Finding or creating a neutral environment in which to study the MTF population is impossible in today’s world because of the lack of social and societal neutrality. Little is actually known about their sexual orientation, specifi cally what happens as they become more comfortable with their transgender identity and as they decide and then perhaps go about transitioning from living in the social role of the male to living full-time or nearly full-time in the female role. Th e study presented here certainly has its shortcomings, but it is nevertheless one of the few available windows through which to examine the topic of sexual orientation in transgender people as they explored their options and made diffi cult decisions about how to integrate their core gender identity into their daily lives. It has been my privilege to have so many transgender people place their trust in me and share their lives and struggles with me, making it possible to document the information presented herein. I sincerely hope that I have represented them well and accurately.