Gender-affirming care can be provided in a primary care setting or in specialist clinics. A larger workforce is required in order to meet the needs of trans people in Australia. Delivering transgender health is an important role of the endocrinologist and is part of the training curriculum. Adult care is centred around an informed consent model led by client goals. The assessment and initiation of masculinising and feminising gender-affirming hormone therapy are discussed. The contemporary challenges and solutions to increasing capacity within the health service are examined from the perspective of the NSW experience.