Trans-inclusive fertility preservation in the UK: evidence-based clinical guidance, the TransFertility service model and the case for a national pathway.

Transgender and gender-diverse (TGD) individuals face significant barriers to fertility preservation, yet existing guidance from ESHRE, ASRM, WPATH, and the Endocrine Society remains too general for translation into implementation-ready national pathways. This review synthesizes evidence on the reproductive effects of gender-affirming hormone therapy, clinical outcomes of fertility preservation in TGD populations, the intersection of neurodiversity and gender diversity, and the structural, interpersonal, and intrapersonal barriers to equitable reproductive care-translating this evidence into a trans-inclusive clinical pathway. We present TransFertility, a dysphoria-informed service model developed at Guy's and St Thomas' NHS Foundation Trust, London. Over 39 months, the model achieved a greater than 19-fold increase in referrals, 100% consultation attendance, over 90% treatment initiation, and 96.7% treatment completion, with no serious adverse events. The absence of a UK national pathway for trans-inclusive fertility preservation represents a critical equity gap. We propose that the evidence synthesized here, together with TransFertility's outcomes, provides a robust foundation for national consensus guideline development. This work's principal contribution is demonstrating that dysphoria-informed care can move from theoretical framework to functioning clinical reality: a reproducible, multidisciplinary pathway showing that structural redesign of administrative, clinical, and psychosocial components improves access, engagement, and treatment completion for TGD individuals.