This paper draws on interviews with 10 psychologists working in NHS (National Health Service) Adult Gender Identity Clinics across the UK and focuses on the way they put their clinical knowledge about gender into practice. It also questions how two major NHS consultations set the parameters for professional and clinical practice in relation to gender affirming technologies despite their methodologies being at variance with each other and having severe implications for treatment options. Findings indicated that psychologists believed their experiences of working in a gender clinic was deeply problematic, leading them to question their mental health, their agency at work, and recent shifts to professionalise their role by introducing 'specialist' level accountability. They were routinely challenging a dated neo-liberal system that lacks compassion, is inflexible, reductive, functionalist and interventionist. Such a system sustains a cis-normative, neo-liberal framework at the expense of transgender and non-binary pedagogy and testimony.