Approach to the Patient: Hormonal Therapy in Transgender Adults with Complex Medical Histories.

While endocrinologists continue to initiate gender-affirming hormone therapy (GAHT) in healthy transgender and gender diverse (TGD) patients, they may also encounter more TGD patients in their clinics with complex medical histories that influence the patient-provider shared decision-making process for initiating or continuing GAHT. The purpose of this Approach to the Patient article is to describe management considerations in two adults with thromboembolic disease and two adults with low bone mineral density in the setting of feminizing and masculinizing GAHT.