18 Chapter 1 ETHICAL DILEMMAS In the Netherlands, PS is part of the treatment protocol for transgender adolescents. Elsewhere in the world, for example in some other countries in Europe and North America, it is not always standard of care due to various ethical concerns and/or financial constraints (Gridley et al., 2016; Puckett, Cleary, Rossman, Newcomb, & Mustanski, 2019; Naiingolan, 2021). These concerns include worries about the treatment’s impact on physical, cognitive, and psychosocial development, and doubts about a minors’ competence to make decisions with possibly far-reaching consequences (Anacker et al., 2021; Chen et al., 2020; Kreukels & Cohen-Kettenis, 2011). Treatment teams providing PS to adolescents are inherently faced with all kinds of ethical dilemmas, which have become increasingly pressing since the exponentially growing numbers of referrals and the public attention regarding transgender care (Gerritse et al., 2018). It seems that with the increasing visibility of transgender persons, and awareness of transgender health issues, a growing polarization between two ‘camps’ occurs; people who criticize the use of early medical treatment state that boundaries are being crossed by the use of early medical treatment, stemming from the principle to ‘first do no harm’, while advocates of early medical treatment believe that the current treatment is too restrictive, stemming from the principle of ‘self-determination’. Although according to the people criticizing early medical treatment, PS might entail risks, refraining the adolescents from the treatment might have harmful life-long effects as well with regard to psychological, social, and/or medical well-being of the adolescent (de Vries et al., 2021). So, in order to provide transgender minors the care they need, it is necessary that the debate moves forward by elucidating these different perspectives and by pursuing depolarization. Clinical science can help resolve controversy through profound follow-up, which is not yet thoroughly developed in this area (Levine, 2018). Additional data on the treatment and its potential effects, and elucidation of the underlying moral considerations of all stakeholders are therefore essential in order to move forward the debate and bring the necessary nuance in the field. AIMS The Netherlands play a pioneering role in using PS in transgender adolescents. As with other controversial medical ethical issues, like euthanasia and abortion, this stance meets both international criticism and support. Since the immense increase in the number of minors seeking professional help for their gender incongruent experiences, and since more and more people express their opinions of what, according to them, is the best care for transgender minors, this has become even more pressing (e.g. Arnoldussen et al., 2020; Arnoldussen et al., 2022b; Kaltiala-Heino et al., 2015; Kaltiala et al., 2020; Shumer & Spack, 2013). Because of the controversies surrounding the use of PS, it is essential to underpin