The aim of this review is to present an overview of the sex differentiation and sex determination processes in eels in relation to the urgent need to provide scientific knowledge to better protect and manage the Anguilla genus. Indeed, the global decline of the three main temperate eel stocks, Anguilla anguilla, Anguillidae (Fisheries Management and Ecology, 2003, 10, 365); Anguilla japonica, Anguillidae (Casselman, Eel Biology, Springer Japan, 2003, 293) and Anguilla rostrata, Anguillidae (Tatsukawa, Eel Biology, Springer, Japan, 2003, 255), raises concerns about the necessity to better understand all stages of the life cycle of eels (Righton and Walker, Journal of Fish Biology, 2013, 83, 754). Little is known about the mechanisms involved in the production of males and females in this species with environmental sex determination. Previous reviews identifying the density of individuals as the major factor influencing sex determination were undertaken (Krueger and Oliveira, Environmental Biology of Fishes, 1999, 55, 381; Reviews in Fish Biology and Fisheries, 2005, 15, 37). Here, we review the current advances on the subject, focusing on the roles of early growth rate and interindividual relationships, which are mechanisms underpinned by density, as well as the sex differentiation process, and we question how this knowledge might influence global conservation measures.