This study examines how the farmer-to-farmer (F2F) extension approach is implemented by farmer trainers in Cameroon. Those farmers selected to lead F2F extension are often known by different names but in this study, we use the term “lead farmer” (LF) as a generic term even though different names sometimes imply different roles. A questionnaire was used to collect data from 160 randomly selected LFs in six regions in Cameroon in 2013. The study describes the activities of LFs and the support they receive, assesses their technical competence and identifies factors that motivate them, as well as the challenges they face in implementing the F2F approach. In Cameroon, about half of the LFs (52 percent) were between 41 and 55 years old. Most LFs (81 percent) were married, and more than half had education levels above primary school. A majority of LFs started serving in their roles between 2005 and 2009. After their selection, through their group/community or from the extension field staff, LFs received an initial residential training of 6.8 days on average (median = three days). They also received additional training during their service. The major functions of LFs were to provide other farmers with technical advice, supervise their activities, and mobilize their community for awareness or training sessions. Although LFs declared that their competencies in the techniques that they taught others were often insufficient, they rated their competence level on the innovations that they disseminated at 3.8 on a scale of 1 to 5. Most (93 percent) topics taught by LFs were supported with practical exercises, and 91 percent of techniques were actually applied by trainees on their farms. Training needs were generally set by organizations who conducted their own training needs assessments. Lead farmers had some involvement in this process as training needs were identified through farmers’ requests. On average, a lead farmer trained five groups of 26.3 farmers each and 37 additional farmers outside of organized groups (median of total number of trainees per LF = 65). The most common places where LFs conducted training were in group/community halls, at trainees’ houses/farms, or at the LF’s house/farm. Transportation and communication expenses were mainly paid by LFs themselves. Half of the LFs received training and demonstration materials from the organizations supporting their efforts. Almost all LFs (95 percent) reported being able to increase their income from being a LF and 94.4 percent believed that their trainees were also able to earn more income as a result of the new farming techniques that they learned. To improve upon their activities, 57 percent of LFs collaborated with government extension agents. In addition, some LFs met among themselves, mostly once a month. Since they started their work as LFs, each one had trained on average 231 farmers (median = 100). In the year before the interview, LFs had trained on average 58 farmers (median = 17). There was no significant difference between male and female LFs concerning the numbers of farmers trained. Female LFs trained more women compared to their male colleagues (74percent against 41 percent of trainees being women, respectively). Overall, 53.7 percent of farmers trained in the past year were female. Almost all LFs (98.1 percent) mentioned at least one topic that they successfully passed on to their trainees. However, 86.9 percent of LFs also cited topics for which training was less successful. The number of female and male LFs trained in the past year were not significantly different. Female LFs seemed to work more with individual farmers than their male counterparts. When working with groups, they mostly associated with one group only while men LFs worked with five groups on average. Female LFs also tended to train more farmers in their own houses/farms than men LFs, who trained more in community halls and in the trainees’ houses/farms. Altruism, increasing one’s income and getting early access to new technologies were the main motivations for LFs to become or remain LFs. A majority (60 percent) of LFs found the F2F approach to be very useful for developing local capacity, increasing technology adoption and increasing access to extension. Identified challenges were budget limitations, insufficient transportation and lack of communication support. Almost all LFs (94 percent) reported their intention to continue to train fellow farmers even after organizations working with them leave or the projects end. To improve the F2F approach and to make it beneficial to more farmers, 81 percent of LFs mentioned issues related to their motivation, such as “improving their conditions” and the desire to be supported in becoming real “model farmers”. Interview responses also indicate that there is a need to train more LFs and/or refresh their knowledge, especially in communication skills and improved agricultural practices, as well as to build awareness of authorities and projects/organizations of the importance of the F2F approach and to encourage more youth to join groups served by LFs.