Metabolic Effects of Gender-Affirming Hormonal Therapy in Youth

Youth who are transgender and gender diverse (TGD) experience metabolic conditions with differing rates than their peers who are cisgender. Mental health, minority stress, and related behaviors likely play a significant role in these differences. At the same time, the sex hormones (ie, estrogen and testosterone) play an integral role in metabolic health with sexual dimorphic patterns. Emerging research is evaluating the positive, negative, or neutral metabolic changes seen with gender-affirming hormonal therapy (GAHT) in adolescents and young adults. In this review, we summarize these findings, specifically evaluating five domains: (1) cardiovascular health, (2) lipid metabolism, (3) insulin resistance, (4) body composition, and (5) liver function. Using the available evidence, we highlight the baseline characteristics prior to GAHT, describe the expected changes with therapy, and review the current guideline-based screening recommendations while on GAHT for metabolic conditions.