Reproductive health needs and parenthood aspirations remain insufficiently explored among individuals facing fertility-impacting conditions such as trans* populations. Traditional standardized measures often fail to capture the emotional, structural, and socio-legal barriers experienced by marginalized groups. Participatory Action Research (PAR) provides a community-based approach emphasizing collaboration and empowerment, ensuring that participants' voices directly inform scientific inquiry, clinical practice, and policy. This study aims to investigate reproductive health experiences across diverse gender identities and fertility-impacting conditions in Italy, with a focus on trans* participants. Objectives include identifying barriers and unmet needs, co-constructing new narratives on parenthood, and producing participant-driven recommendations to improve reproductive healthcare and policy. A PAR methodology was implemented in collaboration with Advisory Committee Members (ACM), composed of LGBTQ+ community leaders, health professionals, and organization workers. Participants aged 18-49 were recruited via social media, reproductive clinics, university networks, and LGBTQ+ associations. Data collection involved focus groups guided by semi-structured questions and collaborative activities. Sessions included three phases: (1) open-ended reflection on reproductive experiences, (2) co-construction of group concept maps to visualize decision-making factors, and (3) consensus-building to generate community-informed materials, including recommendations for healthcare professionals, educational resources, and advocacy tools. Data (transcripts, concept maps, artifacts, and researcher/ACM notes) were analyzed through inductive Thematic Analysis using NVivo. Findings provided in-depth qualitative insights capturing the individual complexity of navigating parenthood desire across diverse gender identities and fertility-impacting conditions. Moreover, structural and emotional barriers specific to trans* participants have been identified—such as medical gatekeeping, misgendering by providers, and lack of tailored reproductive information. PAR methodology fostered empowerment, enhancing participants' agency in reproductive decision-making and strengthening community connections. Results inform inclusive reproductive health services, psychological practices, and policies, promoting equitable access to parenthood for marginalized populations.