Gender is a socially and culturally determined construct, which denotes a person’s perception of being a male, female, both, or neither. It lies on a spectrum from binary gender to gender queer. Transgender (TG) refers to the broad spectrum of individuals who identify with a gender different from their gender at birth. The distress caused by any incongruency between the assigned and perceived gender is known as gender dysphonia (GD) and is classified under mental and behavioural disorders in the International Classification of Diseases-10 and Diagnostic and Statistical Manual of Mental Disorders-5. Current population estimates of TG people range from 0.17 to 1,333 per 100,000. There are no general population studies for Sri Lanka (SL). Transsexuals face various forms of abuse, including sexual, physical and psychological abuse, most often due to transphobia. They have a high risk of engaging in transactional sex and hence a high risk of HIV infection. GD in adults is associated with an elevated prevalence of co morbid psychopathology, especially depression, anxiety disorders and sociality. Management of GD individuals needs a multi sectorial or multi element team approach. SL is making some progress in this direction, with the Ministry of Health having recently approved a Gender Recognition Certificate. However, all stakeholders should be involved in formulating management guidelines on transsexuality.