Introduction: Increasing body dysmorphic symptoms and health anxiety and decreasing autonomic functioning are very important problems of transgender people. Therefore, the purpose of this study was to investigate the effectiveness of reality therapy training on the body dysmorphic symptoms, health anxiety and autonomous functioning in transgender people.
Methods: This study was a semi-experimental research method with a pretest-posttest design with a 2-month follow-up and a control group. All transgender people who lived in Tehran in the second half of 2024 constituted the statistical population of this study. Using the snowball sampling method, 30 of these people were selected and randomly assigned to the experimental group (15 people) and the control group (15 people). On the experimental group, a 7-session reality therapy training package based on choice theory book was implemented (Each session was 90 minutes). The subjects answered body dysmorphic concern questionnaire (Oosthuizen & et al. 1998), health anxiety questionnaire (Salkovskis & et al. 2002) and autonomic functioning questionnaire (Weinstein & et al. 2012). Data were analyzed using mixed analysis of variance and Bonferroni post hoc test in SPSS version 22.
Results: The results showed that there is a significant difference between the two experimental and control groups in the reduction of body dysmorphic symptoms (F=(2,27)=39/417, P<0/001) and health anxiety (F=(2,27)=5/931, P<0/001) and the increase of autonomous functioning (F=(2,27)=18/323, P<0/001) from the pre-test stage to the follow-up stage. 
Conclusion: Overall, it can be concluded that psychologists and psychiatrists can use reality therapy to reduce symptoms of body dysmorphic disorder and health anxiety and enhance the autonomous functioning of transgender individuals.