Tsunade is the only known still-living member of the Senju clan; she is directly descended from the First Hokage, her grandfather Hashirama Senju--and is related to the Second Hokage, her granduncle Tobirama Senju. Along with Orochimaru and Jiraiya, Tsunade is one of the Legendary Sannin of Konoha.

Tsunade excels in medical ninjutsu and was referred to by Shikaku as the world's strongest and most beautiful kunoichi. Jiraiya also mentioned that Tsunade was the only ninja in the world who could spike a drink without a shinobi knowing it.