This chapter examines the law in England and Wales governing consent to medical treatment for trans children and adolescents. First, the general legal principles governing consent to children’s medical treatment in England and Wales are detailed. In doing so, the various avenues to consent for children’s medical treatment in England and Wales are laid out. Second, it will be seen that, historically, there has been limited guidance from case law on the situation of trans young people; however, this was altered with the landmark 2020 decision of the High Court in Bell v Tavistock and Portman NHS Trust and subsequent appeal. Key changes to the law in respect of trans youth’s ability to seek medical treatment as a result of these judgements are analysed. Finally, the law is synthesised as to what represent the current legal principles applicable to trans youth seeking medical treatment in England in Wales.