Ten years ago, trans-gender people were looking for respectful and safe accompaniment. It was in this context of difficulty in finding answers that the Maison Dispersée de Santé de Lille began to set up a support service. The approach was immediately anchored in the gender transition pathway within primary care medicine, i.e. in access to local care. Caregivers and users, we build together our practice of health and care by meeting, debating, listening and sharing individual and collective expertise. Thus, we have gradually built a rigorous and non-rigid framework of a global, bio-psycho-social accompaniment that takes into account experiential learning. This framework must take into account the health of each individual in order to propose, follow and adapt a hormone replacement treatment. It allows for the accompaniment of physical changes, possible pre-existing psychological suffering or that which appears during the transition, as well as the upheaval of one's place in society. People with gender variations need medical support because they are part of a social reality that leads to this demand. The prevalence of transidentity has long been underestimated and this need has also been underestimated. Our experience of more than ten years of accompanying transitions of women and men in this context shows the feasibility of transitions in primary care within the French system of care and medico social support.