Inclusion Criteria:  (1) youth is between the ages of 8-14 years (2) youth self-asserts a transgender identity (3) youth has expressed interest in GnRHa or is currently on GnRHa treatment; or (1) AYA is between the ages of 13-24 years, (2) AYA self-asserts a transgender identity, and (3) AYA has expressed interest in gender-affirming hormone (GAH) or is currently on GAH treatment. Parents of eligible youth will be eligible to participate.  Exclusion Criteria:  (1) youth/parents are unable to read, speak or understand English (2) youth/parents are unable or unwilling to provide consent/assent/parental permission for study participation.