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Over the past 20 years, there has been a notable global rise in the number of children and adolescents presenting with gender identity issues, prompting significant shifts in clinical, social, and political discourse. In response to growing concerns about early medical intervention and the long-term effects of puberty blockers and cross-sex hormones, the UK commissioned the Cass Review to evaluate current methods for treating gender dysphoria in young people. This paper presents some key findings of this Review, along with the rationale and framework of the Family Consultation Service (FCS), a psychotherapeutic alternative to the previously promoted affirmation approach. The FCS offers a reflective, non-medicalised assessment framework to support families in exploring the psychological and developmental factors underlying a child’s declaration of transgender identity. Drawing on psychoanalytic principles and clinical experience, the model emphasises family dynamics, comorbidities, attachment history, and adolescent identity development. Through a dual-therapist approach, the FCS provides a space for both children and parents to consider complex emotional and relational factors that may contribute to gender distress. This paper advocates a comprehensive, cautious, and evidence-based approach to assessment and care, particularly given the limited quality of long-term data and the neurodevelopmental vulnerabilities of the current cohort. The paper offers a framework for future service provision aligned with developmental and psychodynamic best practice.