The phenomenon of heterosexual men being aroused by gender variance and transgender dynamics or being aroused by male sexuality is often perplexing and uncomfortable, for both professionals and patients alike. This training will first offer basic education on gender variance, gender identity and transgender as well as the dynamic of men who have sex with men. This will include a cultural-historical context and the various contemporary terms and diagnostic classifications used to describe the spectrum of these dynamics. Focus will then shift specifically to the topic of heterosexual men who are sexually aroused by gender-variance and/or male-male sexuality. Based on clinical experience and qualitative research, theoretical understandings for this psychosexual arousal and expressed sexual behavior will be reviewed. Clinical implications aimed at helping professionals gain increased comfort and skill in addressing these complex issues will be presented. This will include a discussion of homophobic and transphobic assumptions commonly made by clinicians and related professionals.