International college students face psychosocial adjustment challenges transitioning into college, which may be heightened for international student-athletes (ISAs) who also have to adjust to Division I (DI) athletics. Even so, there are limited articles that synthesize the research on this population. Thus, we sought to fill this gap by examining studies focused on the adjustment experiences of ISAs. A qualitative interpretive meta-synthesis is a method used in social work research to synthesize the findings of qualitative studies (Aguirre & Bolton, 2014). We used qualitative interpretive meta-synthesis to conduct an exhaustive search of the literature, construct themes, and synthesize themes of qualitative research regarding ISAs and their adjustment experiences. We identified 11 articles with three overarching themes: (a) acculturative stress, (b) adjustment to the college experience, and (c) adjustment to athletics in the United States. Findings suggest ISAs experience not only transitional stress related to their identities as a student and as an athlete but also from their acculturation experiences. Thus, we propose ISAs transitioning to college experience a ternary-or three way-role negotiation of student identity, athlete identity, and cultural identity. Social workers employed at Division I institutions and within Division I athletic departments have the opportunity to advocate for the needs of this population.