Fatigue limit state design check for offshore wind turbines is based on SN curves and the Palmgren–Miner rule approach and focuses normally on stationary processes for which startup and/or shutdown operations induced transient load processes are normally not accounted for. However, large databases of real-time measurements show that the shutdown and startup operations may appear in any operational conditions and the frequency of such operations could be considerable. Although design standards require fatigue design checks for the transient load processes induced by startup and shutdown operations, relevant publications addressing this issue are very limited in particular for floating wind turbines. This paper focuses on analyzing the importance of startup and shutdown induced transient load processes on fatigue damage in the tower of two MW-level horizontal axis semi-submersible wind turbines. The analysis is carried on by comparing short-term fatigue damage in several environmental conditions with and without the startup and shutdown induced transient load processes. It is found that, in many environmental conditions, startup and/or shutdown operations may make an increase in short-term fatigue damage by 10% to 100%, while in some situations, the fatigue damage may be increased by up to 200%. The importance of the transient load processes on long-term fatigue damage is related to the occurrence frequency of startup and shutdown events. Publicly available data indicate that the average time between two consecutive shutdown events might be less than 39 h. However, more data and analysis are needed regarding these issues.