213 Summary 11 function as well. Some clinicians mentioned that the extra time provided them time for additional assessment. Although international transgender guidelines emphasize providing time for exploration of gender identity as an important reason for PS, many adolescents nowadays seem to have clear ideas about their gender identity and treatment wishes, and experience PS as the first step of GAMT (Coleman et al., 2012; Hembree et al., 2017). For some discontinuers however, PS offered a valued period of exploration. The extra time served a function for some parents and clinicians in some cases as well. Guidelines could be modified to provide more customized care, taking adolescents’, parents’, and clinicians’ ideas about the functions of PS into account. Chapter 8 Whereas the effects of PS are reversible, long-term use of gender-affirming sex steroids may affect fertility, and if gonadectomy is performed, the transgender person will definitely be infertile. Infertility may have a major impact on the lives of transgender minors, and previous studies suggest that fertility preservation can influence quality of life in transgender adolescents. Nowadays, the World Professional Association for Transgender Health (WPATH) and Endocrine Society recommend counselling regarding fertility preservation options before initiating treatment with PS. However, two recent studies from the United States indicate that transgender minors rarely use fertility preservation. In order to get insight into the use of fertility preservation among Dutch transgirls, chapter 8 describes how many adolescents made use of fertility preservation in a Dutch cohort of transgirls who started treatment with PS. In addition, we assessed if information about the risk of infertility had been given, if discussion of the option of fertility preservation was documented in the medical file, and what the given reason for declining fertility preservation was if the adolescent had not made use of fertility preservation. Furthermore, we explored what factors were associated with the use of fertility preservation. The study was a retrospective review of medical records of 35 transgirls who started treatment with PS between 2011 and 2017 at the Curium-Leiden University Medical Centre gender identity clinic in Leiden, the Netherlands. Extracted data from the medical files were age, intelligence quotient (IQ), Tanner stage, testicular volume, ethnicity, sexual orientation, psychiatric comorbidity, family situation, and information about the desire to have children. All adolescents had been informed on the risk of infertility, and 32 (91%) of them were counselled about the option of fertility preservation. Thirteen (41%) of the counselled transgirls were referred for sperm cryopreservation, and twelve (38%) of them had actually
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