Through an analysis of recently published treatment protocols, research findings and clinical experience, and guided by the principle of “first, do no harm,” the author argues that the use of pharmacological and surgical interventions in the treatment of gender dysphoric youth, especially in light of what is known about the transience of cross-gender identification in children, is mistaken both clinically and ethically. He further argues that psychotherapy, neglected by most of those advocating pharmacological and surgical interventions, is the best treatment option for these patients. The author elaborates some of the modifications of psychotherapeutic technique with both patients and their parents that he has found to be most effective with this population.