200 Chapter 10 LIMITATIONS AND DIRECTIONS FOR FUTURE RESEARCH Outlining the various challenging themes involved in the care of transgender minors, and providing empirical data regarding the ethical dilemmas that are of concern in the care of transgender minors, gives clinicians direction to deal with these dilemmas, and informs and guides minors referred to the gender identity clinic. Some of the studies included in this thesis are largely focused on transgender minors receiving care as it is provided in the Netherlands. Therefore, the findings of these studies might not be similar for all other contexts, especially because the minors participating in our studies had extensive and thorough diagnostic evaluation before they were assessed eligible for treatment with PS. Transgender adolescents and their parents in other contexts, for example without this support, might have other considerations and thoughts about early medical treatment. Similar research with transgender minors and their parents in other contexts would therefore be a great addition. In order to bring the ethical debate further, additional systematic interdisciplinary and (worldwide) multicentre long-term data regarding the themes outlined in this thesis are needed, as it provides evidence-based data as a foundation for optimization of the care given. Furthermore, these research data are essential in order to bring some empirical answers into the debate regarding early medical treatment. CLINICAL IMPLICATIONS Although PS is not a risk-free medication and additional (worldwide) multicentre long-term quantitative and qualitative data are called for to better understand the possible adverse reactions and benefits of the treatment, treatment with PS still seems promising for transgender minors when given in a context of sufficient psychological support (e.g. Rafferty et al., 2018; Ramos et al., 2021; Turban & Ehrensaft, 2018). However, despite the promising current state of science regarding the medical and psychological aspects of care for transgender minors, many transgender minors, their parents, their clinicians, and others still express concerns and face ethical dilemmas regarding the use of early medical treatment for these minors. Apparently, promising results regarding the medical and psychological aspects of the treatment are not sufficient, and an ethical justification for the treatment seems to be required in addition. Therefore, data is needed from an ethical perspective to fill in this gap in this ongoing debate regarding the use of early medical treatment for transgender minors. The findings outlined in this thesis seem to justify the use of early medical treatment for transgender minors from this ethical point of view, as proposed in the two established international transgender guidelines (Coleman et al., 2022; Hembree et al., 2017). However, an appropriate individual treatment plan should be drawn
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