Transgender and gender-diverse (TGD) individuals face significant barriers to healthcare access, including healthcare providers' (HCPs) lack of knowledge on TGD-specific healthcare issues, discrimination, and mistreatment. The World Professional Association for Transgender Health recommends integrating TGD health competencies into training. However, specific guidance on what these competencies should be, particularly from a patient-centered lens, is lacking. Hence, the purpose of this study was to establish core competencies for HCPs and clinics providing gender-affirming care using patient perspectives.Patients who were 16 years or older and seeking gender-affirming care at tertiary care centers or communities in Canada, Denmark, the Netherlands or the United States 2018-2020 were included. Concept elicitation interviews were conducted, and the interviews were analyzed using content analysis approach.84 participants were included. Participant-elicited core competencies were described at the level of HCP and the clinic. Competencies pertaining to HCPs were categorized into 4 domains: generic traits (professionalism, nonjudgmental attitude, openness), cultural competency (awareness of TGD-specific health issues, trauma-informed care), patient-centered care (incorporating patient preferences, knowledge, and goals into treatment plans), and care organization and delivery (multi-disciplinary care). Competencies pertaining to clinics were categorized into 2 domains: generic traits (timeliness, efficiency, responsiveness) and gender-affirming care-specific cultural competency (culturally competent support staff, discrete check-in processes, non-assumptive forms).Patient-centered core competencies should be integrated into HCP trainings and clinic workflows and have the capability to improve the quality of care that TGD patients receive.