According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents’ competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents’ medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated.

A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10–18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used.

Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not.

By using the MacCAT-T and clinicians’ assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS.

根据国际跨性别护理指南，青春期抑制（PS）的一个重要先决条件是跨性别青少年给予知情同意（IC）的能力。在社会上，跨性别青少年是否能够做到这一点值得怀疑，这在一些国家甚至导致获得这种干预的机会有限。因此，本研究检查了跨性别青少年的医疗决策能力 (MDC)，以以结构化、可复制的方式为开始 PS 提供 IC。此外，还调查了 MDC 的潜在相关变量，例如年龄、智力、性别、心理功能。

在两个荷兰专门的性别认同诊所内，对 74 名跨性别青少年（年龄 10-18 岁；16 名出生分配的男孩，58 名出生分配的女孩）进行了一项横断面半结构化访谈研究。为了评估 MDC，使用了基于参考标准（临床评估）和麦克阿瑟治疗能力评估工具（MacCAT-T）的判断，这是一种经过验证的半结构化访谈。

在跨性别青少年中，93.2%（参考标准判断；74 人中的 69 人）和 89.2%（MacCAT-T 判断；74 人中的 66 人）被评估为有能力同意。方法间一致性为 87.8%（74 个中的 65 个）。参考标准和基于 MacCAT-T 的判断的评估者间一致性分别为 89.2%（222 个中的 198 个）和 86.5%（222 个中的 192 个）。智商和性别都与 MacCAT-T 总分显着相关，而年龄、情绪和行为挑战水平以及诊断轨迹持续时间则没有。

通过使用 MacCAT-T 和临床医生的评估，本研究中分别有 93.2% 和 89.2% 的跨性别青少年被评估为有能力同意开始 PS。