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This qualitative exploratory study, investigates elementary-level school leaders’ knowledge of transgender youth and the practices they use to develop trans-inclusive schools. Schools are legally required to “…treat transgender students consistent with their gender identity…” (U.S. Department of Education, 2014, p. 25). However, despite the growing visibility of trans students, educational leaders seldom receive training related to transgender youth or the laws that protect them. The findings from this study offer new information about school leaders’ knowledge of transgender children and how that knowledge influences whether they develop supportive educational practices. Whereas medical and legal knowledge appear to positively influence principals’ support for transgender students, cognitive empathy alone is insufficient for developing practices that support educational equity for transgender students.