A: I would assume that its out of sheer ignorance.  Believe it or not, many physicians still use oral hormones, even in the treatment of menopause and even in women over 60, as well as in trans gender women, at a much higher dosage.  But the risk is amplified along with the dosage in trans women, opening them up to clots, strokes, heart attacks & sudden death, which non-oral treatment greatly reduces. Oral estrogens should undoubtedly in my opinion never be given to transgender patients.