Relationships in which one partner is transgender are disproportionately challenging compared to other LGBQ+ relationships (Gamarel et al., 2014; Pulice-Farrow et al., 2017). While research has yet to examine how transgender-cisgender couples experience emotional intimacy, it is theorized that this process may be critical for relationship health during gender transition. This study explored how transgender-cisgender couples experience emotional intimacy during their transition process. Symbolic interactionism was used to examine the questions: (1) How do perceptions of couple emotional intimacy influence how each partner assigns meaning to their experiences with transitioning? and (2) How do partners communicate about their emotional experiences during their transition process? Constructivist grounded theory was used to analyze individual interviews with 20 transgender and cisgender participants (ten couples) using group-level analysis. The process model that emerged from the data indicated that transgender and cisgender partners experienced emotional tensions internally and within their relationships as they created meaning from their experiences with transitioning. Tensions created pathways for partners to emotionally withdraw from or engage in communication about their experiences. Communication processes ebbed and flowed as partners created meaning for their relationship in transition. When couples engaged in communication, they created shared meaning about their experiences and strengthened emotional intimacy. Data revealed that these processes of building and sustaining emotional intimacy were interactional and iterative. Recommendations for research and clinical work with these couples are provided, in light of these findings.