A reflection on how the absence of a psychodynamic perspective may disadvantage gender care and decision-making.

Objective: To reflect on factors that may have led to the widespread implementation of gender affirming care (GAC) for minors by psychiatric clinical leaders despite the absence of a robust evidence base and the known risks of harm.

Conclusions: The progressive rejection of psychodynamic thinking by the profession of psychiatry may have contributed to psychiatrists failing to question key aspects of GAC for minors. Further, numerous unconscious factors potentially contribute to the foreclosure of thinking about the risks of gender medicine.