Hypoactive sexual desire disorder (HSDD) is a common condition among transgender women. However, to date, there are no specific guidelines for managing HSDD in transgender individuals. Clinically relevant publications on the management of HSDD (from 1985 to 2020) were searched in the PubMed and Medline databases, using the following terms: “sexual desire,” “sexual health,” “HSDD,” “transgender,” “gender affirmation treatment,” “sexual therapy,” “testosterone treatment,” “central nervous system active drugs,” and variants. Since sexual desire may be influenced by various factors, a comprehensive evaluation of HSDD should include biological, psychological, and social factors, in order to identify possible predisposing, precipitating, and maintaining factors. Among treatment options, transgender women may benefit from various sexual therapy strategies, and or central nervous system active drugs, such as flibanserin, bremelanotide, bupropion, and buspirone, and transdermal testosterone, bearing in mind that this option may be poorly accepted by patients due to the risk of virilizing effects (Cocchetti et al. Int J Impot Res 33:703–709, 2020).