I would like to thank Drs Weiss and Green for the clarification that they have provided regarding the 2011 World Professional Association for Transgender Health guidelines. These guidelines continue to evolve as we clinicians continue to have experience caring for transgender patients. Although these guidelines are supposed to serve as a framework for providers caring for transpatients, I strongly recommend that clinicians follow the recommendations closely especially with regard to the surgical care of these patients. In regard to fertility preservation, I highly recommend that providers discuss patient needs and expectations before surgery, especially oophorectomy. Egg retrieval and cryopreservation are options before oophorectomy, and a comprehensive discussion should be had with patients about the advantages and disadvantages of oophorectomy at the time of hysterectomy vs a staged procedure. I recommend referral to a reproductive endocrinology specialist for adequate counseling about fertility options before hysterectomy with or without oophorectomy.