Hourou Musuko is, without a doubt, the most realistic anime I've ever watched. The story and most of the characters seem like something that could and would exist in real life. The art style is unique and picture-book-esque, but it somehow makes it more realistic. There is never a change in animation to accompany silly anime-style reaction faces. There are no characters jumping ten feet into the air with speed lines behind them, and no crazy sound effects. There is no fairy-tale happy ending. Even for a slice of life anime, this is rare.
Realism isn't everything, though. Despite what teenaged Call of Duty players might say, realism isn't the best thing, and it often isn't happy. Hourou Musuko may have a couple funny moments, and some episodes might leave you touched or inspired, but for the most part, any person watching it will be left with the bitter taste of the reality of gender roles and social status in their mouth. I don't know if a homophopic/anti-transgender person would enjoy this show, but if there's one thing they could watch that might make them sympathize, this would be it.
The opening theme is okay, but feels kind of cheesy. The ending theme is pretty bland, and I usually skipped it. I don't remember any of the background music, but I know it was there. To me this means that it was really subtle, and there weren't too many repeated tracks. I call that a plus. The music never obstructs or overtakes the scene.
Lining the anime was a emotionally moving coming-of-age story about love triangles and self-identity. There were several plot threads that were just left hanging loose, and the ending was highly unsatisfying. But for some reason, I couldn't help but feel it was important for the theme of the anime. Real life is filled with loose threads and disappointing endings. The story of gender dysphoria and the way society looks upon those who have it is a sad, yet-unfinished story. Would I like to see a follow up to this anime? Yes. Do I think it's necessary? No.
I don't think this anime is for everyone. This anime is for people who can watch something with a mature perspective. It is for people who don't need slapstick comedy, H, or buff action heroes in their anime. If I was watching this with somebody, and they were laughing and joking about it, I would turn it off. It deserves a different level of respect, and if a person is capable of giving that respect, then I definitly recommend it to them.