93 Medical decision‑making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians 5 The informants stated that, besides being able to understand the relevant information about the treatment, adolescents need to be able to understand and appreciate the (long-term) consequences of the treatment to be decision-making competent. However, most adolescents and parents indicated that they/their children were not actually able to understand and appreciate all the (long-term) consequences. “I was aware of all the disadvantages [of the treatment with puberty suppression]. Especially the mood swings, and I did underestimate those I think [the adolescent laughs].” - Interview with a transboy who continued PS; age at start PS: 10.9; age at interview: 17.6 “She [my daughter] was well informed [about the treatment with puberty suppression and its (possible) consequences], she really understood, but neither we as parents nor X [my daughter] knew [beforehand] what it would be like.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.9; age at interview: 17.8 “When they are so small [younger than 12 years old] they [...] only have one goal in mind, namely: to become the woman you feel you are. I find it hard to assess whether she [my daughter] had really understood and appreciated that [the effects of the treatment and its (possible) consequences]. I do not think that they [adolescents of that age] are able to understand and appreciate all of it.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.0; age at interview: 18.1 In addition to understanding the relevant information, and being able to understand and appreciate the (long-term) consequences, the informants wondered about how deliberate the adolescent’s decision to start with PS was. Clinicians stated that adolescents should be able to appreciate the impact of the treatment on their own situation. Of importance, most parents of adolescents who proceeded to GAH, as well as a few parents of adolescents who discontinued PS, thought that their child’s decision to start with PS was made deliberately. In contrast, most adolescents themselves, both continuers and discontinuers, thought they were not aware of the importance and impact of the decision. “Of course, I was very young at the time [when I decided about starting the treatment with puberty suppression], but I had been whining about it for a long time already. It was more like: ‘I have to do it, I have to do it’. Did I think it through [what the treatment with puberty suppression and its (possible) consequences entailed]? No. Was I eventually satisfied with it [the treatment with puberty suppression]? Yes.” - Interview with a transgirl who continued PS; age at start PS: 14.2; age at interview: 17.9
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