Trillium stamineum

Threats specific to Twisted Trillium are poorly understood. Among related Trillium species in eastern North America, the overabundance of White-tailed Deer is the primary threat (Leege et al. 2010). Loss of natural predators, reduction in hunting pressure, and land-use changes causing increased carrying capacity have resulted in an increased White-tailed Deer population across much of eastern North America since the mid-20^th century (Russell et al. 2001). Herbivory of early season growth causes recruitment failure in the current year and often the following year in related Trillium species causing long-term demographic changes and ultimately population declines (Augustine and Frelich 1998). Further study is needed to determine the population trajectory for the species and the impact of White-tailed Deer overabundance on Twisted Trillium population. Related species are also negatively impacted by introduced Honeysuckle (Lonicera japonica) via indirect changes in forest composition (Leege et al. 2010). Chinese Privet (Ligustrum sinense) is thought be a more severe threat than other invasive competitors and is present in much of the species' range. The impact of logging operations and silviculture on Twisted Trillium is not currently known, but has caused declines in related species (Case and Case 2009). Feral hogs (Sus domesticus) are present within the species' range and may present a threat to some subpopulations.

Though not specifically protected in much of its range, the species occurs in several protected areas (IUCN and UNEP-WCMC 2019). Additional research is needed on the species’ life history, population, and population trend.