BACKGROUND. Transgender and gender diverse (TGD) individuals represent a heterogeneous and growing population. Unmet needs, epistemic changes and political activism are leading to a transformation of care delivery. The free and informed consent model based on primary care is widely promoted. General practitioners remain insufficiently trained and informed about TGD issues. To present a review of TGD health needs. To build common knowledge between consumers and professionals to face epistemic inconsistencies in science. To illustrate practical organizational changes. METHODS. This work lies at the con?uence of academic, experiential and ?eld knowledge. It is based on a review of recent scientific publications, a thematic synthesis of activist literature and a ?eld experiment in community care. OUTCOMES. Public health-based approaches share an epistemic proximity to arguments from the activist world, unlike specialized approaches, particularly in mental health, which lack ecological validity. Concrete examples of successful implementation also tend to reinforce this practical validity. DISCUSSION. Conceptualizing TGD people as a population at risk for systemic risks appears a better solution than hyperspecialized approaches based on diagnostic and prognostic assessment. Thus, transforming health care services towards primary care does not mean shifting tasks, but rather putting forward new practices and a new medical and paramedical stance in the service of self-determination and human rights.