Transgender adolescents are increasingly seeking hormonal intervention to achieve a body consistent with their gender identity. These treatments include gonadotropin-releasing hormone agonists (GnRHa) to suppress puberty and the genderaffirming hormones testosterone and estrogen. Given that these interventions affect reproductive function, current treatment guidelines recommend prior fertility counseling and access to fertility preservation (FP). 1 However, despite a previous report that 36% of transgender adolescents want biological children in the future, 2 3 recent North American studies 3-5 identified that less than 5% of transgender adolescents accessed FP. Whether these low rates reflect service barriers (eg, cost and availability), unwillingness to delay hormonal treatment for FP, and/or an intrinsic lack of desire for FP is unclear.We performed a retrospective review to examine FP use among transgender adolescents receiving hormonal intervention at our pediatric gender service in Australia. We hypothesized that the nature of our clinic, which is publicly funded and located alongside a pediatric oncofertility center, might reduce barriers and increase FP uptake.