Objectives To describe weight, body mass index, blood pressure, lipids, and hormone levels in transgender women and men presenting for initiation of cross-sex hormone therapy at a community clinic in the United States. Methods Twenty three transgender women (persons assigned male at birth who identify as women and want to use estrogen to develop female secondary sex characteristics) and 34 transgender men (persons assigned female at birth who identify as women and want to use testosterone to develop male secondary sex characteristics) presenting for initiation of hormone therapy at a community health center were enrolled. Body mass index, blood pressure, lipids, and sex hormone levels were measured at baseline and 6 months. Persistence of menses at 6 months in transgender men was recorded. Results Sixteen transgender women and 31 transgender men completed the study. Baseline and 6 month median blood pressures and lipid values were within a normal clinical range. Median systolic blood pressure in transgender women dropped from baseline 130.5 mmHg (IQR 11.5) to 120.5 mmHg (IQR 15.5) at 6 months (p=.006). Testosterone levels remained elevated in 33% and estradiol levels were supratherapeutic in 19% of transgender women at 6 months. Median body mass index for transgender men was 29.1 kg/m2 (IQR 11.2) at baseline and (30.0 kg/m2 (IQR 11.4) at 6 months (p=.024). Six month total testosterone levels were subtherapeutic in 32% and estradiol levels remained elevated in 71% of transgender men. Conclusions In transgender women, estrogen therapy, with or without anti-androgen therapy, was associated with lower blood pressure. In transgender men, testosterone therapy was associated with increased body mass index. The study had insufficient power to detect other associations. Monitoring of hormone levels to guide therapy appears to be useful.