In Europe, 71 murders resulting in the death of transgendered persons were reported between 2008 and 2013, 20 of which perpetrated in Italy, the second highest rate in Europe after Turkey. We retrospectively analyzed the homicides of transgender people recorded at the Medicolegal Bureau in Milan from January 1993 to December 2012. First we considered the sociodemographic data of 20 victims and the circumstantial details of their deaths, then we examined the data related to the cause of death from the autopsy reports. Our data show that victims are mostly immigrants, biological males presenting with a feminine attire and with varying degrees of feminization. The large majority of the victims were sex workers from South America. As for murderers, they were unknown in 7 cases (35%); all the 13 murderers identified were males, aged between 17 and 63 (M age = 31 years). In 38% of the cases, the murderer was the victim’s current or former partner. For half of the homicides, it was possible to identify at least one primary indicator of lesbian, gay, bisexual, and transgender (LGBT) hate crime. Our findings call for the need to make explicit in Italian legislation that a crime perpetrated on the ground of sexual orientation and gender identity constitutes a hate crime.