Purpose <p>To describe the transgender population attending our clinics, the treatments of choice, and their clinical outcomes. To evaluate whether gender-affirming hormone therapy (GAHT) with testosterone in transmen affected ovarian stimulation, and the embryological and clinical outcomes.</p> Method <p>Multicenter retrospective observational study analyzing transgender patients attending fertility clinics. We analyzed demographic, embryological, and clinical information regarding fertility preservation (FP) in transmen and transwomen, intrauterine insemination, intracytoplasmic sperm injection, third-party oocyte donation, and reception of oocytes from partner (ROPA) cycles among transmen or their partners. ROPA and oocyte-FP cycles were divided according to whether the patient was receiving testosterone therapy before stimulation (Tpos) or not (Tneg). We also described a preimplantation genetic testing for aneuploidies ROPA cycle undergone by a Tpos transman.</p> Results <p>Transgender individuals have increasingly undergone ART procedures over the years with a trend towards treatments in which transmen are biologically involved. Nonetheless, cycles analyzed were predominantly performed in their cis partners using sperm banks, with the choice depending on the partner’s age. Embryological and clinical outcomes were comparable to the general population. The sample size of transwomen seeking FP was limited, showing abnormal sperm parameters that may have been influenced by estrogen and antiandrogen therapy. Tpos or Tneg cycles did not significantly differ in the analyzed stimulation, embryological, or clinical parameters.</p> Conclusions <p>The preferred treatment may be influenced by the occurrence of GAHT or gender affirming surgery (GAS) and the desire for biological involvement. Testosterone therapy before ovarian stimulation does not seem to alter embryological or clinical outcomes.</p>