Transgender people, whose assigned gender at birth does not match their gender identity, face a grim reality in much of the Middle East and North Africa region, including daunting obstacles to legal gender recognition. To get a better sense of these obstacles, I reviewed existing legal frameworks and case law, and conducted interviews in Egypt, Lebanon, and Tunisia, talking to activists and experts as well as transgender people about their experiences. Building on existing research on violence and discrimination against transgender people in the region, this analysis summarizes what I found. Legal gender recognition for transgender people refers to the official recognition of their gender identity—the gender that they are most comfortable with expressing when given a choice—including their ability to change their name and gender marker on identification documents to reflect their gender identity. When denied legal recognition of their gender identity, transgender people are systemically marginalized, and their existence based on their gender identity is undermined. Egypt, Lebanon, and Tunisia lack clear avenues for transgender people to obtain legal gender recognition, increasing their vulnerability to abuses by security forces such as arbitrary arrests, and to systemic discrimination in healthcare, housing, and employment. Medical and judicial authorities in these countries arbitrarily restrict access to legal gender recognition based on misinformed perspectives that see transgender identities as pathological. In the absence of the necessary legal and regulatory frameworks to grant such recognition, judicial authorities in the three countries are tasked with reviewing individual gender recognition applications submitted by transgender people. Laden with obstacles, this process is protracted (it can take from three to ten years), expensive, and inaccessible to most transgender people. Due to the absence of legislative frameworks for granting legal gender recognition, it is up to individual judges in each country to make decisions based on their interpretation of the law. Judicial authorities often require transgender applicants to have completed all surgical and hormonal interventions before reviewing their cases. The judicial forensic medical authorities are often tasked with examining transgender applicants to ensure they meet this requirement. Transgender people face significant obstacles to receiving gender-affirming healthcare in the three countries. Although none of the three countries criminalize transgender identity, security forces often conflate it with sexual orientation, perceiving transgender women as gay men and transgender men as lesbian women, who are prosecuted under various laws. The discrepancy between transgender people’s official documents and gender expression makes them vulnerable to police abuse, including harassment and arbitrary arrests. Transgender detainees in Egypt and Lebanon are often placed in cells that do not reflect their gender identity, or in solitary confinement for lack of alternatives. Transgender people in such facilities endure ill-treatment that can amount to torture, such as forced anal examinations, a discredited practice to “prove” same-sex activity. The separate sections below on Egypt, Lebanon, and Tunisia summarize obstacles to legal gender recognition in each country, drawing on review of laws and legal cases, three fatwas (religious rulings) on legal gender recognition, and interviews conducted in 2021 with transgender people, activists, and legal experts. I interviewed 16 transgender people: five from Egypt, six from Lebanon, and five from Tunisia–four of whom are activists. I also interviewed two legal experts from Egypt, a lawyer from Lebanon, and a lawyer from Tunisia. I analyzed four judicial cases from Egypt, two from Tunisia, and two from Lebanon, as well as three fatwas (religious rulings) on legal gender recognition. I refer to some of those interviewed by pseudonyms for their protection. All the quotes included below are from my interviews. The individual accounts and comments do not purport to be representative of all transgender people in the three countries, but are offered as illustrations of common issues transgender people face, and are consistent with what has been reported elsewhere.