The purpose of the present study is to explore how clinical psychologists work psychotherapeutically with gender variant youth. Gender variant refers to people who do not identify with the gender they were assigned at birth. Over the past 15 years, a prevailing management of gender variant youth has been to clinically suppress puberty, in order to gain time for determining if a full transition is necessary. Research within the gender binary tradition has demonstrated that a carefully selected group of gender variant youth benefit from physical treatment and a transition to the other gender, but little is known about the underlying processes behind the decisions regarding puberty suppression and the psychotherapeutic processes clinical psychologists aim for. Besides, there has not been much focus on the clients that seek treatment, but are not selected. The overarching research question guiding the present study is: How do clinical psychologists relate to puberty suppression in their work with gender variant youth? To explore the research question, five semi-structured interviews were conducted with clinical psychologists working at a European clinic. The data were analysed through thematic analysis. The results indicated that the participants deploy facilitative and explorative therapeutic strategies in their work, in order to enable clients to make informed decisions regarding puberty suppression. Participants explained that important outcomes for the clients included enhanced abilities to negotiate identity with cultural discourses and integration of thoughts and feelings within social contexts. The use of puberty suppression can be an advantage in order to create space for reflection. A potential pitfall can be that it provides the signal to clients that the management is going to be only medical, at the expense of exploration of gender identity and different ways of managing gender variance and distress related to it. The present study aims to contribute to the current research on clinical work with gender variant youth, because it encourages clinical psychologists to focus more on the processes behind decisions regarding puberty suppression, instead of predictors of future gender identity. In addition, it suggests that clinicians should be open for a variety of gender identities and expressions. Thus, it challenges heteronormative assumptions within prevailing treatment and suggests more openness in terms of treatment outcome.