As gender diversity becomes more understood and accepted in mainstream culture, medical systems and health care providers must learn to provide comprehensive and affirming care to gender diverse individuals. As the number of gender diverse pediatric patients continues to grow, these patients will be cared for by pediatric solid‐organ transplant programs. This review summarizes the basic principles of gender‐affirming care and describes how transplant teams can provide equitable and affirming care to young gender diverse patients undergoing solid organ transplant (SOT). In addition, this review uses kidney transplant as a framework to explore gender‐affirming hormone therapy and gender‐affirming surgery in the setting of transplant, laboratory value interpretation in gender diverse individuals, and the importance of an individualized approach in care of the gender diverse transplant recipient.