This paper presents a complete 200Gb/s PAM-4 transmitter (TX) in 28nm CMOS technology. The transmitter features a hybrid sub-sampling PLL (SSPLL) with a delta-sigma (?S) modulator, clock distribution network with flexible timing control, and data path with a hybrid 5-tap Feed-Forward Equalizer (FFE) and T-coil for bandwidth extension. The prototype chip achieves 4.69 pJ/bit efficiency, 54mV eye height, 0.27UI eye width, and 97% RLM under -6dB channel loss at 50GHz.