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Exposure to exogenous estradiol can lead to precocious puberty in prepubertal girls. Transgender persons should be thoroughly informed of the risk of transmission of transdermal hormones and be advised to wash hands, use gloves and avoid skin contact shortly after hormone application. Patients with children must be warned of the risk and Gender Clinics should consider the possibility of prescribing alternative routes of administration such as tablets or patches in high-risk patients.