Youth and young adults often report difficulties in accessing comprehensive healthcare to meet their health and wellbeing needs. An uncoordinated and under-resourced healthcare system results in young people reporting numerous barriers in seeking services when they need them. For transgender young adults, the challenges are even greater. with fewer services able to cater for their specific health and wellbeing needs. A constructivist grounded theory approach was used to guide the collection of data to understand the processes transgender and young gender-diverse adults use to navigate the healthcare system. Semi-structured interviews were undertaken with a small cohort of ten transgender young adults aged between 18 and 24 years. The processes of constant comparative analysis, theoretical sampling and saturation were used to generate a substantive grounded theory Who am I? – this is me. Three categories emerged from this study in relation to the young people’s interactions with the healthcare system. These were: Seeking My Authentic Self and the process of gender affirmation and validation; Knowing I Matter But..., which is defined as having meaningful engagement with healthcare providers; and the third category, My Transition Enabled, is about being able to access trusted and accessible health care for life. This study has highlighted that, despite the recent developments in acknowledging the needs of transgender young adults, there continue to be significant gaps in consistent transgender healthcare provision across New Zealand. The study also confirms that there are barriers preventing young people accessing the right level of care for their health, and mental wellbeing needs. From the substantive theory, a framework of affirmative healthcare is proposed to provide healthcare decision-makers and planners a consumer-informed road map, which prioritises meaningful and trusting engagement between healthcare providers and service users. Mitigating barriers to accessing services and building the capability of the workforce in transgender health and mental health is crucial for better healthcare for transgender young adults.