88 Chapter 5 “Aren’t we [clinicians] reading into it, or aren’t parents reading into it? Where are these signals coming from? Are they [these signals] coming from the adolescents themselves or are they coming from the people around them? Are they [the adolescents] being coloured [by the thoughts and opinions of the people around them]? These are all pretty complicated things.” - Focus group with clinicians Additionally, the clinicians asked themselves what role parents and clinicians should have in the decision-making process. Who is responsible for the decision and its consequences? Some stated that, on the one hand, parents are responsible, since they are the ones giving informed consent according to the law (for adolescents < 12 years of age; for those aged 12-16 together with the adolescents). On the other hand, some clinicians wondered how parents can make a decision based on the interpretation of the feelings and behaviour of their child. Furthermore, they pointed out the large role of clinicians in assessing which adolescents would benefit from treatment. “I feel with those young children [about 11 years old] that the parents take over the medical decision-making competence from the children. [...] Legally that’s also the case; they [the parents] decide for the child.” - Focus group with clinicians “Do we [the clinicians] consider ourselves most competent in medical decisionmaking in the whole process [diagnostic trajectory] of gender dysphoria? Considering all people involved, who are most competent in medical decision-making? Especially when you think about the fact that we [the clinicians] have such an important role in decisions about the treatment. Does that then imply, that we consider ourselves most competent to understand and appreciate what is best for the adolescent [whether or not to start treatment with puberty suppression]?” - Focus group with clinicians Choosing between two negatives; is there really any choice? Most adolescents who proceeded to GAH after PS and their parents stated that they did not feel they had a choice whether or not to start PS. Strikingly, none of the adolescents who discontinued PS or their parents explicitly stated that they had the feeling that they did not have a choice whether or not to start PS. “For me [...] it was never really a choice. [...] Of course it is a choice in the way that you can choose to do it [start treatment with puberty suppression or not], but in my mind it was never really a choice, but just something I wanted to do to move forward in the journey.” - Interview with a transgirl who continued PS; age at start PS: 12.4; age at interview: 18.5