The 3rd International Workshop on Klinefelter Syndrome, Trisomy X, 47, and XYY syndrome was held in Leiden, the Netherlands, on September 12-14, 2022. Here, we review new data presented at the workshop and discuss scientific and clinical trajectories. We focus on shortcomings in knowledge and therefore point out future areas for research. We focus on the genetics and genomics of supernumerary sex chromosome syndromes with new data being presented. Most knowledge center specifically on Klinefelter syndrome, where aspects on testosterone deficiency and the relation to bone, muscle and fat was discussed, as was infertility and the treatment thereof. Both Trisomy X, 47 and XYY syndrome are frequently affected by infertility. Transitioning of males with Klinefelter syndrome was addressed, as this seemingly simple process is in practice often difficult. It is now realized that neurocognitive changes are pervasive in all supernumerary sex chromosome syndromes, which was extensively discussed. New intervention projects were also described and exciting new data concerning this was presented. Advocacy organizations were present, describing the enormous burden carried by parents when having to explain their child’s specific syndrome to most professionals whenever in contact with health care and education systems. It was also pointed out that most countries do not have health care systems that diagnose patients with supernumerary sex chromosome syndromes, thus pinpointing a clear deficiency in the current genetic testing and care models. At the end of the workshop a roadmap towards the development of new international clinical care guidelines for Klinefelter syndrome was decided.