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The present study descriptively explores the childhood experiences, social transition and disclosure milestones and trajectories, reactions to disclosure, gender affirmation at school, dissatisfaction with sex characteristics, and desires for gender affirming medical care (GAMC) within a sample of transgender children and adolescents presenting for GAMC. Participants were children and adolescents (N= 224; Age 6–17 years) who participated in an initial assessment at a multidisciplinary gender affirming program in Dallas, Texas. Data were extracted from assessment notes and participants also completed self-report measures of current depression, anxiety, and body-related dissatisfaction. Most participants reported awareness of their gender identity in childhood or early adolescence and started to take steps in social transition and disclosure during adolescence, prior to presenting for …