Nationally and internationally, increasing numbers of trans and gender diverse children and adolescents are presenting for care. In response, gender affirming hormonal therapies that seek to align physical characteristics with an individual’s gender identity are increasingly being employed in adolescents with gender dysphoria. Depending on a young person’s identity and goals, these therapies may aim to achieve full pubertal suppression, modulation of the effects of endogenous pubertal sex hormone and/or development of secondary sex characteristics congruent with their affirmed gender. Endocrine practice in this area is still relatively novel and while short-term outcomes are encouraging, longer-term data from prospective longitudinal cohorts of adolescent are still lacking. This presentation will provide an overview of current pharmacological options and potential treatment pathways, reported outcomes and clinical challenges in the management of trans and gender diverse adolescents.