Metabolic Effects of Gender-Affirming Hormonal Therapy in Youth.

Transgender and gender diverse youth experience metabolic conditions at differing rates than cisgender peers, with mental health, minority stress, and related behaviors likely playing a significant role.

• The review identifies mental health and minority stress as contributing factors to metabolic health disparities in TGD youth.
• Sex hormones (estrogen and testosterone) play an integral role in metabolic health with sexual dimorphic patterns.
• The paper frames these differences as existing prior to any gender-affirming hormonal therapy.

Gender-affirming hormonal therapy (GAHT) produces variable metabolic changes across five domains in adolescents and young adults.

• The five domains evaluated were: cardiovascular health, lipid metabolism, insulin resistance, body composition, and liver function.
• Changes with GAHT were characterized as positive, negative, or neutral depending on the domain and direction of hormonal therapy.
• The review focused on adolescents and young adults as the primary population.

The review summarizes baseline metabolic characteristics in TGD youth prior to initiation of GAHT.

• Baseline characteristics were described for each of the five metabolic domains prior to GAHT.
• TGD youth show differing baseline rates of metabolic conditions compared to cisgender peers.
• The review used available emerging research to characterize these pre-treatment differences.

Current guideline-based screening recommendations for metabolic conditions exist for TGD youth on GAHT.

• The review includes a summary of guideline-based screening recommendations for monitoring metabolic health while on GAHT.
• Screening recommendations are reviewed in the context of each of the five metabolic domains.
• The review aims to provide clinicians with guidance on monitoring metabolic changes during GAHT.

Estrogen and testosterone have sexual dimorphic effects on metabolic health that are relevant to understanding GAHT's impact in TGD youth.

• Sex hormones are described as playing 'an integral role in metabolic health with sexual dimorphic patterns.'
• The hormonal basis for metabolic changes informs the expected directional changes seen with exogenous estrogen or testosterone administration.
• This hormonal framework underlies the review's evaluation of GAHT effects across all five metabolic domains.