Purpose <p>This study aimed to determine if clinicians who provide potential gonadotoxic medications refer pediatric patients differently for a fertility preservation (FP) consultation based on race, ethnicity, socioeconomic status, or preferred language of the patient.</p> Methods <p>This was a retrospective cohort study at a single tertiary care center. Patients assigned female at birth aged 5–21&#xa0;years who underwent treatments considered medium to high risk for gonadotoxicity from 2017 to 2022 were included. Patients were excluded if they were referred from outside institutions already undergoing treatment or if they had a diagnosis of hemophagocytic lymphohistiocytosis. The primary outcome in the study was the presence of a referral to the FP team for patients undergoing gonadotoxic therapy.</p> Results <p>The total cohort included 236 patients, 122 (51.6%) of whom were referred to the fertility preservation team. There was no significant difference in patients’ racial or ethnic backgrounds between referred and not referred. Those not referred were significantly younger (13.4 vs 16.3, <i>P</i> &lt; .001) and less likely to speak English (7.1% vs .8%, <i>P</i> = .013). Patients less than 10&#xa0;years of age made up 36.8% of those not referred, and only 1.6% of those referred. There was no difference in average Area Deprivation Index score between those referred and not (4.4 vs 5.0, <i>P</i> = .16), and referrals did not differ significantly between patients of low, medium, or high socioeconomic status (<i>P</i> = .28).</p> Conclusion <p>Only half of appropriate patients were referred for fertility preservation counseling, and non-English speakers were significantly less likely to be referred, demonstrating a substantial need to address underlying referral disparities.</p>