This special issue of Sexual Health presents a collection of articles that addresses issues facing transgender individuals that are particularly challenging. Issues covered range from sexual health education in schools, the need for accurate epidemiological measurements, the perils of inaccurate diagnostic labels of transgender children, legal issues, the disproportionately high prevalence of HIV and sexually transmissible infections (STIs), and the role of primary care. We need to think critically, constructively and compassionately about transgender people. Particularly, we must look beyond the hype and objectively consider the evidence, without forgetting the people who are trying to cope with feelings that may be causing them great distress.