This qualitative grounded theory study is the first of its kind aimed at understanding the decision-making process of parents and guardians of transgender and gender-diverse (TGD) youth providing informed consent for their children to undergo gender-confirming endocrinological interventions (GCEI), such as hormone replacement therapy and puberty blockers. Using primarily intensive interviews supported by observational field notes and document review, this study examined the decision-making processes of a national sample of participants who identified as a parent or legal guardian of at least one TGD youth and who have given informed consent for the youth in their care to undergo GCEI. A variety of inhibiting and contributing factors were illuminated as well as a "dissonance-to-consonance" model that participants used to combine contributing factors to overcome inhibitors and grant informed consent. Implications for professional counseling practitioners are discussed, including guidance for direct services, gatekeeping, case management, and advocacy functions.