Nuances of gender affirming therapy for transgender women with spinal cord injury.

CASE DESCRIPTION: 56-year-old transgender woman with new spinal cord injury (SCI) on gender affirming hormonal therapy (GAHT) with estrogen and spironolactone.

FINDINGS: After her injury, estrogen and spironolactone were discontinued, for blood clots and hypotension, respectively. Alternative options were explored.

CLINICAL RELEVANCE: Little is known about GAHT in SCI for transgender women. Shared decision making should be used to navigate risks, benefits, and alternative options.