This study investigated the influence of H2 preconditioning on the nucleation and growth of self-assembled germanium islands on silicon (001). For standard samples, atomic force microscopy and Raman spectroscopy showed a steady evolution of a bimodal island size distribution as small islands ripened into large ones through strain relief via intermixing and defect formation. For preconditioned samples, H2 exposure during cooldown led to an accelerated initial evolution, doubling the density of slightly larger islands with a narrow size distribution and few unusually large islands, as strain relief occurred via increased intermixing during nucleation and growth. However, evolution then saturated earlier due to higher compressive strain inhibiting further nucleation and growth.