Concern is widely being published that the occurrence of toxic cyanobacteria is increasing in consequence of climate change and eutrophication, substantially threatening human health. Here, we review evidence and pertinent publications to explore in which types of waterbodies climate change is likely to exacerbate cyanobacterial blooms; whether controlling blooms and toxin concentrations requires a balanced approach of reducing not only the concentrations of phosphorus (P) but also those of nitrogen (N); how trophic and climatic changes affect health risks caused by toxic cyanobacteria. We propose the following for further discussion: (i) Climate change is likely to promote blooms in some waterbodies—not in those with low concentrations of P or N stringently limiting biomass, and more so in shallow than in stratified waterbodies. Particularly in the latter, it can work both ways—rendering conditions for cyanobacterial proliferation more favourable or less favourable. (ii) While N emissions to the environment need to be reduced for a number of reasons, controlling blooms can definitely be successful by reducing only P, provided concentrations of P can be brought down to levels sufficiently low to stringently limit biomass. Not the N:P ratio, but the absolute concentration of the limiting nutrient determines the maximum possible biomass of phytoplankton and thus of cyanobacteria. The absolute concentrations of N or P show which of the two nutrients is currently limiting biomass. N can be the nutrient of choice to reduce if achieving sufficiently low concentrations has chances of success. (iii) Where trophic and climate change cause longer, stronger and more frequent blooms, they increase risks of exposure, and health risks depend on the amount by which concentrations exceed those of current WHO cyanotoxin guideline values for the respective exposure situation. Where trophic change reduces phytoplankton biomass in the epilimnion, thus increasing transparency, cyanobacterial species composition may shift to those that reside on benthic surfaces or in the metalimnion, changing risks of exposure. We conclude that studying how environmental changes affect the genotype composition of cyanobacterial populations is a relatively new and exciting research field, holding promises for understanding the biological function of the wide range of metabolites found in cyanobacteria, of which only a small fraction is toxic to humans. Overall, management needs case-by-case assessments focusing on the impacts of environmental change on the respective waterbody, rather than generalisations.