Transgender patients experience significant social disadvantages and health care disparities. They suffer abuse, harassment, and discrimination that shatters family ties, disrupts or limits their education, employment, and financial well-being and causes significant housing insecurity. Without familial support, education, housing, or financial resources, it is no wonder their health suffers and it does. They are at increased risk for obesity and tobacco use, which increases their risk of hypertension, elevated cholesterol, and diabetes and consequently their risk of cardiovascular disease and morbidity. Transgender patients are also at significantly increased risk for mental illness, drug and alcohol abuse, which has led to a reprehensible rate of suicide approaching 50%. Transgender patients report very high rates of being denied treatment, having delayed treatment, and being discriminated against in the health care setting. We can make our patient-centered medical homes not only cis-centered but trans-centered as well. By making small changes in our daily practice we can have a big impact on improving the health and well being of our transgender patients who truly need our support and care.