender people themselves in MCD, and the integration of clinical ethics support into daily work processes (Vrouenraets et al., 2020). CONCLUDING CONSIDERATIONS Ethical and moral challenges and dilemmas are inextricably linked to transgender care, especially when it concerns children and adolescents, and the possible life-long consequences of providing them with or refraining from early medical treatment. This is because it is a relatively new field, in which developments are rapid, there is still relatively little empirical data available on long-term outcomes, and it is a subject of a polarized debate. The challenges and dilemmas regarding early medical treatment for transgender minors, which were already expressed by clinicians about a decade ago, as described in our first article from 2015, only seem to have enlarged and sharpened since then (Vrouenraets et al., 2015). Initially, these dilemmas appeared to be an issue only for those directly involved in this care. However, today, a much broader group of people is expressing their