Personal thermal-moisture management (PTMM) provides a targeted approach to improving human comfort while reducing building energy consumption. However, its practical application remains limited by two major barriers. The theory-reality gap arises from the limited ability of current models to describe multiphysics coupling within dynamic human–clothing–environment systems. The materials-system gap reflects the difficulty of translating strong laboratory performance into wearable and durable functional garments. This review proposes a new three-tier classification framework based on energy use, including zero-energy passive systems, low-energy intelligent switching systems, and high-energy active driving systems. Using this framework, we summarize recent advances in smart textiles for PTMM and discuss their thermal-moisture performance, energy consumption, durability, practical limitations, and possible solutions. This review aims to address the main barriers in the field and support the translation of dynamic thermal-moisture management garments from laboratory research to everyday use.