Legal, ethical and clinical complexities surrounding consent to medical treatment for gender dysphoric youth in Australia continue to develop. Significant but inconsistent changes to case law principles are requiring lawyers, policymakers, clinicians and youth to grapple with an ever-shifting context. Until recently, all gender diverse youth seeking treatment were required to seek either judicial approval of treatment or judicial assessment of Gillick competency, depending on the stage of treatment sought. In significant developments, judicial decisions in Re Jamie in 2013 and Re Kelvin in 2017 removed the need for court oversight of treatment in many circumstances. However, those decisions contained conceptual difficulties, the situation for minors falling outside the ambit of those decisions is relatively unexamined, and subsequent decisions by Family Court judges have left this area unsettled. In addition, new Australian Standards of Care and Treatment Guidelines specific to this group represent a significant development in the clinical context. While in early court judgements treatment for gender diverse youth could have been viewed as novel, and perhaps deserving of judicial scrutiny, there is now relatively established medical consensus on appropriate treatment. Despite this, the legal context remains unclear and the law’s conformity with fundamental legal principles warrants scrutiny. This presentation outlines recent developments in the law and clinical guidance relating to consent for medical treatment of gender diverse youth, with particular focus on the 2017 case of Re Kelvin and subsequent cases. Conclusions are drawn regarding implications for law, clinical practice, and gender diverse youth.