For the transgender individual whose misrepresentative outer appearance is at the root of his or her personal conflict, skin is a critical component of establishing self-harmony. Physical transformation often begins with hormonal intervention, which, if done early enough, can interfere with puberty and help guide natural contouring into the desired gender. Studies of hormone use in transgender individuals show potential skin-related side effects, with testosterone creating an oilier canvas, and estrogens leading to dryness and body hair loss. For example, a transgender man may in turn experience worsened acne, while, conversely, a transgender woman may develop eczema and itchiness. As for the face, invasive surgery is the most widely used technique to reshape one’s facial structure into its desired gender. Unfortunately, many individuals rely on non-professionals for their procedures, incurring devastating consequences ranging from nodules and swelling to infections. Exogenous hormones affect hair and sebum production, gender-confirming surgeries often require dermatologic pre- and postoperative interventions, and postoperative anatomy may show unique presentations of routine skin conditions. Given the complexities of the transitioning process, transgender individuals may face unique dermatologic needs in addition to routine care. Transgender individuals have to consider that their skin characteristics are definitely different from typical men’s and women’s.