dotnet/coreclr#17732 added support for reflection-invoking methods that return unmanaged pointers by reference (so e.g. ref void* Do()), but methods that get them by-reference as their parameters are still pretty broken (so e.g. void Do(ref void* x)).

For example:

using System;
using System.Reflection;

unsafe class Program
{
    public static void InvokeMe(out int* pointer)
    {
        pointer = (int*)0x12345;
    }

    static void Main(string[] args)
    {
        typeof(Program).GetMethod(nameof(InvokeMe)).Invoke(null, new object[] { null });
    }
}

Will crash the runtime with an ExecutionEngineException.

(Note this behavior is on parity with the desktop CLR, so it has quite likely been this broken for 17 years.)