High strength β titanium alloys are widely used in large load bearing components in the aerospace field. At present, large parts are generally formed by die forging. Different initial microstructures and deformation process parameters will significantly affect the flow behavior. To precisely control the microstructures, researchers have conducted many studies to analyze the microstructure evolution law and deformation mechanism during hot compression. This review focuses on the microstructure evolution of high strength β titanium alloys during hot deformation, including dynamic recrystallization and dynamic recovery in the single-phase region and the dynamic evolution of the α phase in the two-phase region. Furthermore, the optimal hot processing regions, instability regions, and the relationship between the efficiency of power dissipation and the deformation mechanism in the hot processing map are summarized. Finally, the problems and development direction of using hot processing maps to optimize process parameters are also emphasized.