Increasing numbers of transgender individuals are presenting for gender-affirming medical care. For trans women, gender-affirming hormone therapy (GAHT) promotes feminization but also inhibits spermatogenesis. In this presentation, I will present data that challenges two common assumptions in relation to the reproductive health of trans women. Firstly, there has been a widespread belief that trans adolescents are not interested in undertaking sperm cryopreservation for future reproductive purposes. However, we observed that – when given the opportunity – a majority of trans adolescents attempt to freeze their sperm prior to undertaking hormonal therapy, which indicates the importance of offering fertility preservation. Secondly, there is a common assumption that the inhibition of spermatogenesis that occurs secondary to GAHT is permanent, resulting in life-long infertility. However, in a recent longitudinal study, we observed the recovery of viable spermatozoa in nine trans women who stopped GAHT for reproductive purposes. In this way, these preliminary findings suggest that the negative impact of GAHT on spermatogenesis can be reversed, casting doubt on previous claims that GAHT in trans women inevitably leads to permanent infertility.