The risk of acute thrombotic events such as venous thromboembolism (VTE) and ischemic stroke in transgender women receiving hormone therapy was addressed in our longitudinal Study of Transition, Outcomes and Gender (STRONG). STRONG is a cohort of transgender people enrolled in Kaiser Permanente’s Georgia, Northern California, and Southern California regions. This project found increased risk of VTE and ischemic stroke among transwomen treated with estrogen; however, the development of practical recommendations for the management of transwomen will require a more formal pharmaco-epidemiologic analysis evaluating comparative risks of different hormone formulations, routes of administration, and doses. These data are available, but the definitive analyses were not possible due to sparse treatment-specific strata. To address these limitations, we will include additional subjects identified at existing STRONG sites through the end of 2018 and extending follow up through mid-2019.