How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?

If physiologic concentrations of testosterone are not exceeded and the hematocrit is monitored to avoid a pathologic level of erythrocytosis, the risk for thrombosis from testosterone GAHT does not appear to in excess of the general population.

I would refer you to the following two articles that provide perspective on this:

Connors & Middeldorp, PMID 31465627

Iwamoto et al., PMID 37683089

Extrapolating this information to a patient with a family history of VTE: I would council on signs/symptoms of VTE to seek medical care along with minimizing vascular risk factors (i.e. smoking cessation, lipid control, etc), but testosterone use would not be an indication for anticoagulation nor would it be an indication for an inherited thrombophilia scree...