This contribution considers developments in the field of ‘twin studies’ in times of rapid changes in society, and technological and methodological advances. The classical twin design is of value to emerging and re-emerging phenotypes, including those from evolving omics technologies and offers advances for modeling causality, intergenerational transmission, gene-environment correlation and interaction. We summarize what we have learned about twinning and look at whether twins and twin studies are representative of the general population and cover global diversity. We provide an updated overview of twin concordance and discordance for major diseases and disorders, which convey a crucial message: the genetic code is not as deterministic as often believed. This has important implications for genetic risk prediction tools utilized by researchers and clinicians, as predictions can only go as far as the monozygotic twin concordance rates.