While transgender and gender-diverse individuals desire parenthood at similar rates as cisgender people, research suggests that many do not receive adequate fertility counseling. Because some medical and surgical gender-affirming therapies may affect the ability to reproduce, comprehensive fertility counseling before the initiation of such therapies is critical to the care of gender-diverse patients. Community physicians can inform transgender, gender-diverse, and nonbinary patients about their fertility preservation options, including sperm, egg, or embryo freezing. When ready to start a family, transgender and gender-diverse patients may choose from a wide spectrum of fertility treatments, including insemination, in vitro fertilization, and third-party reproduction with a gestational carrier, donor sperm, or donor eggs. Health care providers can improve fertility care for transgender and gender-diverse people by becoming familiar with their reproductive health; inquiring about their gender identity, pronouns, and preferred terms for body parts, and revising clinic forms to include that information; and understanding the potential barriers to care these individuals face, including the cost of care, the risk of elevated dysphoria, limited access to fertility centres in rural communities, and the fear and lived experience of discrimination. [ABSTRACT FROM AUTHOR]