Measuring patient satisfaction (i.e., patients' subjective evaluation of health care services received) is increasingly important in assessing health care outcomes because of the current emphasis on greater partnership between providers (therapist, doctor, staff) and consumers (patients) in health care. In care of transgender persons, achieving good patient satisfaction is particularly challenging given the primary role mental health professionals play as arbiters of who has access to sex reassignment and when such candidates are ready. Dependence on a mental health professional in this "gate- keeping" role is perceived by some members of the transgender community as unnecessarily pathologizing. This study compared satisfaction ratings of 180 transgender and 837 other sexual health patients with psychotherapeutic, psychiatric and sexual medicine services provided at a university-based sexual health clinic. Five consecutive surveys conducted during 1993-2002 showed high patient satisfaction. We found few significant differences between transgender and other sexual health patients, except that in 1995, transgender patients had higher satisfaction on their perceived ability to handle the problems that originally had led them to therapy. Survey results helped target areas in need of improvement (e.g., friendliness and courtesy of staff, handling of phone calls), and efforts resulted in significant increases in patient satisfaction. These findings put individual complaints in perspective and showed that despite the challenges inherent in providing transgender care good satisfaction can be achieved. We encourage providers to implement quality assurance and improvement procedures to give patients the opportunity to provide feedback and have a voice in shaping their own health care.