Purpose of Review <p>It is widely accepted that maternal genes and the in-utero environment can impact offspring’s health. While fathers have long been considered mere conduits of genetic information, emerging evidence suggests that the paternal preconception environment can also affect offspring’s health. This review delves into the biological mechanisms, beyond DNA inheritance, by which paternal preconception exogenous exposures can shape offspring outcomes, and factors that influence these mechanisms. We also discuss practical and methodological hurdles in epidemiological studies of male lineage inheritance.</p> Recent Findings <p>A wide range of paternal exposures, from environmental pollutants to diet and lifestyle factors, have been linked with offspring’s health. Several biological mechanisms, including epigenetic modifications in sperm, alterations in seminal fluid microbiome, and changes in the chemical composition of semen, may mediate these effects. Currently, most data come from animal models. Human research is hindered by difficulties in establishing and maintaining cohorts, accurately assessing paternal exposures, untangling the complex interactions among epigenetic mechanisms, and defining relevant exposure windows.</p> Summary <p>Fathers play a more significant role in shaping their children's health than previously thought. By unraveling the complex mechanisms underlying paternal environmental and genetic influence, we can potentially unlock new opportunities for transgenerational disease prevention and health promotion. The knowledge gained can empower the design of precision environmental health interventions that benefit future generations.</p>