Internationally and within New Zealand there has been a substantial increase in the demand for gender affirming healthcare over the past decade. The Youth’12 secondary school survey, estimated that approximately 1.2% of adolescents in New Zealand identify as transgender.¹ It is likely that this level of referrals to health services will continue in the foreseeable future. This guideline has been developed following the recognition that New Zealand’s previous good practice guide, Gender Reassignment Health Services for Trans People within New Zealand,² which was based heavily on the World Professional Association of Transgender Health, Standards of Care, version 6 (WPATH SOC v6),³ requires updating to be in step with current practice and international guidelines. Transgender healthcare is a rapidly evolving area of medicine. WPATH is the international body responsible for producing standards of care. WPATH SOC v7,⁴ was published soon after New Zealand’s good practice guide and version 8 is currently in development. This guideline is not intended to replace the WPATH SOC but to present additional guidance for the provision of gender affirming healthcare in Aotearoa, New Zealand. We hope that this guide will be used to support the development of health services providing gender affirming healthcare around the country and provide guidance to District Health Boards (DHBs). We use Sir Mason Durie’s health framework to inform the kaupapa or approach of these guidelines. WPATH SOC v7 encourages culturally appropriate approaches which are contextually based.⁴ Durie’s model for health promotion development, Te Pae Māhutonga (the Southern Cross), has two guiding principles which correspond to the pointer stars of the constellation, Te Mana Whakahaere and Ngā Manukura.⁵