In this episode, journalist David P. Ball is joined by Dr. Marcus Greatheart, a family physician, registered social worker, and author. Together, they explore how clinicians can create safe and affirming spaces for trans and gender-diverse youth in substance use care by addressing systemic barriers, promoting trauma-informed approaches, and challenging fear-based narratives. They also speak with Toby and Alec, members of the Substance Use Beyond the Binary Youth Action Committee at the BC Centre on Substance Use. Drawing from their lived experiences with substance use and barriers to gender-affirming care, Toby and Alec offer valuable insights into navigating the healthcare system. Finally, David and Dr. Greatheart hear from family physician Dr. Andrea Moir, who shares lessons from her work providing gender-affirming care for young people. Dr. Moir discusses the impact of stigma, the importance of nonjudgmental approaches, and practical steps clinicians can take to foster more inclusive healthcare environments. We extend a special thank you to Christian Barborini for their dedication in supporting engagement with the Substance Use Beyond the Binary Youth Action Committee at the BC Centre on Substance Use. Their work was instrumental in facilitating the participation of Alec and Toby in this episode. Access the show notes here (https://bit.ly/APP-S5E5).