Caring for Transgender and Gender-Diverse Patients in the Urgent Care Setting

October 2026 Postscript #1

Test Your Knowledge

A 20-year-old transgender woman presents to urgent care with unilateral calf pain and swelling that began the previous day. She recently restarted estrogen therapy obtained online after losing access to her previous clinician. She denies chest pain, shortness of breath, fever, trauma, or recent immobilization. Her vital signs are temperature, 98.4˚F; heart rate, 96 beats/min; blood pressure, 122/78 mm Hg; respiratory rate, 16 breaths/min; and oxygen saturation, 99% on room air. Examination reveals mild swelling of the left calf compared to the right, tenderness along the posterior calf, and no erythema, fluctuance, open wound, or bony tenderness. Distal pulses are intact.

Which of the following is the most appropriate next step?

1. Reassure her that calf pain is unrelated to gender-affirming hormone therapy and recommend NSAIDs.
2. Tell her to stop all hormone therapy immediately and follow up with her primary care doctor, as needed.
3. Treat empirically with antibiotics for cellulitis and discharge.
4. Assess for venous thromboembolism risk, explain the concern, and refer her for same-day diagnostic evaluation.