Transgender and gender diverse people seek gender-affirming hormone therapy to masculinize or feminize their bodies. Aligning physical appearance with gender identity through hormone therapy is associated with improvements in mental health. To evaluate gender identity, clinicians must determine its persistence, assess the patient’s decision-making capacity, and address possible confounding mental health conditions. For feminizing hormone therapy, an estradiol is paired with an adjunctive androgen-lowering agent to increase the body’s estrogen and decrease testosterone. For masculinizing hormone therapy, testosterone is administered. Gender-affirming hormone therapy is generally safe when supervised by a physician. There are limited recommendations for perioperative hormone therapy modification.