Associate Prof Campbell Paul is a consultant child and adolescent psychiatrist who has been at the Royal Children’s Hospital for many years in psychiatry and infant mental health. Over the last 15 years he has worked with many children and young people experiencing gender dysphoria, and their families, and he was involved in the establishment of the original RCH Gender Service. Transgender children and young people have endured sometimes profound distress and may feel very alienated. It has been very exciting to see the further development of the Gender Service driven by colleagues from RCH Adolescent Health and the formation of many new support networks and services for young people and their families. There is an increasing community awareness and acceptance of gender diversity for children and young people. An understanding of the development of a child’s identity, especially gender identity, is important for all clinicians.