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Estrogen-based gender-affirming hormone therapy is critical for helping patients address unwanted secondary sexual characteristics and induce physical changes in accordance with their gender identity. However, the use of estrogen-based gender-affirming hormone therapy may increase the risk of venous thromboembolism. This review article summarizes the current evidence describing venous thromboembolism risk among patients using various forms of estrogen, including transgender and cisgender individuals. 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