The modern concept of gender diversity is a challenge in today's medicine. Medical doctors in pediatrics and adolescent medicine or in gynecology are confronted with the topic of trans-identity and the endocrine treatment with sexual steroids more and more often. Studies show that comprehensive and multidisciplinary care in centers with expertise can improve the general health of young people with trans-identity. Contraception, fertility and family planning should be addressed before endocrine treatment is initiated. Unintended pregnancies can also occur in young persons with trans-identity. The aspect of contraception should be an integral part of medical counseling and education. Before the initiation of endocrine treatment and surgical options, the possible desire to have children at a later time in life and family planning options should be addressed.