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This article is based on an ethnography of the medical-scientific conferences of two organizations, one international (World Professional Association for Transgender Health; WPATH), which brings together, in a long-term partnership, health professionals and trans activists, and the other French (Société d’étude et de prise en charge de la transidentité; SOFECT), which only assembles health professionals. This ethnography highlights the dynamics of the controversies that oppose these two categories of actors in the evolution of the support of trans people, which mainly concern the psychiatric approach to trans situations and the recognition of the diversity of gender identifications. The contrast between the characteristics of the WPATH (a hybrid forum) and the SOFECT (a professional association) allows us to observe the different rhythms and intensities of these controversies. The article highlights two ways of managing controversies based on two types of relations between the representatives of health professionals and trans associations.