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The use of puberty-delaying or blocking hormonal treatment of adolescents with gender identity disorder (GID) has become increasingly common. In the present study, we examined demographic, behavior problem, and psychosexual measures to see if any of them correlated with the clinical decision to recommend, or not recommend, puberty-blocking hormonal therapy in a consecutive series of 109 adolescents (55 females, 54 males) with GID evaluated between 2000 and 2009. Of the 109 adolescents, 66 (60.6%) were recommended for puberty-blocking hormonal therapy and 43 (39.4%) were not. A combination of five (of 15) demographic, behavior problem, and psychosexual measures were identified in a logistic regression analysis to significantly predict this clinical recommendation. The quantitative data were complemented by clinical case descriptions and some follow-up information. We discuss our data in relation to the Dutch model of early biomedical treatment for youth with GID and consider areas that require further clinical and empirical examination.