80 Chapter 5 investigate the perceptions of transgender adolescents who proceeded to GAH after PS, adolescents who discontinued treatment with PS, their parents, and clinicians regarding transgender adolescents’ MDC concerning PS. METHODS Participants The interviews and focus groups were conducted in the context of a larger study on transgender adolescents’ competence to consent to PS and the function of this treatment. Study methods are described in full in the article about the perceptions of the various informants on the function of PS (Vrouenraets et al., 2022b). Briefly, transgender adolescents who proceeded to GAH after treatment with PS (‘continuers’), adolescents who discontinued treatment with PS (‘discontinuers’), and their parents were recruited from the gender identity clinics in Amsterdam and Leiden between January and September 2019. The informants were interviewed using a topic list (see Appendix B, which can be found at page 223) to explore their considerations and experiences. The same topics were discussed in focus groups with clinicians of the two Dutch gender teams. Semi-structured individual interviews were conducted with 14 adolescents and 12 parents. The informants consisted of: 1. Eight transgender adolescents who were treated with PS and subsequently with GAH; 2. Six adolescents who had been treated with PS and had discontinued this treatment; 3. Eight parents of adolescents who were treated with PS and subsequently with GAH; 4. Four parents of adolescents who had discontinued treatment with PS. Inclusion criteria for the adolescents who had continued treatment (group 1) were: (a) diagnosis of gender dysphoria according to DSM-IV or DSM-5, depending on which version of the DSM was used at the time of diagnosis (American Psychiatric Association, 2013), (b) had started PS at age 10-15 years, (c) had used PS for at least 12 months, (d) had used GAH for at least six months, and (e) age at the time of the interview between 15 and 20 years. The aim was to have at least as many adolescents in group 1 as in group 2. Therefore, thirteen consecutive adolescents were asked to participate when they attended their regular follow-up appointment. Eight adolescents agreed to participate. Five adolescents declined for various reasons. Inclusion criteria for the adolescents who had discontinued treatment (group 2) were: (a) diagnosis of gender dysphoria according to DSM-IV or DSM-5, depending on which version of the DSM was used at the time of diagnosis (American Psychiatric Association, 2013), (b) had started PS at age 10-17 years (a wider age range was chosen for those that discontinued PS to allow the inclusion of as many participants as possible given the limited
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