217 Summary 11 The field of the care of transgender children and adolescents has been, and still is, in motion, and the associated ethical challenges and dilemmas, require the clinician to take an adjusted role with regard to (medical) treatment for transgender minors. They can be seen as balance artists; initially they had to balance between the treatment wishes, demands, and voices from predominantly the transgender minors, their parents, and their own (M. de Vries, 2020). Nowadays, the voices of other influences, such as professional associations, the media, and case law seem to have become louder. Therefore, clinicians need to find an adequate balance in the force fields between these different ‘layers’, of which some are relatively ‘new’, and of which all are continuously in motion concerning their perspective on the ethical dilemmas that play an important role in early medical treatment for transgender minors, as outlined in this thesis, into account (M. de Vries, 2020). Although PS is not a risk-free medication and additional (worldwide) multicentre long-term quantitative and qualitative data are called for to better understand the possible adverse reactions and benefits of the treatment, treatment with PS still seems promising for transgender minors when given in a context of sufficient psychological support (e.g. Rafferty et al., 2018; Ramos et al., 2021; Turban & Ehrensaft, 2018). However, despite the promising current state of science regarding the medical and psychological aspects of care for transgender minors, an ethical justification for the treatment seems to be required in addition. Therefore, data is needed from an ethical perspective to fill in this gap in this ongoing debate regarding the use of early medical treatment for transgender minors. The findings outlined in this thesis seem to justify the use of early medical treatment for transgender minors from this ethical point of view, as proposed in the two established international transgender guidelines (Coleman et al., 2022; Hembree et al., 2017). Despite this justification, various concerns as described in this thesis still need to be weighed with each individual minor. The results of this thesis show that, among others, the minors’ MDC, the possible physical and/or psychological harmful effects of early medical interventions and of refraining from interventions, the consequences for fertility, the co-occurring psychosocial challenges, physiological puberty in developing a consistent gender identity, and the social context play an important role regarding early medical treatment and therefore should be taken into account when determining the most appropriate care for the minor in question. Additionally, dissemination of knowledge and support concerning the assessment of MDC and encountered ethical dilemmas is desirable in order for clinicians to adequately support minors and their parents in the decision-making process regarding early medical treatment. A good step to do so has been taken by some Dutch researchers; they have,
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