AIMS: To describe and synthesise qualitative studies exploring sexual and gender minority migrants' experiences of health service access and utilisation. DESIGN: Systematic meta-synthesis of qualitative studies. DATA SOURCES: Systematic searches in four databases and citation screening were conducted in 2023 and 2024. English-language empirical qualitative studies published in scientific journals within 10 years were included. Of 1109 screened, 21 reports were included. METHODS: Included reports were appraised using CASP and JBI checklists. Extracted results were analysed with inductive content analysis in a collaborative process. RESULTS: All reports had acceptable quality, including 365 participants from 72 countries. A range of external and internal barriers to accessing health services were reported, including financial constraints and fears. Although migrants expressed an appreciation of health services, they also experienced non-affirming behaviours and discrimination related to their intersecting identities. Several essential components in health services necessary to cater to the needs of migrants were addressed, including the personality and manner of health professionals as well as adherence to confidentiality. CONCLUSION: Barriers to health services, intersectional discrimination and non-affirming behaviours when interacting with health services are pressing issues that need further attention. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Ensuring safety through affirming support is key to achieving high-quality and accessible health services for sexual and gender minority migrants. Nurses and other health professionals need to carefully consider intersectional layers related to sensitivity and safety when supporting sexual and gender minority migrants. Open, friendly, validating, respectful and encouraging communication is essential in clinical settings. IMPACT: This review addressed experiences of health services amongst a marginalised population. The findings highlight the importance of affirming care and are relevant for health professionals, stakeholders and decision-makers. REPORTING METHOD: ENTREQ. PATIENT OR PUBLIC CONTRIBUTION: Two persons with lived experience were involved in the meta-synthesis.