diff --git a/fastmcp_slim/fastmcp/tools/base.py b/fastmcp_slim/fastmcp/tools/base.py
index 90f550555..614649481 100644
--- a/fastmcp_slim/fastmcp/tools/base.py
+++ b/fastmcp_slim/fastmcp/tools/base.py
@@ -62,8 +62,34 @@ logger = get_logger(__name__)
 ToolResultSerializerType: TypeAlias = Callable[[Any], str]
 
 
+def resolve_serialize_by_alias(value: Any) -> bool:
+    """Resolve the effective ``by_alias`` setting for serializing *value*.
+
+    Pydantic's low-level serialization helpers (``to_json``,
+    ``to_jsonable_python``) default ``by_alias`` to ``True``, which silently
+    ignores a model's ``serialize_by_alias`` config. When *value* is a Pydantic
+    model we consult that config instead, falling back to ``True`` to preserve
+    FastMCP's longstanding default of emitting aliases when no preference is
+    declared.
+    """
+    if isinstance(value, type):
+        model = value if issubclass(value, BaseModel) else None
+    elif isinstance(value, BaseModel):
+        model = type(value)
+    else:
+        model = None
+
+    if model is None:
+        return True
+
+    configured = model.model_config.get("serialize_by_alias")
+    return True if configured is None else configured
+
+
 def default_serializer(data: Any) -> str:
-    return pydantic_core.to_json(data, fallback=str).decode()
+    return pydantic_core.to_json(
+        data, fallback=str, by_alias=resolve_serialize_by_alias(data)
+    ).decode()
 
 
 class ToolResult(BaseModel):
@@ -110,7 +136,8 @@ class ToolResult(BaseModel):
 
             try:
                 structured_content = pydantic_core.to_jsonable_python(
-                    value=structured_content
+                    value=structured_content,
+                    by_alias=resolve_serialize_by_alias(structured_content),
                 )
             except pydantic_core.PydanticSerializationError as e:
                 logger.error(
@@ -321,7 +348,9 @@ class Tool(FastMCPComponent):
             return ToolResult(content=content)
 
         try:
-            structured = pydantic_core.to_jsonable_python(raw_value)
+            structured = pydantic_core.to_jsonable_python(
+                raw_value, by_alias=resolve_serialize_by_alias(raw_value)
+            )
         except (pydantic_core.PydanticSerializationError, UnicodeDecodeError):
             return ToolResult(content=content)
 
diff --git a/fastmcp_slim/fastmcp/tools/function_parsing.py b/fastmcp_slim/fastmcp/tools/function_parsing.py
index cc7b253a0..3024199fd 100644
--- a/fastmcp_slim/fastmcp/tools/function_parsing.py
+++ b/fastmcp_slim/fastmcp/tools/function_parsing.py
@@ -10,10 +10,10 @@ from dataclasses import dataclass
 from typing import Annotated, Any, Generic, Union, get_args, get_origin, get_type_hints
 
 import mcp.types
-from pydantic import PydanticSchemaGenerationError
+from pydantic import BaseModel, PydanticSchemaGenerationError
 from typing_extensions import TypeVar as TypeVarExt
 
-from fastmcp.tools.base import ToolResult
+from fastmcp.tools.base import ToolResult, resolve_serialize_by_alias
 from fastmcp.utilities.docstring_parsing import ParsedDocstring, parse_docstring
 from fastmcp.utilities.json_schema import compress_schema
 from fastmcp.utilities.logging import get_logger
@@ -56,6 +56,53 @@ def _contains_prefab_type(tp: Any) -> bool:
     return False
 
 
+def _unwrap_model(tp: Any) -> type[BaseModel] | None:
+    """Unwrap ``Annotated`` and return the underlying Pydantic model, if any."""
+    if get_origin(tp) is Annotated:
+        return _unwrap_model(get_args(tp)[0])
+    if isinstance(tp, type) and issubclass(tp, BaseModel):
+        return tp
+    return None
+
+
+def _resolve_output_by_alias(tp: Any) -> bool:
+    """Resolve ``by_alias`` for the output schema of return type *tp*.
+
+    Unwraps ``Annotated`` and ``Optional``/``Union`` wrappers to find the
+    underlying Pydantic model so the generated schema honors the model's
+    ``serialize_by_alias`` config — keeping it consistent with how the runtime
+    result is serialized. Containers (``list[Model]`` etc.) are not unwrapped:
+    their schema keeps the default, matching the runtime path which only
+    special-cases a directly-returned model.
+
+    Known limitation: a single schema is generated with one ``by_alias`` value,
+    while the runtime resolves the alias mode per returned value. They cannot
+    diverge for a plain single-model return, but a union return can produce more
+    than one runtime alias mode that no single schema can describe:
+
+    - distinct models with *conflicting* ``serialize_by_alias`` (e.g. ``A | B``
+      where ``A`` opts out but ``B`` opts in), and
+    - a model arm alongside a container arm (e.g. ``Model | list[Model]``):
+      a directly-returned model honors its config, but a returned ``list`` is
+      serialized with the default alias mode, so the two variants disagree.
+
+    Pydantic's schema generator does not consult per-model ``serialize_by_alias``
+    and the runtime does not recurse into containers, so honoring every variant
+    would require per-arm schema assembly. This is an accepted edge; single-model
+    returns and unions whose arms all resolve to the same mode are consistent.
+    """
+    origin = get_origin(tp)
+    if origin is Annotated:
+        return _resolve_output_by_alias(get_args(tp)[0])
+    if origin is Union or origin is types.UnionType:
+        for arg in get_args(tp):
+            model = _unwrap_model(arg)
+            if model is not None:
+                return resolve_serialize_by_alias(model)
+        return True
+    return resolve_serialize_by_alias(tp)
+
+
 T = TypeVarExt("T", default=Any)
 
 logger = get_logger(__name__)
@@ -282,8 +329,13 @@ class ParsedFunction:
             )
 
             try:
+                # Honor the model's serialize_by_alias config so the schema's
+                # field names match the serialized result (see base.py).
+                by_alias = _resolve_output_by_alias(clean_output_type)
                 type_adapter = get_cached_typeadapter(clean_output_type)
-                base_schema = type_adapter.json_schema(mode="serialization")
+                base_schema = type_adapter.json_schema(
+                    mode="serialization", by_alias=by_alias
+                )
 
                 # Generate schema for wrapped type if it's non-object
                 # because MCP requires that output schemas are objects
@@ -293,7 +345,9 @@ class ParsedFunction:
                     # Use the wrapped result schema directly
                     wrapped_type = _WrappedResult[clean_output_type]
                     wrapped_adapter = get_cached_typeadapter(wrapped_type)
-                    output_schema = wrapped_adapter.json_schema(mode="serialization")
+                    output_schema = wrapped_adapter.json_schema(
+                        mode="serialization", by_alias=by_alias
+                    )
                     output_schema["x-fastmcp-wrap-result"] = True
                 else:
                     output_schema = base_schema
diff --git a/fastmcp_slim/fastmcp/tools/tool_transform.py b/fastmcp_slim/fastmcp/tools/tool_transform.py
index e7e0cea06..3d6697fc5 100644
--- a/fastmcp_slim/fastmcp/tools/tool_transform.py
+++ b/fastmcp_slim/fastmcp/tools/tool_transform.py
@@ -17,7 +17,12 @@ from pydantic.json_schema import SkipJsonSchema
 
 import fastmcp
 from fastmcp.exceptions import FastMCPDeprecationWarning
-from fastmcp.tools.base import Tool, ToolResult, _convert_to_content
+from fastmcp.tools.base import (
+    Tool,
+    ToolResult,
+    _convert_to_content,
+    resolve_serialize_by_alias,
+)
 from fastmcp.tools.function_parsing import ParsedFunction
 from fastmcp.utilities.async_utils import (
     call_sync_fn_in_threadpool,
@@ -346,15 +351,23 @@ class TransformedTool(Tool):
             # First handle structured content based on output schema, if any
             if self.output_schema is not None:
                 if self.output_schema.get("x-fastmcp-wrap-result"):
-                    # Schema says wrap - always wrap in result key
-                    structured_output = {"result": result}
+                    # Schema says wrap - serialize the inner result first (so its
+                    # serialize_by_alias config is honored) before nesting, since
+                    # wrapping in a dict would otherwise mask the model's config.
+                    structured_output = {
+                        "result": pydantic_core.to_jsonable_python(
+                            result, by_alias=resolve_serialize_by_alias(result)
+                        )
+                    }
                 else:
                     structured_output = result
             # If no output schema, try to serialize the result. If it is a dict, use
             # it as structured content. If it is not a dict, ignore it.
             if structured_output is None:
                 try:
-                    structured_output = pydantic_core.to_jsonable_python(result)
+                    structured_output = pydantic_core.to_jsonable_python(
+                        result, by_alias=resolve_serialize_by_alias(result)
+                    )
                     if not isinstance(structured_output, dict):
                         structured_output = None
                 except Exception:
diff --git a/tests/tools/tool/test_results.py b/tests/tools/tool/test_results.py
index 263ca6c65..fc3668273 100644
--- a/tests/tools/tool/test_results.py
+++ b/tests/tools/tool/test_results.py
@@ -1,9 +1,12 @@
+import json
 from dataclasses import dataclass
-from typing import Any
+from typing import Annotated, Any
 
 import pytest
 from mcp.types import CallToolResult, TextContent
+from pydantic import BaseModel, ConfigDict, Field
 
+from fastmcp import Client, FastMCP
 from fastmcp.tools.base import Tool, ToolResult
 
 
@@ -233,3 +236,160 @@ class TestSerializationAlias:
                 component_data = result.structured_content
             assert component_data["componentId"] == "test123"
             assert "id" not in component_data
+
+
+class TestSerializeByAlias:
+    """Tests that a model's serialize_by_alias config is honored at runtime.
+
+    pydantic_core's serialization helpers default by_alias to True, which
+    silently ignores serialize_by_alias=False. The serialized result and the
+    generated output schema must both reflect the model's configured behavior.
+    """
+
+    async def test_serialize_by_alias_false_uses_field_names(self):
+        """serialize_by_alias=False emits field names in schema, structured, and text."""
+
+        class Biofile(BaseModel):
+            model_config = ConfigDict(serialize_by_alias=False)
+            id: str = Field(alias="_id")
+            filepath: str
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_biofile() -> Annotated[Biofile, Field(description="data")]:
+            return Biofile(_id="123", filepath="/p")
+
+        async with Client(mcp) as client:
+            tools = {t.name: t for t in await client.list_tools()}
+            result = await client.call_tool("get_biofile", {})
+
+        assert result.structured_content == {"id": "123", "filepath": "/p"}
+        assert json.loads(result.content[0].text) == {  # type: ignore[union-attr]
+            "id": "123",
+            "filepath": "/p",
+        }
+        assert set(tools["get_biofile"].outputSchema["properties"]) == {  # type: ignore[index]
+            "id",
+            "filepath",
+        }
+
+    async def test_unset_config_preserves_alias_default(self):
+        """A model with an alias but no serialize config keeps emitting the alias."""
+
+        class Biofile(BaseModel):
+            id: str = Field(alias="_id")
+            filepath: str
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_biofile() -> Biofile:
+            return Biofile(_id="123", filepath="/p")
+
+        async with Client(mcp) as client:
+            tools = {t.name: t for t in await client.list_tools()}
+            result = await client.call_tool("get_biofile", {})
+
+        assert result.structured_content == {"_id": "123", "filepath": "/p"}
+        assert set(tools["get_biofile"].outputSchema["properties"]) == {  # type: ignore[index]
+            "_id",
+            "filepath",
+        }
+
+    async def test_serialize_by_alias_true_uses_alias(self):
+        """serialize_by_alias=True emits aliases, same as the default."""
+
+        class Biofile(BaseModel):
+            model_config = ConfigDict(serialize_by_alias=True)
+            id: str = Field(alias="_id")
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_biofile() -> Biofile:
+            return Biofile(_id="123")
+
+        async with Client(mcp) as client:
+            tools = {t.name: t for t in await client.list_tools()}
+            result = await client.call_tool("get_biofile", {})
+
+        assert result.structured_content == {"_id": "123"}
+        assert set(tools["get_biofile"].outputSchema["properties"]) == {"_id"}  # type: ignore[index]
+
+    async def test_nested_models_respect_config(self):
+        """serialize_by_alias=False propagates through nested models."""
+
+        class Inner(BaseModel):
+            model_config = ConfigDict(serialize_by_alias=False)
+            inner_id: str = Field(alias="_iid")
+
+        class Outer(BaseModel):
+            model_config = ConfigDict(serialize_by_alias=False)
+            id: str = Field(alias="_id")
+            inner: Inner
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_outer() -> Outer:
+            return Outer(_id="1", inner=Inner(_iid="2"))
+
+        async with Client(mcp) as client:
+            result = await client.call_tool("get_outer", {})
+
+        assert result.structured_content == {"id": "1", "inner": {"inner_id": "2"}}
+
+    async def test_annotated_optional_return_stays_consistent(self):
+        """Annotated[Model, ...] | None resolves the model inside the union arm.
+
+        Regression: the union arm is a typing.Annotated object, so a naive
+        isinstance check skipped the model and the schema fell back to aliases
+        while the runtime serialized field names, breaking client validation.
+        """
+
+        class Biofile(BaseModel):
+            model_config = ConfigDict(serialize_by_alias=False)
+            id: str = Field(alias="_id")
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_biofile() -> Annotated[Biofile, Field(description="x")] | None:
+            return Biofile(_id="1")
+
+        async with Client(mcp) as client:
+            tools = {t.name: t for t in await client.list_tools()}
+            # client-side validation of structured content against the schema
+            # raises if they disagree
+            result = await client.call_tool("get_biofile", {})
+
+        schema_props = set(tools["get_biofile"].outputSchema["properties"])  # type: ignore[index]
+        assert schema_props == set(result.structured_content)  # type: ignore[arg-type]
+        assert result.structured_content == {"result": {"id": "1"}}
+
+    @pytest.mark.parametrize("serialize_by_alias", [True, False, None])
+    async def test_schema_and_structured_content_agree(self, serialize_by_alias):
+        """The output schema field names always match the structured content keys."""
+        if serialize_by_alias is None:
+            config = ConfigDict()
+        else:
+            config = ConfigDict(serialize_by_alias=serialize_by_alias)
+
+        class Model(BaseModel):
+            model_config = config
+            id: str = Field(alias="_id")
+            name: str
+
+        mcp = FastMCP()
+
+        @mcp.tool
+        def get_model() -> Model:
+            return Model(_id="1", name="x")
+
+        async with Client(mcp) as client:
+            tools = {t.name: t for t in await client.list_tools()}
+            result = await client.call_tool("get_model", {})
+
+        schema_props = set(tools["get_model"].outputSchema["properties"])  # type: ignore[index]
+        assert schema_props == set(result.structured_content)  # type: ignore[arg-type]
diff --git a/tests/tools/tool_transform/test_tool_transform.py b/tests/tools/tool_transform/test_tool_transform.py
index 2e0b7e975..c7a6b88ea 100644
--- a/tests/tools/tool_transform/test_tool_transform.py
+++ b/tests/tools/tool_transform/test_tool_transform.py
@@ -658,6 +658,53 @@ async def test_from_tool_decorated_function_via_client():
         assert "Result 0 for hello" in result.content[0].text
 
 
+async def test_transform_fn_result_respects_serialize_by_alias():
+    """A model returned by a transform_fn honors serialize_by_alias when no schema."""
+    from pydantic import ConfigDict
+
+    class Item(BaseModel):
+        model_config = ConfigDict(serialize_by_alias=False)
+        id: str = Field(alias="_id")
+
+    def base() -> None:
+        pass
+
+    async def transform() -> Any:
+        return Item(_id="42")
+
+    transformed = Tool.from_tool(base, transform_fn=transform, output_schema=None)
+    result = await transformed.run({})
+
+    assert result.structured_content == {"id": "42"}
+
+
+async def test_transform_fn_wrapped_result_respects_serialize_by_alias():
+    """A wrapped transform result serializes the inner model before nesting.
+
+    Optional model returns get a wrap-result schema; the inner model must be
+    serialized with its own config before being placed under "result", or the
+    wrapped dict masks the config and the data no longer matches the schema.
+    """
+    from pydantic import ConfigDict
+
+    class Item(BaseModel):
+        model_config = ConfigDict(serialize_by_alias=False)
+        id: str = Field(alias="_id")
+
+    def base() -> None:
+        pass
+
+    async def transform() -> Item | None:
+        return Item(_id="42")
+
+    transformed = Tool.from_tool(base, transform_fn=transform)
+    assert transformed.output_schema is not None
+    assert transformed.output_schema.get("x-fastmcp-wrap-result")
+    result = await transformed.run({})
+
+    assert result.structured_content == {"result": {"id": "42"}}
+
+
 class TestProxy:
     @pytest.fixture
     def mcp_server(self) -> FastMCP: