Pediatric endocrinologist Norman Spack co-founded the Gender Management Service at Boston Children’s Hospital, a groundbreaking clinic that serves young people who are physically intersexed or transgender, and their families. He is one of the first and only doctors in the world to provide hormone replacement therapy to minors. Spack’s interest in transgender youth began in 1974 when he worked as a volunteer for Bridge Over Troubled Waters, an organization in Boston and Cambridge that serves street youth, many of whom are the victims of sexual and domestic abuse. In 1985, while working in the first private practice of adolescent medicine in New England, which he co-founded in 1978, a transgender graduate student was referred to him. Spack saw an opportunity to learn from a population that had been underserved by the medical profession. He was named clinical director of the Endocrine Division at Children’s in 1998 and more recently became director of the model Gender Management Service in the Endocrine Division. Since 1992, he has served as a clinical instructor in pediatrics at Harvard Medical School, and in April 2004 he was named senior associate in endocrine history. He is celebrating his 40th year at Boston Children’s Hospital and is an assistant professor of pediatrics at Harvard Medial School, where he has introduced the topic of transgenderism into the second-year curriculum.