STUDY OBJECTIVE: To explore reasons for menstrual suppression method choice among transgender and gender-diverse (TGD) youth at the time of method initiation DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of baseline data from a prospective cohort study of menstruating TGD youth (N = 55), aged 12-17 years, initiating a hormonal method for menstrual suppression in a gender health specialty clinic at a single site, quaternary hospital in the Midwest INTERVENTIONS AND MAIN OUTCOME MEASURES: Participants completed a baseline survey that included identifying the most important reason, as well as other important reasons, for menstrual suppression method selection. RESULTS: The mean age was 14.9 (SD 1.5) years, and most participants identified as White (81.8%) and male or transgender male (90.9%). For menstrual suppression, participants chose progestin-only pills (43.6%), followed by depot medroxyprogesterone acetate injections (29.1%), levonorgestrel intrauterine devices (21.8%), and continuous combined oral contraceptive pills (5.5%). The 3 most reported reasons important to method choice were "seemed like the best choice for me," "ease of use," and "I don't want anything with estrogen in it." "Uncomfortable with a device in my body" and "not wanting a pelvic exam" were also frequently indicated as important factors influencing method choice. CONCLUSION: Consistent with a patient-centered approach, comfort level with estrogen, implantable devices, and pelvic exam should be assessed early when discussing menstrual suppression options with TGD youth.