Leading educators and clinical experts on transgender health care from Harvard, Fenway Health, and The Fenway Institute address access issues for transgender patients seeking care by providing a plan to integrate gender-affirming hormone therapy, surgical referrals, or wrap-around services into primary care. Such programs provide a much-needed service for this underserved but increasingly visible population that experiences significant health inequities. Authors provide a concise and practical guide to developing transgender health programs within existing primary care practices. Programs may be as streamlined as having one or two clinicians who provide hormone therapy within a welcoming primary care practice. The guide provides tips on how to access low-cost clinical training and how to generate organizational buy-in for the development of new services. The plan can be adapted across primary care practices of varying sizes and resources. This is the first peer-reviewed publication that provides a guide to implementing a transgender health program in primary care settings.