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Over the last 10 years we have moved from the gender transition of a few older people after extensive psychotherapy, usually men who identify as women, undergoing surgery to reach a resemblance of the appearance of the opposite sex, to the prescribing of hormone blockers and cross sex hormones to children and young people often who have mental health challenges, are gender non-conforming or are, or will grow up to be, homosexual. This is now predominantly young girls and women who are rejecting growing up to be women, and may be reacting to a sexualised stereotype of womanhood.Does the current health system approach overdiagnose gender incongruence or is this the sensible treatment of distressed young people who will become much more content living as if they were the other sex? Is cross sex treatment necessary for the health and wellbeing of our patients, or is it a human right to go through the correct puberty?This presentation will look at the problem of how we diagnose and treat trans identifying people, the problem of how best to treat them when they present to the doctor as transgender, whether they should be able to change their sex marker on medical records, and how medical care is complicated after transition, based on unusual anatomy and confusing clinical presentation.I draw on reports, some of which I have been involved in producing, over the last year published by a number of organisations that have looked carefully at the problems of data collection in the NHS, consent to treatments, the honesty and integrity of our medical organisations, the health outcomes for those affected and the consequences for the people who care for them in the medical setting.This is a controversial area that covers aspects of the expansion of definitions of disease, policy driving treatment, social media, impact on providers of care, costs and life-long medicalisation.