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The degree of legal recognition provided to transgender people varies widely throughout the world.

Many countries now legally recognise sex reassignments by permitting a change of legal gender on an individual's birth certificate.

0.8% (1.125) of 18- to 24-year-old university students who are birth-assigned males (whose sex/gender as indicated on their ID card is male) report that the ‘sex/gender I feel in my heart’ is female, while another 0.4% indicating that their perceived gender was ‘other’.

Among birth-assigned females, 2.9% () indicated they perceived their gender as male, while another 1.3% indicating ‘other’.

In September 2017, the Botswana High Court ruled that the refusal of the Registrar of National Registration to change a transgender man's gender marker was "unreasonable and violated his constitutional rights to dignity, privacy, freedom of expression, equal protection of the law, freedom from discrimination and freedom from inhumane and degrading treatment".

LGBT activists celebrated the ruling, describing it as a great victory.

Justice KS Radhakrishnan noted in his decision that, "Seldom, our society realizes or cares to realize the trauma, agony and pain which the members of Transgender community undergo, nor appreciates the innate feelings of the members of the Transgender community, especially of those whose mind and body disown their biological sex", adding: Non-recognition of the identity of Hijras/transgender persons denies them equal protection of law, thereby leaving them extremely vulnerable to harassment, violence and sexual assault in public spaces, at home and in jail, also by the police.

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In some countries, an explicit medical diagnosis of "transsexualism" is (at least formally) necessary.

In others, a diagnosis of "gender dysphoria", or simply the fact that one has established a non-conforming gender role, can be sufficient for some or all of the legal recognition available.

The DSM-V recognizes gender dysphoria as an official diagnosis.

Many transsexual people have permanent surgery to change their body, sexual reassignment surgery (SRS) or semi-permanently change their body by hormonal means, hormone replacement therapy (HRT).

In many countries, some of these modifications are required for legal recognition.

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