Transgender individuals and their partners may face unique challenges that other couples do not. These unique challenges merit investigation, understanding and consideration by systemic practitioners in order to provide a culturally attuned service for transgender clients. A systematic review of the literature into the experiences of couples in which one member is transgender identified 22 qualitative papers. A translation and synthesis of constructs from these papers utilising a meta-ethnographic approach generated a number of third order constructs organised into nine overarching themes. These themes included experiences of stigma and discrimination, issues of power, privilege, visibility and identity, and experiences of dissonance and dysphoria that required adjustments and negotiations on the personal and relationship levels. Implications for practice and avenues for future research are discussed.