As the number of solid organ transplant recipients increases in prevalence, so too will the number who identify as transgender. Transgender refers to those whose gender identity is different than the gender or sex they are assigned at birth. Transgender care in the general population may include hormonal and surgical treatment. In the solid organ transplant recipient, hormone therapy can be administered but requires an assessment of potential drug interactions with transplant-related medications as well as other potential medical risks. Surgical therapy involves decision-making between surgeons experienced in gender-affirming surgery and the transplant team, as proximity to the graft may affect surgical options. Laboratory reference intervals in transgender patients remain an area of study.