19 General introduction 1 the Dutch treatment strategy, and to keep on formulating the moral grounds for using it. People who criticize the use of PS, and those who support this treatment option seem to have different underlying ideas about, among others, adolescents’ decision-making competence, decision-making authority, and the role of concurrent psychological, social, and/or medical issues, often without openly stating them (e.g. Dubin et al., 2020; Baron & Dierckxsens, 2021; Lemma, 2018). It is an essential task to elucidate these underlying considerations. More insight in the core of the ethical dilemmas surrounding PS, and more empirical data regarding these dilemmas are needed for at least four reasons. First, to ensure that treatment for transgender minors is not only clinically, but also ethically appropriate. Second, to find common ground between various clinicians around the world regarding early medical treatment. Third, to provide the stakeholders in the field direction to deal with these ethical dilemmas in clinical practice. And fourth, to allow clinicians to safely exercise the clinical judgment to undertake the course of action which is in the child’s best interests, based on objective, scientific data and not (largely) on subjective opinions. Therefore, the first overall aim of this research is to gain more insight in the core of the ethical dilemmas that play a role in the care of transgender minors, and the underlying intuitions and considerations of stakeholders in the field regarding early medical treatment. The stakeholders are transgender adolescents who proceeded with GAMT after PS, adolescents who were diagnosed with gender dysphoria but who did not proceed with GAMT after starting treatment with PS, their parents, clinicians working in gender treatment teams, and people who are critical about the use of early medical treatment for transgender minors. The second, subsequent aim is to provide empirical data regarding these ethical dilemmas in order to give clinicians direction on how to deal with these dilemmas, and to inform and guide the minors referred to the gender identity clinics regarding these ethical dilemmas. CENTRAL RESEARCH QUESTIONS To provide a response to the above aims, the following questions will be addressed: Part 1. Setting the scene: perceptions of stakeholders on ethical issues • What are the perceptions, views, and ideas of people who criticize the use of early medical treatment for gender dysphoria, and of those who support it, regarding PS in gender dysphoria, the aetiology of gender dysphoria, and the concepts sex, gender, child competence, and best interests? And do these perceptions, views, and ideas of proponents of PS differ from those of opponents, and if so, in what sense? (chapter 2); • What are the perceptions, views, and ideas of adolescents diagnosed with gender