49 Perceptions of sex, gender, and puberty suppression: a qualitative analysis of transgender minors 3 Another aspect that was mentioned was the issue of having enough time before making a decision regarding starting treatment with PS: “Inmy opinion 12 is a good ageminimumbecause then these children and adolescents have time to consider what they want before making a decision regarding starting treatment with puberty suppression.” - Interview with a transgirl; age: 17;0 The opinion to define different age limits for boys and girls because most boys mature later than girls do, was raised by another adolescent: “I would probably pick different ages for boys and girls. For girls I would put the age at I guess 11, and for boys I would put it at 13. Simply because biologically males mature later than females do.” - Interview with a transboy; age: 18;5 On the other hand, the adolescents have doubts about the competence of children to make decisions regarding topics like this: “Although a 10-year-old may realise what is going to happen in the short-term, he or she might not be fully aware of the long-term consequences.” - Interview with a transboy; age: 15;9 The lack of data on the long-term effects of puberty suppression There are limited data on the consequences of PS for bone mineral density (Klink et al., 2015) and executive brain function (Staphorsius et al., 2015) but much remains unknown about the long-term effects of this treatment. Most adolescents stated that the lack of long-term data did not and would not stop them from wanting PS. They said that being happy in life was more important for them than any possible negative long-term consequence of PS, as described by these three adolescents: “The possible long-term consequences are incomparable with the unhappy feeling that you have and will keep having if you do not receive treatment with puberty suppression.” - Interview with a transboy; age: 18;3 “I would rather live 10 years shorter but live a very happy life being myself, than live 10 years longer and be unhappy my whole life.” - Interview with a transboy; age: 17;7 “It is not a choice, even though a lot of people think that. Well, actually it is a choice: living a happy life or living an unhappy life.” - Interview with a transgirl; age: 14;5
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