In recent years, the fertility and parenthood of transgender men have emerged as significant medical and societal subjects. Since the 2016 french legal reform, transgender men have been able to retain their reproductive organs, opening the door to discussions regarding their fertility and pathways to parenthood. To evaluate the medical, legal, and ethical issues associated with the fertility of transgender men in France, we have analysed three scenarios adapted from real clinical cases and contrasted them with the existing literature: a termination of pregnancy (abortion), a medical termination of pregnancy (TOP), and a continued pregnancy. These cases illustrate the specific challenges encountered in practice: lack of awareness regarding reproductive risks, legal hurdles in accessing abortion and medical termination of pregnancy, the impact of bodily dysphoria during pregnancy, issues surrounding legal parentage, and the still-limited utilization of oocyte cryopreservation. The literature confirms that testosterone does not constitute a reliable method of contraception and that parenthood for transgender men remains hindered by medical, social, and legal barriers. The management of fertility in transgender men must be multidisciplinary, inclusive, and tailored to legislative developments in order to meet growing needs in contraception, oocyte preservation, and parenthood.