When faced with the significant personal difficulties patients presenting to mental health services bring, it is understandable that clinicians hesitate to manage gender as well – the need appears neither so necessary nor so immediate given the limited resources one has to draw upon. Harm management and capacity are naturally the primary considerations in such instances. Nonetheless due consideration must be given to a person’s gender, just as we do with cisgender men and women – indeed, for trans people, matters of gender may be more pressing and therefore more pertinent to the clinical encounter than they are for cisgender people. For example, endeavouring to create a therapeutic alliance with a severely depressed individual to manage suicidal risk will be next to impossible if they are misgendered – that is, if they are referred to by an inappropriate name and pronouns. In this instance, to say that one is focusing on suicidality is to miss the point. Indeed, such an approach would only exacerbate the problem if the patient has a depressive illness precipitated by their belief that they will not be accepted because of their trans status.