Municipal wastewater treatment plants (WWTPs) are essential for protecting public health, however, their contribution to greenhouse gas (GHG) emissions has often been overlooked. Achieving carbon-neutral operation requires more than incremental improvements in energy efficiency; it calls for a rethinking of process design, energy flows, and resource recovery strategies. This review examines recent developments across several key pathways, including carbon capture through A-B configurations, energy recovery via anaerobic digestion, and low-carbon nitrogen removal based on autotrophic processes such as partial nitritation–anammox. Emerging technologies, such as microalgal and bioelectrochemical systems, are also reviewed, although their large-scale applicability remains uncertain. Particular attention is given to the trade-offs introduced by advanced treatment for micropollutant removal, which can significantly increase energy demand if not carefully integrated. Beyond individual technologies, the paper highlights the importance of system-level optimization, life-cycle assessment, and data-driven control strategies. A staged roadmap is proposed to distinguish near-term improvements from longer-term transitions. Rather than presenting a single solution, the review emphasizes that feasible pathways depend strongly on local conditions, including influent characteristics, climate, and energy mix.