92 Chapter 5 “I do not know if I understood it [what the treatment and its consequences entail] for 100 percent. But I knew that I could always stop it [the treatment] and that the male hormones would then come back. I knew that they were monthly injections, that they would stop [the release of] my male hormones in terms of physical aspects.. [like] hair growth or lowering of the voice. So in that respect, I was aware of what it [the treatment and its consequences] did and what it [the treatment and its consequences] was [were].” - Interview with a transgirl who continued PS; age at start PS: 12.4; age at interview: 18.5 “I do not think so [that my child made a deliberate decision to start puberty suppression], because we actually did not even know what the disadvantages [of the treatment] were.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.4; age at interview: 18.6 Three adolescents who proceeded to GAH after PS stated that during the time that they received treatment with PS, they began to better understand what the treatment involved. “I think that I did take it in [the information about puberty suppression] back then [when I thought about starting the treatment with puberty suppression], but that I did not understand it very well. However, over the years, let’s say between 13 and 15 [or] 16 [years of age], I started to really understand the consequences that [the treatment] has, why I was doing it, why this was helping me, why it could also serve as extra time for reflection. Basically, everything to do with it [the treatment and its (possible) consequences].” - Interview with a transgirl who continued PS; age at start PS: 12.9; age at interview: 17.8 “[I] maybe [understood] for about three quarters [what the treatment entailed before I started the treatment]. After the first injection [with puberty suppression] I was like, well I understand what they mean. And when I really noticed that nothing changed, I was like, I think I fully understand it now. So I understood most of it [what the treatment entailed before I started the treatment].” - Interview with a transboy who continued PS; age at start PS: 12.0; age at interview: 16.3 Some clinicians wondered to what extent adolescents should be able to understand the information regarding the treatment to be decision-making competent. “Are you [the adolescent] able to understand the information I provide? [The question then is] Where do you draw the line?” - Focus group with clinicians
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