At a recent conference in London the problems and possibilities of clinical management in gender identity disorder (GID) of adolescents were addressed. The number of referrals of adolescents with GID has tripled in recent years. With the uncertainties of the DSM classification and the lack of reliable criteria diagnosis remains controversial. Atypical gender behaviour is rather common in children but persistent GID in adolescence is only seen in 25% of the referred children. The role of pubertal hormones in brain development is the subject of studies but no clear answers are (yet) available. Prenatal hormone exposure is clearly linked to child play behaviour but does not appear to be the most important factor for gender identity. An option for adolescents with persistent GID and an increase of distress at puberty is puberty-delaying treatment with GnRH analogues. This treatment relieves distress and no detrimental physical effects have been observed, but follow up is limited. From an ethical point of view, the developing autonomy of the adolescent with GID should receive more attention and a practical approach should underscore the experimental nature of the intervention and the possibility of withdrawal from treatment. In dealing with adolescents with GID puberty-delaying treatment is a valuable option with encouraging preliminary results, but long term outcome studies and more research are necessary.