Trans* (transgender, non-binary, and gender nonconforming) youths are disproportionately burdened by poor mental health outcomes, including but not limited to depression, anxiety, and suicidal ideation and attempts. These adverse outcomes often result from marginalisation, stigma, lack of support, rejection, and bullying. This chapter will explore the prevalence of mental health issues among trans* youths, clarify relevant terminology, and discuss coexisting and comorbid health issues. In addition, we will refer to recent changes in the approaches to working with trans* young people, following the Cass Report, the NHS England response, and the government’s guidance for schools. The increasing number of young people presenting to services has led to a demand that outstrips the available resources. This chapter will provide guidance to those working with trans* young people to understand the current landscape, the views shaping services, and the concerns of young people, parents, and trans communities. Reflection points and activities will be provided through this chapter to aid those working with trans* young people. The benefits of this chapter are further enhanced by the fact that one of the authors has provided personal perspective of being a trans woman.