Objectives Transgender people are a heterogeneous and growing population in visibility and numbers. They face documented difficulties in accessing health care systems, mainly based on the lack of training of professionals and discrimination. These barriers are particularly apparent in the field of reproductive health and are hampered by heteronormative and cisnormative public and legislative policies. These difficulties limit the ability of transgender people to reproduce and have a significant impact on transition journeys with consequences for psychological and social well-being. In addition, the multiplicity of legislative frameworks and practices increases the social and economic disparities that have already been identified as important determinants of transgender health and well-being. The purpose of this study is to report on field realities and strategies adopted by individuals to preserve their fertility. Methods We conducted a systematic review of activist literature from European organizations and French local associations. After analyzing the quality of the included documents, we conducted an exploratory qualitative analysis and modeling putting into dialogue the challenges at the French and European levels. Secondly, the results were analyzed by gender and experience of transition. Results The French system does not allow for adequate access to reproductive health, but associations have been able to put in place workaround strategies that remain insufficient in relation to needs. The disparity of legislative frameworks and practices at the European level contributes to both the slowing down of access and the development of complex and inappropriate strategies that increase population gaps. Conclusions The current organization of the health system traps transgender people in a paradox between dependence and lack of appropriate response. There is an urgent need to put in place adapted and human rights-based pathways, both in terms of practices and public policies and legislation. The expertise of the associations appears essential for their development.