This talk will explore advanced topics in medical care of transgender and gender diverse individuals. It will explore the ethical principles of autonomy, beneficence, and non-maleficence in making medical decisions when children, adolescents, and adults are involved.  It will explore the use of evidence behind the chosen name for adolescents, and how to use affirming pronouns when parents are not in agreement.  The issues of controversy such as “rapid-onset gender dysphoria”,  “watchful waiting”, early treatment with puberty blockers, informed consent, and cancer risks.