7 TPC Digest During the 21st century, transgender and gender-diverse (TGD) identity in the United States has been associated with pervasive patterns of mistreatment and discrimination across social, educational, occupational, legal, and health care experiences. Despite these trends, affirming stances toward TGD identity have been developing almost simultaneously, tracing their roots to Christine Jorgensen’s transition in the 1950s. About a decade later, endocrinological interventions were pioneered that aimed to medically support TGD patients who wished to feminize or masculinize their bodies to be more congruent with their gender identity without surgery. These gender-confirming endocrinological interventions (GCEI) have been associated with positive physical and mental health outcomes and have been made available to people across the developmental life span from pre-puberty through late adulthood. GCEI have been growing in popularity among TGD minors, but in the United States minors almost always need their parents or legal guardians to provide informed consent for GCEI. Nearly all of the research regarding GCEI has been conducted on adults. The literature on the long-term risks and benefits of GCEI on minors is ongoing but not complete. This leaves both TGD youth and their parents in a difficult position to make meaningful decisions without a body of rigorous research to instill confidence in giving or denying consent. This qualitative grounded theory study is the first of its kind aimed at better understanding the decision-making process that parents and guardians of TGD youth go through when providing informed consent for the minor in their care to undergo GCEI. Using primarily intensive interviews supported by observational field notes and document review, this study examined the decision-making processes of a national sample of participants who identified as a parent or legal guardian of at least one TGD youth and who have given informed consent for the youth in their care to undergo GCEI. A variety of inhibiting and contributing factors were illuminated as well as a “dissonance-to-consonance” model that participants used to combine contributing factors to overcome inhibitors and grant informed consent. Inhibiting factors included lack of knowledge and awareness of issues and concerns related to TGD identity, fear, doubt, grief over a lost parenting narrative, and rejection from health care providers (or payors) and parenting partners. Contributing factors included parental attunement to the experiences and emotions of the youth in their care, access to affirming education about TGD issues and GCEI, and the presence and/or development of affirming relationships and community. Participants used prior exposure to the experiences of historically minoritized people, openness to new ideas and information, and acceptance of new ideas and information to conduct a TGD-affirming cost-benefit analysis using contributing factors to overcome inhibitors, grant informed consent, and experience relief. The results of this study appear to provide a plausible model for professional counselors to follow when providing care for TGD youth and their families. They also provide fresh reference points for counselor educators employing multicultural perspectives for instruction on ethics, professional identity, and family systems counseling, among other considerations. Charles F. Shepard, PhD, NCC, LPC, is a visiting faculty member at James Madison University. Darius A. Green, PhD, NCC, is the PASS Program Assistant Coordinator at James Madison University. Karli M. Fleitas, MA, is a doctoral student at James Madison University. Debbie C. Sturm, PhD, LPC, is a professor at James Madison University. Correspondence may be addressed to Charles F. Shepard, MSC 7704, James Madison University, 91 E. Grace Street, Harrisonburg, VA 22807, sheparcf@jmu.edu. Charles F. Shepard, Darius A. Green, Karli M. Fleitas, Debbie C. Sturm Informing Consent A Grounded Theory Study of Parents of Transgender and Gender-Diverse Youth Seeking Gender-Confirming Endocrinological Interventions 7 | TPC Digest