TY - JOUR
T1 - Medical decision-making competence regarding puberty suppression
T2 - perceptions of transgender adolescents, their parents and clinicians
AU - Vrouenraets, Lieke Josephina Jeanne Johanna
AU - de Vries, Annelou L. C.
AU - Arnoldussen, Marijn
AU - Hannema, Sabine E.
AU - Lindauer, Ramón J. L.
AU - de Vries, Martine C.
AU - Hein, Irma M.
N1 - Funding Information: We thank the adolescents, their parents, and the clinicians who participated in this study. Besides, we would like to thank the FWOS (Fonds Wetenschappelijk Onderzoek Seksualiteit) for funding the research project. The funding source had no role in the study design, in the writing of the manuscript, and in the decision to submit the manuscript for publication. Publisher Copyright: © 2022, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents’, their parents’, and clinicians’ perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents’ MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC’s relevance. The four criteria one needs to fulfill to have MDC—understanding, appreciating, reasoning, communicating a choice—were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents’ support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
AB - According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents’, their parents’, and clinicians’ perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents’ MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC’s relevance. The four criteria one needs to fulfill to have MDC—understanding, appreciating, reasoning, communicating a choice—were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents’ support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.
KW - Adolescents
KW - Gender dysphoria
KW - Gender incongruence
KW - Medical decision-making competence
KW - Puberty suppression
KW - Qualitative study
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85138239048&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36115898
UR - http://www.scopus.com/inward/record.url?scp=85138239048&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00787-022-02076-6
DO - https://doi.org/10.1007/s00787-022-02076-6
M3 - Article
C2 - 36115898
SN - 1018-8827
VL - 32
SP - 2343
EP - 2361
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 11
ER -