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The World Professional Association for Transgender Health’s Standards of Care suggests a letter of recommendation be provided from a mental health professional if a transsexual desires hormone therapy or surgery. Therefore, transsexual clients have a unique dependence on therapists to obtain medical treatments needed to live life in their affirmed gender. Despite this need for therapeutic services, most therapists lack the training that is necessary to sensitively serve transsexual clients, particularly transsexual youth. While a published clinical assessment tool exists for therapists to determine readiness of adult transsexual clients for medical gender transition, no similar tool is available for therapists working with transsexual youth. This article discusses therapeutic issues specific to transsexual youth and families and presents a clinical assessment tool for determining transsexual youth’s readiness for medical treatments.