Internationally and within Aotearoa, New Zealand, there has been a substantial increase in the demand for gender affirming healthcare over the past decade. It is likely that this level of referrals to health services will continue in the foreseeable future. The Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand were developed following the recognition that the previous good practice guide required updating to be in step with current practice and international standards. This article presents a summary of the guideline focusing on puberty blockers, hormonal therapies, access to surgery and other gender affirming healthcare. We hope these guidelines will support the development and provision of services providing gender affirming healthcare around the country and provide helpful guidance to all health professionals involved in the care of trans people.