Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender identity.

Historically, clinicians labelled trans people as heterosexual or homosexual relative to their sex assigned at birth. Within the transgender community, sexual orientation terms based on gender identity are the most common, and these terms include lesbian, gay, bisexual, asexual, queer, and others.

According to a 2023 study based on United States (U.S.) data, transgender people are more likely to be a sexual minority than cisgender people are, including in "sexual orientation, behavior, and attraction". In terms of self-description, the most common were bisexual (18.9%), queer (18.1%), and straight (17.6%).

Also in the U.S., transgender respondents to one 2015 survey self-identified as queer (21%), pansexual (18%), gay, lesbian, or same-gender-loving (16%), straight (15%), bisexual (14%), and asexual (10%). A second study found 23% reported being gay, lesbian, or same-gender-loving, 25% bisexual, 4% asexual, 23% queer, 23% straight and 2% something else.

A 2015 survey of roughly 3,000 American trans women showed that at least 60% were attracted to women and 55% were attracted to men. Of the trans women respondents, 27% answered gay, lesbian, or same-gender-loving, 20% answered bisexual, 19% heterosexual, 16% pansexual, 6% answered asexual, 6% queer, and 6% did not answer.

Foerster reported a 15-year successful relationship between a woman and a trans man who transitioned in the late 1960s.

In the 20th century, trans men attracted to women struggled to demonstrate the existence and legitimacy of their identity. Many trans men attracted to women, such as jazz musician Billy Tipton, kept their trans status private until their deaths.

Until the mid-2010s, medical textbooks commonly suggested that most transgender men were straight. However, a 2015 survey of roughly 2000 American trans men showed more variation in sexual orientation or sexual identity among trans men. 23% identified as heterosexual or straight. The vast majority (65%) identified their sexual orientation or sexual identity as queer (24%), pansexual (17%), bisexual (12%), gay/same-gender loving (12%), asexual (7%), and 5% did not answer. Author Henry Rubin wrote that "[i]t took the substantial efforts of Lou Sullivan, a gay FTM activist who insisted that female-to-male transgender people could be attracted to men." Matt Kailey, author of Just Add Hormones: An Insider's Guide to the Transsexual Experience, recounts his transition "from 40-something straight woman to the gay man he'd always known himself to be." Researchers eventually acknowledged the existence of this phenomenon, and by the end of the 20th century, psychiatrist Ira Pauly wrote, "The statement that all female-to-male transgender are homosexual [Pauly means attracted to women] in their sexual preference can no longer be made."