84 Chapter 5 “The first few months I was very happy with it [the inhibition of secondary sexual characteristics] until I realised what if I will not be fertile anymore.” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 17.0; age at discontinuation PS: 17.9; age at interview: 27.8 “At the moment I know that I would like to have children when I grow older [while at the time I made the decision regarding starting treatment with puberty suppression, I did not have a desire to have children] [...] That’s the only thing I wonder about, whether I was able enough to make that decision at the time.” - Interview with an assigned female at birth who had discontinued PS; age at start PS: 17.0; age at discontinuation PS: 17.9; age at interview: 27.8 “Before she [my daughter] started treatment with puberty suppression, she had frozen sperm. I found that very intense. Ehm... for her too of course. [...] I thought it had quite an impact on such a young child, who had to go into that room to fill up a jar [with sperm]. […] I found that quite difficult to deal with [as a parent].” - Interview with a parent of a transgirl who continued PS; age at start PS: 14.2; age at interview: 17.9 The clinicians mentioned several consequences of PS which give them a feeling of unease when treating adolescents with PS. One of these consequences, a concern that all clinicians shared and which was mentioned by adolescents and parents too, is the possible loss of fertility if adolescents proceed to GAH and possibly gonadectomy. “I think that the part regarding wanting to have children is a tricky one. They [the adolescents] just cannot understand and appreciate that [the impact of possible infertility].” - Focus group with clinicians The clinicians, just as most adolescents and parents, stated that not being able to understand and appreciate the impact of certain consequences of PS is inherent to the adolescent’s age and/or developmental stage, for example, the possible consequence of loss of fertility for one’s future life and relationships. Furthermore, they stated that even some adults are unable to understand and appreciate the impact of such consequences. “How can you leave such a choice [whether or not you want biologically related children when you are older] to these children?” - Focus group with clinicians “That [possible infertility due to treatment with puberty suppression and subsequent gender-affirming hormones and/or surgery] is a very complicated one. As if children of that age [12 or 13 years old] can even begin to imagine what it [infertility] really implies.” - Focus group with clinicians
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