216 Chapter 11 in this care. However, today, a much broader group of people is expressing their opinions and thoughts regarding this subject. Additionally, the role of the media and case law are increasing. With this, the debate seems to have become only harsher. Additionally, the controversy seems to have become greater, and people claiming the risks of early medical treatment, and the ones claiming its benefits appear to be driven apart even further (e.g. Lament, 2014; Osserman & Wallerstein, 2022). Currently there hardly seems to be much little room for a ‘nuanced middle-ground’ anymore (e.g. Bazelon, 2022). More insight in the core of the ethical dilemmas that play a role in the care of transgender minors, and more empirical data that could give direction in some of the ethical dilemmas are needed in order to give clinicians direction to deal with these issues, and to inform and guide minors referred to the gender identity clinic. Therefore, the first overall aim of this research was 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. The starting point of this thesis was a broad interview study we conducted which gave insight into the ethical dilemmas that play a role in the use of early medical treatment for transgender minors according to the stakeholders (Vrouenraets et al., 2015; Vrouenraets et al., 2016). In this context, we interviewed clinicians working with transgender minors, and people criticizing the use of early medical treatment for transgender minors from around Europe and North-America, transgender minors themselves, and their parents. Multiple themes, described in chapter 2 and 3, emerged which gave rise to different, and sometimes even opposing, views on the treatment for transgender minors. In subsequent chapters, we examined several of these themes to gain deeper understanding of the controversies and possible solutions. In the general discussion we reflect on the meaning of our study outcomes to the broader context of the political and public discussions. We will do this by means of five themes that consistently emerged in these discussions: the minors’ medical decision-making competence (MDC), considerations regarding starting or refraining from PS, co-occuring psychosocial challenges, the social context, and clinical ethics support. One by one, these themes are discussed. For each theme, it is described how the considerations, ideas and newly obtained scientific data, when applicable, have changed and developed over the years.
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