37 Early medical treatment for transgender children and adolescents: an empirical ethical study 2 maturation. They state that the ability of adolescents to make decisions regarding their own medical treatment should be determined based on the following diverse aspects: their cognitive abilities, emotional maturity, and the presence or absence of comorbidities. Various informants do mention the child’s chronological age as a criterion; some state that the child should be at least 12, 13, or 14 years old, whereas others mention the age of 16 years as the cut-off age. “I suppose [...] the child [should be] at least 12 or 13 [years old] but it depends on the child, their background, family and supportive systems too.” - Interview with a psychologist Some state that not a child’s chronological age should count, but the fact that the child’s puberty has started. One informant stated that the decision whether to start with hormones should only be made during adulthood: “We should facilitate his or her process of integration in the society and if he or she would undergo hormone- and surgical treatments he or she could decide [on this] during adulthood.” - Interview with a psychiatrist We asked who should have authority to take decisions regarding early medical treatment. Some informants stated that the adolescent is able to give informed consent himself or herself. Others stated that minors must at least partially depend on their parents or other caregivers to make decisions regarding their treatment. Some noted that there is no discussion in other situations where minors receive medication; for example, parents making decisions about starting children on anti-epileptic medication without the child’s consent. These informants therefore question why there is a discussion about the authority to decide on the start of medication in GD. It was further mentioned that a team of specialists experienced in treating transgender minors are responsible for these minors and the recommended treatment. “People do not ask about how kids feel about going on this mood stabilization, how do you feel about going on this medication for depression. The only place where this happens is gender. […] all kids are entering the clinic on five psychotropic medications without hesitation [of the parents and clinicians]. And nobody has this discussion.” - Interview with a paediatrician “The fact that somebody wants something badly, does not mean that a clinician should do it for that reason; a medical doctor is not a candy seller.” - Interview with a professor of health care ethics and health law