204 Chapter 11 Chapter 1 In the last decades, in various parts of the world, the number of minors seeking care regarding their gender incongruent experiences has increased tremendously throughout the Western world, and transgender minors have increasingly become a subject of discussion (e.g. Aitken et al., 2015; Arnoldussen et al. 2020; Arnoldussen et al., 2022b; Chen et al., 2016; Handler et al., 2019; Kaltiala et al., 2020; Pang et al., 2020; Wood et al., 2013; Wiepjes et al., 2018). Additionally, over the years, the term used to address this condition changed, there has been an increase of media attention regarding transgender children and adolescents worldwide, and case law also plays an increasing role in the care and rights of transgender individuals nowadays (e.g. Dyer, 2020a; Pang et al., 2020; Stolberg, 2017; GLAD GLBTQ Legal Advocates & Defenders, 2017; Walch et al., 2021). Herewith, the question of how to best organize care for these children and adolescents has become very prominent. However, determining what constitutes the best care for these transgender minors brings ethical issues and dilemmas along. The recommendations regarding the (medical) treatment for these children and adolescents have been in development as well. Over the last few decades, the possibility of treatment with puberty suppression (PS) has generated a relatively new, but controversial dimension to the clinical management of transgender adolescents. Even though the use of PS in the care of these minors was adopted by a rapidly increasing number of gender identity clinics, and two established international transgender guidelines included this treatment option, many clinicians working with transgender minors remain critical (Coleman et al., 2022; Hembree et al., 2017; Rew et al., 2021; Vrouenraets et al., 2015). Another issue in the care of transgender adolescents about which there is no consensus is the minors’ MDC when starting PS. According to two established international transgender guidelines, an important prerequisite to start treatment with PS is that transgender adolescents are competent to give informed consent (Coleman et al., 2022; Hembree et al., 2017). However, there is increasing public discussion whether adolescents are actually competent to make a decision regarding PS treatment, especially because the treatment has far-reaching long-term consequences (e.g. Baron & Dierckxsens, 2021; D’Abrera et al., 2020; Giordano et al., 2021; Levine, 2022; Pang et al., 2021; Siddique, 2021; Tampier, 2022). To date, little empirical research exists regarding minors’ MDC to decide on starting PS, and little is known about the perceptions of the transgender adolescents, their parents, and clinicians on the minors’ MDC to decide on starting PS. Research regarding these aspects is needed to underpin both the ethical debate and clinical practices. Debate about care for transgender minors moves between extremes, and discussions are at times emotion-laden. People claiming the risks of the use of early medical treatment, and the ones who stress its benefits seem to have different underlying ideas about,
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