An increase in referral rates of transgender youth to services has been observed on an international level (Chen et al 2016, Fuss et al 2015). There is a paucity of knowledge vis-a-vis paediatrician’s experience and knowledge of caring for transgender youth. General paediatricians knowledge is limited, with training on provision of routine care, supporting transgender patients and their families and co-ordination of medical management recommended (Shires et al 2017). Paediatric endocrinologists may be involved in prescription of hormonal therapy in transgender youth, in accordance with the updated Clinical Practice Guideline by the Endocrine Society in 2017. Gender identity and expression is best conceptualized as a spectrum, and not simply a binary concept. The term transgender can be considered an umbrella term, encompassing the broad spectrum of individuals who transiently or persistently identify with a gender different from their assigned sex at birth. An inversion of the sex ratio of referred adolescents has been observed, with a number of clinics reporting more youth assigned female at birth referred in recent years than youth assigned male at birth (Aitken et al 2015; Kaltiala-Heino et al 2015). This presentation will include an overview for paediatricans. The gender spectrum, social and medical transitioning, common co-morbidities, current evidence-base & guidelines and practical management of gender variant youth in the paediatric setting will be covered. Medical, neurodevelopmental and psychiatric co-morbidities will be highlighted. Gender Dysphoria and comorbidity with medical disorders, such as Kleinfelter Syndrome, and neurodevelopmental disorders, such as Autistic Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), will be explored. The current literature reports high co-occurance rates of Gender Dysphoria and ASD (Van Der Miesen et al 2016, Janssen et al 2016, Shumer et al 2016) and is the focus of much attention. Research in recent years highlights elevated rates of co-morbid mental health difficulties, self-harming behavior and suicidality among transgender youth (Chen et al 2016, Holt et al 2016, Kaltiala-Heino et al 2015, Olson et al 2015, Reisner et al 2015).