Purpose of Review <p>Sexual and gender minority (SGM) youth report high rates of unprotected sexual behavior, and young sexual minority men (YSMM) and transgender women (YTW) bear a disproportionally high burden of HIV incidence. Available formulations of pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are highly effective in preventing HIV infection when taken as prescribed before or after an exposure, and yet PrEP utilization and retention remain low among SGM youth who could benefit. This article provides an overview of the available and under-development formulations of PrEP and nPEP and reviews the extant literature on barriers and facilitators to PrEP utilization and retention.</p> Recent Findings <p>Findings indicate that determinants at the structural, social/interpersonal, and individual levels influence PrEP utilization and retention among YSMM and YTW. At the structural level, challenges related to cost, insurance, and healthcare access impede PrEP utilization. At the social/interpersonal level, healthcare providers and parents act as key barriers or facilitators to utilization. At the individual level, lack of information about PrEP and low perceived need are critical barriers.</p> Summary <p>Strategies at multiple socioecological levels are needed to leverage facilitators and overcome barriers to expand PrEP utilization among SGM youth at risk for HIV and optimize PrEP implementation to reduce HIV incidence.</p>