We aimed to determine the characteristics of people with learning disability who cross-dress or who have gender dysphoria. Using a retrospective review of anonymised data from clinical records about people referred to a specialist service. All 13 participants cross-dressed and 12 were biological males. Only one person was in a core transsexual group which may do better from sex reassignment surgery. There was a high level of mental health problems and high levels of reported childhood abuse. Three people were unhappy about their homosexual feelings, and two people had capacity issues. People with learning disabilities experience a wide range of gender identity issues similar to those seen in the non-learning disabled population. They would benefit from a more person centred understanding. People with learning disability may need longer assessments and more psychotherapeutic exploration and intervention prior to thinking about hormone and surgical interventions. Deciding treatment in someone's best interests for those lacking capacity presents complex ethical dilemmas.