The story of True Tears revolves around the protagonist Tetsuya Mizuno, a third year high school student whose role the player assumes, and his interactions with his schoolmates during the second half of his final year attending Mizuho Academy, in which the main part of the story takes place. Tetsuya meets Yuzuko Sanada, a heroine and a childhood friend whom he nicknamed Yuzu one day on his way to school. Yuzuko actually has a crush on Tetsuya. To her advantage, she is skilled at cooking and homemaking, but has a timid personality. He later also meets Rui Nakane at the pool after running errands for Asumi Akiyam, his cousin who is also the school nurse.Rui is the main heroine in the story, who holds vast knowledge, and is very affectionate towards animals to the extent where her aim is to become a veterinarian. Despite her love toward animals, she has a severe fear of touching cats due to a past incident. Not to be mistaken with P.A. Works anime True Tears. Both works share the same name but feature different story and characters.

A manga adaptation based on the visual novel illustrated by Japanese illustrator Kinusa Shimotsuki was serialized in the seinen manga magazine Comp Ace published by Kadokawa Shoten on November 26, 2007.

Takes place three years prior to the events in fortissimo//Akkord:Bsusvier and fortissimo EXA//Akkord:Bsusvier from Momiji Satomura's point of view.

From Half-Baked scans: Sequel to Enigma - Seikon. An anxious Tatsumi confronts Tsuzuki about his visit to Kokakurou. Tsuzuki attempts to reconcile things between them, but when guilt and self-loathing threaten his sanity again, Muraki appears with a shocking revelation. In the omake, Za Chienji - Sequel (The Change), Watari's cure may be even worse than the problem. Pairing: TatsumixTsuzuki, MurakixTsuzuki, Muraki/Tsuzuki/Tatsumi; appearances by Watari, Count, Hisoka. Spoilers: Kyoto arc - manga volumes 7-8, anime episodes 11-13

Pairing: Muraki x Tatsumi As secretary to Chief Konoe, Tatsumi has been secretly monitoring the Muraki family for many years. However, he had no idea he was being observed in turn.

Post-Kyoto arc, Tatsumi and Tsuzuki share a romantic Christmas Eve together. But Muraki has been brought back to life, and he intends to torment Tsuzuki all over again.

Tatsumi x Tsuzuki Muraki x Tsuzuki Tatsumi reveals his feelings for Tsuzuki, but Tsuzuki is haunted by his past. At Kokakurou, Muraki waits to claim his birthright. In the omake, Za Chienji (The Change), Watari's latest potion results in a crazy body swap.