Puberty can be a particularly challenging time for adolescents who are transgender. Access to puberty blocking medication, commonly called 'puberty blockers', is considered an integral component of gender affirmative healthcare. Existing literature provides little insight into how parents of trans children entering into early adolescence navigate decision-making related to puberty blockers. This unique research examines parental perspectives on medical decision-making from a cohort of families with trans children who socially transitioned pre-adolescence (average age 7), and who at time of parental interview were in or approaching, early adolescence (average age 11). Data were analysed through inductive reflexive thematic analysis. Parental reflections are presented within three main themes, concern for protection of adolescent mental health and well-being, parental perspectives on adolescent consent, and managing decision-making without certainty. These findings hold relevance for healthcare policy makers, for parents of trans children, and for healthcare, social services and other professionals supporting trans adolescents and their families.