Various wastewater treatment technologies are available today and biological processes are predominantly used in these technologies. Increasing wastewater treatment systems produces large amounts of sewage sludge with variable quantities and qualities, which must be properly managed. Anaerobic and aerobic digestion and composting are major strategies to treat this sludge. The main indicators of biological stabilization are volatile fatty acids (VFAs), volatile solids (VS), the carbon/nitrogen (C/N) ratio, humic substances (HS), the total organic carbon (TOC), the carbon dioxide (CO2) evolution rate, the specific oxygen uptake rate (SOUR), and the Dewar test; however, different criteria exist for the same indicators. Although there is no consensus for defining the stability of sewage sludge (biosolids) in the research and regulations reviewed, controlling the biological degradation, vector attraction, and odor determines the biological stabilization of sewage sludge. Because pollutants and pathogens are not completely removed in biological stabilization processes, further treatments to improve the quality of biosolids and to ensure their safe use should be explored.