An increasing number of children are coming with their parents to seek out mental-health services as they explore, question, or give voice to their gender concerns. This article presents a particular orientation of practice to help those children, the gender affirmative model, proposing that psychoanalytic practitioners are ideally situated to help these children within this approach, using techniques of listening, mirroring, suspension in psychic intermediate spaces, play, and interpretation. Concepts of the true gender self, false gender self, and gender creativity are presented. Particular attention is paid to prepubertal children who affirm that their gender does not match the sex listed on their birth certificate, and examines the question of whether it is in the best interests of these children to allow them to socially transition to the gender they affirm themselves to be. A case example is presented of a five-year-old exploring gender to demonstrate the gender affirmative clinical approach in a psychoanalytic context.