This special issue presents a collection of articles that addresses issues facing transgender individuals that are particularly challenging.

This review provides an update on the epidemiology and quasi-epidemiology of Gender Dysphoria or a self-reported transgender identity in children, adolescents, and adults. Recent studies suggest an increased prevalence of Gender Dysphoria in adults although it remains a relatively rare behavioural phenomenon. Using the broader descriptor of a transgender identity, however, suggests a much higher prevalence, perhaps due to the influence of increased society acceptance and affirmation of gender-variant identities.

This article reviews problems with the Safe Schools program in Australia which seeks to protect lesbian, bisexual, gay, transgender and intersex young people from bullying. The information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm because it promotes gender transitioning without expert medical advice. The great majority of children resolve gender dysphoria issues around the time of puberty.

WHO is revising its ICD diagnostic manual; the most widely used diagnostic manual worldwide. There is controversy over a proposal for a Gender incongruence of childhood diagnosis targeting young children identifying in a gender other than the one matching the sex they were assigned at birth. The author argues that the proposed diagnosis is unnecessary, potentially harmful, and at odds with WHO’s thinking in regard to other forms of diversity in young people, and that WHO should now abandon the proposal.

Transgender people face legal barriers that can affect their physical and mental health. Health care providers’ awareness of the complexities transgender people often grapple with may help providers better identify negative factors affecting their clients or patients and deliver appropriate and timely interventions.

A child’s anatomy does not always predict gender identity, however, children with gender variant behaviours experience intense pressure to conform to expectations based on assigned gender. Parent initial reactions of disorientation and overwhelm can develop through a process of acquiring information, acceptance, understanding and advocacy. Empowering parents through validation of their experiences, providing resources and strategies, while facilitating confidence and acceptance of their child’s needs, offers parents a solid foundation to support their child’s needs for gender identity integration.

For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.

Transgender people are vulnerable to HIV and STI through a range of intersecting psychosocial factors. As a consequence, transgender people bear a very high burden of HIV and STI, especially in resource- poor countries, although transgender men remain understudied everywhere. Health services can improve access to STI and HIV testing, care and prevention through developing transgender- friendly multidisciplinary services.

This systematic review focussed on HIV and STIs among transgender populations globally. The review underscored how more data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations.

HIV positive transgender women have poorer health outcomes than their cisgender counterparts. Resultsof this study confirm that transgender women are less likely to have suppressed HIV replication, a key indicator of HIV disease progression. Findings from the case-control analyses showed that social support predicts HIV-related health outcomes among transgender women over and above other common correlates of health disparities.