Trans Pathways is a study of the mental health and care pathways of trans and gender diverse young people in Australia. The study aimed to provide a snapshot of the current mental health of trans young people, identify potential causes of mental health problems, determine protective factors for mental health, and identify the support needs of trans young people and their parents and guardians. Service accessibility was also reviewed. 859 young people aged 14-25 years old took part, and the views of 194 parents and guardians were also included. This report summarises the main findings and presents recommendations for governments and health providers, as well as guidance for schools, parents, peers and young trans people. Overall, the study found that trans young people are at very high risk for poor mental health, self-harming and suicide attempts. Around 3 in every 4 trans young people have experienced anxiety or depression, 4 out of 5 trans young people have engaged in self-harm, and almost 1 in 2 trans young people have attempted suicide.