<p>Often primary care providers are called upon to judge the legitimacy of patients’ requests for gender-affirming care. Such requests are not necessarily based on best practices but exist nonetheless. Understanding the basis of such requests and objections to them can assist PCPs in navigating their role as gatekeepers. We address common objections raised to such requests and use common clinical scenarios to show that these objections are based on an incomplete understanding of autonomy. We conclude with a discussion of how a contemporary understanding of how gender identity is constructed might help primary care providers understand their role and how to help patients with their requests, both in gender-affirming care and more generally.</p>