211 Summary 11 unwanted secondary sex characteristics is suppressed in order to reduce distress. Even though the effects of PS on pubertal development are reversible, the treatment may bring short-term adverse effects along. Additionally, few clinical research data are available on long-term adverse effects. Furthermore, opinions about the use of PS vary. To gain more insight into the use of PS in transgender adolescents, chapter 6 documents adolescents’ trajectories after the initiation of treatment with PS. The chapter reports on discontinuation of treatment with PS, prolonged use of PS, and initiation of GAH in order to investigate the duration of treatment with PS. Additionally, it explores reasons for extended use and discontinuation of PS in a retrospective way. The study population consisted of 143 (67%) of the 214 adolescents registered at the Curium-Leiden University Medical Centre gender identity clinic in Leiden, the Netherlands, who were eligible for treatment with PS by virtue of their age/pubertal status, and all started treatment with PS. The adolescents were between the ages of 11 and 18, and 38 of them were transgirls, and 105 were transboys. Of these adolescents who started treatment with PS, treatment status was reviewed. If they had used PS monotherapy for more than three months longer than minimally required before the start of GAH according to the local protocol, the reason for this was noted. Adolescents who had started treatment with PS and had stopped this treatment were included in a detailed review. Baseline characteristics such as age and gender, and data on the start, duration, and discontinuation of treatment were recorded from the medical files, as well as reasons given for the discontinuation of the treatment with PS and the adolescents’ and parents’ views on the treatment. According to the local protocol, before the start of treatment with PS, all adolescents had a diagnostic evaluation by a paediatric endocrinologist and mental health professional to confirm the diagnosis of gender dysphoria according to the DSM-5 criteria, to assess the presence of any medical, psychiatric, or psychosocial problems that might interfere with treatment, to assess if the adolescent was able to give informed consent for the treatment, and to confirm that puberty had started, as recommended by current established international transgender guidelines. We found that after a median duration of 0.8 years (0.3-3.8) on PS, 125 (87%) adolescents started GAH. Nine (6%) adolescents discontinued treatment with PS, five of whom no longer wished GAMT. Several reasons where giving for the discontinuation of PS, being among others, the experience of falling in love, the feeling of being either male or female, experiencing side effects of the treatment, and experiencing of concurrent psychosocial problems interfering with the exploration of gender identity. Thirteen adolescents had used PS for longer than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time. This supports the idea that the time on PS is used as an extended diagnostic phase where adolescents can further explore
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