212 Chapter 11 their gender identity and treatment wishes, and work on issues that might interfere with successful treatment. In conclusion, the vast majority of adolescents who started treatment with PS proceeded to GAH, possibly due to eligibility criteria that select those highly likely to pursue further GAMT. A small number of adolescents discontinued treatment with PS because they no longer wished GAMT. This indicates that not all adolescents and parents assume that the outcome of identification as transgender is the only possible outcome and shows that gender identity can still fluctuate when using PS, at least in some adolescents. However, gender dysphoria subsided in a small number of adolescents and it is uncertain if this would have been different without treatment with PS. Due to the observational character of the study, it is not possible to say if treatment with PS itself influenced the outcome. Some adolescents used PS for a prolonged period before starting GAH while regularly meeting with a mental health professional which is consistent with the use of treatment with PS as an extended diagnostic phase. The great majority who had started treatment with PS continued with GAH. It is important to take this into account when counselling adolescents who consider this treatment and their parents. Chapter 7 Chapter 7 describes the perceptions of transgender adolescents, their parents, and clinicians on the function of treatment with PS for transgender adolescents. It is not known whether the functions of PS as described in established international transgender guidelines correspond to the perceived functions of PS according to the aforementioned stakeholders (Coleman et al., 2012; Hembree et al., 2017). For this study the same sample and method as described in chapter 5 were used. The results show that the continuers, discontinuers, their parents, and clinicians do not all have the same views on the functions of PS. Primarily, all informants considered inhibition of (further) development of secondary sex characteristics an important, and for some the most important, function of PS. Some discontinuers did experience PS as an expanded diagnostic phase, providing them ‘extra’ time before deciding on GAMT, while most continuers saw PS as the first step of GAMT. Nevertheless, some continuers and some of their parents were glad that the effects of PS were reversible even if they did not expect to change their minds. One continuer and several parents used the time (their child was) on PS, to get used to (their child) living in the affirmed gender role. Some clinicians considered it important that adolescents mature a little further during the years they receive PS, and that, while they experience less distress due to the undesired development of their bodies, they may be better able to decide on whether or not to proceed with GAMT and carefully consider the consequences of their decision. One of the discontinuers mentioned this
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