Gender dysphoria, which describes the distress related to the incongruence between a transgender person's experienced gender and their assigned sex at birth, can be alleviated by specific treatments, notably through gender-affirming hormone therapy and surgeries. Transgender people suffer from an excess of cardiovascular and thrombotic risk, of multifactorial origin and influenced by hormonal therapies and surgeries. In this article, we describe the basis of hormonal treatments for transgender people. The associated thrombotic and cardiovascular risks are detailed, along their mechanisms. Finally, the clinical situations and patient profiles requiring a specialized consultation when making decisions about gender-affirming treatment are discussed.