34 Chapter 2 The role of physiological puberty in developing a consistent gender identity In the literature, the concern is raised that interrupting the development of secondary sex characteristics may disrupt the development of a gender identity during puberty that is congruent with the assigned gender (Korte et al., 2008). The interviews and questionnaires show that some treatment teams share this view. “I have met gay women who identify as women who would certainly have been diagnosed gender dysphoric as children but who, throughout adolescence, came to accept themselves. This might not have happened on puberty suppression.” - Interview with a psychologist “I believe that, in adolescence, hypothalamic inhibitors should never be given, because they interfere not only with emotional development, but [also] with the integration process among the various internal and external aspects characterizing the transition to adulthood.” - Interview with a psychiatrist However, although most informants agreed on the fact that treatment with PS indeed may change the way adolescents think about themselves, most of them did not think that PS inhibits the spontaneous formation of a gender identity that is congruent with the assigned gender after many years of having an incongruent gender identity. Some professionals stated that, although the PS may disrupt the development of a consistent gender identity, in some cases, the very real risks of the present (the young person’s distress and consequent possible suicide risk) override the possible risks for the future (the individual’s uncertainty). According to them, we need to take into account what is the best for that individual person. “I think that the distress for a child experiencing the ‘wrong’ puberty is so great that it overrides the opinion that the child should have the experience of ‘crisis of gender’.” - Interview with a psychiatrist Various endocrinologists made the comparison with precocious puberty; a medical condition in which PS have been used for many years, and no cases of GD have been described (at least to their knowledge). Besides, most of them emphasize that they deliberately start treatment with PS only when the minors have reached Tanner stage two or three to give them at least a kind of ‘feeling’ with puberty before starting with PS. Furthermore, some state that this is an issue that should be researched so that decisions can be made based on facts rather than on opinions.