<p>During anthropological analysis of human skeletal remains, sex assessment is a key step in forensic identification of individuals. For transgender individuals, complications can arise during the estimation of biological sex, as physical characteristics may not correspond with the documented gender recorded at registration of the missing person with authorities. In this systematic review, we analyzed the current literature focusing on methods employed for state-of-the-art identification of skeletal remains of transgender and gender-diverse individuals in forensic anthropology, including the effects on the skeleton of gender-affirming hormone therapy and/or facial gender-affirmation surgery. Our findings support the need for additional studies using larger sample sizes and control groups involving different treatment regimens or longitudinal studies at different follow-up intervals. Furthermore, studies suggest that the impact of surgery involving the skull may provide identifying elements due either to the presence of surgical artifacts, traces of materials used for implants, or the possible incongruence with the pelvis in cases of sex estimation. Further studies are needed to investigate the impact of these anatomical aspects on outcomes related to forensic anthropology.</p>