Background: The transition from paediatric to adult healthcare is a critical period for young individuals with endocrine conditions. Despite numerous published recommendations, Europe still lacks recent, comprehensive, evidence-based, and practically applicable guidelines for endocrine healthcare transition. Objective: The aim of the study was to develop European consensus guidance for transition from paediatric to adult care in endocrine conditions through a structured, evidence-based approach. Methods: A systematic literature review identified 351 recommendations from 55 articles (2011–2023). Articles were included if they provided recommendations on the transition from paediatric to adult care for patients with endocrine diseases or general (non-disease-specific) transition guidance. The guidance was developed by a core multidisciplinary group (n = 7) and refined through focus groups with 18 experts from 10 European countries, representing both paediatric and adult care settings. Patient representatives have reviewed and approved it. Results: The guidance includes recommendations across 11 domains: structure of transition service, patient empowerment, patient-professional relationship, multidisciplinary team organisation, healthcare provider education, timing and planning, care coordination, management of non-attendance, psychological support, parent/caregiver role, and readiness tools. Each recommendation was rated as either “recommend” (strong) or “suggest” (conditional) based on expert consensus and available evidence. Conclusion: This ESE-ESPE guidance provides a comprehensive, practical framework for endocrine healthcare transition, applicable across different European healthcare settings. The recommendations emphasise structured programs, care coordination, and patient-centred approaches to optimise transition outcomes.