The Northern Triangle countries, including El Salvador, Guatemala, and Honduras, are sources of a significant number of asylum seekers in the United States today. This article examines the underlying societal dynamics in these countries and considers the typical profile of transgender immigrant women seeking asylum in the U.S. on the legal grounds of having faced gender-based violence in their countries of origin. It analyzes the relevant international conventions as well as the social determinants of the health and mental health of transgender asylum seekers. It draws from 35 cases of transgender immigrant women subjected to child sexual abuse; sexual assault, including assault by police; and forced sex work; it reviews examples from the academic and gray literature, including a precedent-setting case heard before the Inter-American Court on Human Rights. It discusses the implications for social science professionals, including the role of experts of country conditions. It provides guidance for immigrant service providers and advocates, particularly the importance of gender-affirming policies and healthcare to this population deserving of protection.