A 44-year-old woman presented to a rural emergency

We thank Dr. Townsend and colleagues for their letter 1 in response to our article. 2 It is regrettable that the authors feel our report perpetuates inequity in the care of transgender people. The focus of our report was to review the evidence for estrogen as a thrombotic risk factor, while also guiding colleagues to some readily accessible educational materials that may prove helpful in the care of transgender people. In writing the case, we took advice from the patient, transgender people and health care specialists. Our goal was to help physicians and patients in similar situations, as they work together to optimize health. We're on the same side here and appreciate their comments.