Family creation can be an important part of transsexual, transgender, or gender nonconforming (TGNC) people’s lives. The implications for fully informed consent leading to gender confirming medical interventions are significant as some interventions will impact an individual’s ability to procreate. In some cases, adolescents who initiate puberty suppression may be foreclosing on their ability to provide genetic material to create a family. TGNC people are making decisions to create families in increasing numbers. This article addresses options that are relevant to TGNC people with a range of gender identities and expressions to assist TGNC people to make informed choices about the important life domain of family creation. This article focuses primarily upon reproductive options, including assistive reproductive technologies (ART) for family creation in addition to options of fostering or adopting and chestfeeding for TGNC people. The article also addresses working with TGNC clients who are unable to access family creation options. This article does not address how to parent TGNC children.