Agroforestry is an established practice along the east coast of Madagascar, but it is a recent development in the Central Highlands. This region faces land degradation, loss of tree cover and rapid population growth which limit agricultural productivity and the potential for reforestation. Agroforestry could be a sustainable approach to overcoming these problems. Here, we surveyed 802 smallholder farms in the regions of Analamanga, Vakinankaratra and Itasy to establish a typology of existing systems, and to assess the adoption factors and challenges of agroforestry adoption. 27% of farmers practiced agroforestry, with significant regional variation: 46% in Vakinankaratra, 21% in Itasy and 15% in Analamanga. Farmers identified three types of agroforestry based on the services provided by trees: wood energy, horticultural, and biomass agroforestry. Wood energy agroforestry, practiced by 56% of adopters, combines forest species with rainfed crops on the upper slopes. Horticultural agroforestry, practiced by 38% of adopters, integrated fruit with market garden crops at the bottom of slopes. Biomass agroforestry, practiced by 6% of adopters, consisted of hedges of leguminous shrubs planted around plot boundaries. Farmers who received project support and have a large family workforce are more inclined to adopt agroforestry, unlike those who own forests or crop monoculture. Household education level and origin influenced the choice of agroforestry type. Knowledge deficit is the main barrier of agroforestry adoption. If the challenges of its adoption are overcome, agroforestry in this region could provide a sustainable source of wood energy and generate income for households.