We examined the role of gender-confirming treatment (GCT; i.e., hormonal treatment and genital surgery), psychological well-being, and body satisfaction in the sexual feelings and behaviors of transgender adults. A survey was conducted among a nonclinical sample of 325 male-to-female (MtF) and 251 female-to-male (FtM) Dutch adults (17-76 years, M = 41.87), divided into those with no GCT desire, those who desired (more) GCT, and those who completed GCT. Findings indicated that whereas GCT may positively affect sexual feelings, particularly in MtF persons, body satisfaction may play an even bigger role. Those without a GCT desire may experience particular difficulties in their sexual experiences.