95 Medical decision‑making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians 5 Some adolescents and clinicians thought that parents find it a reassuring idea that the first medical step has effects that are largely medical reversible. Some parents confirmed this idea whereas others did not. “I think that especially for my parents, the decision to start treatment with puberty suppression was easier [compared to the decision to start treatment with genderaffirming hormones].” - Interview with a transgirl who continued PS; age at start PS: 12.9; age at interview: 17.8 “Especially for ourselves [as parents] it was extra time to reflect and think. I liked the idea that it [the effects of the treatment with puberty suppression] was [were] still reversible, even though I did not doubt her [gender incongruent] feelings or think that would ever be necessary. But I liked that about it [the treatment]. So I think the way we [as parents] experienced it [the fact that the effects of the treatment with puberty suppression are reversible] was different from the way she [our daughter] did; for her it was more like the beginning of [gender-affirming medical] treatment.” - Interview with a parent of a transgirl who continued PS; age at start PS: 12.0; age at interview: 18.1 The clinicians had diverging views on the fact that effects of PS are largely medical reversible and the role this should play in the decision-making process. “I also think, even though it [the effects of the treatment with puberty suppression] is [are] reversible, it is still an invasive treatment with substantial disadvantage.” - Focus group with clinicians “You wonder if 11, 12, [and] 13 year-olds can really understand and appreciate what they are getting into [when starting treatment with puberty suppression]. But especially for ourselves, as psychologists, it is helpful that it [the effects of the treatment with puberty suppression] is [are] reversible.” - Focus group with clinicians The role of age, intelligence, and mental health problems The informants mentioned several factors they consider when assessing the adolescent’s MDC, among others, the adolescent’s developmental age, intelligence, and the presence of mental health problems. Clinicians stated that the younger the adolescent is when deciding about PS, the less likely to understand and appreciate what the treatment and its consequences entail.
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