Effects of Aging and Gender-Affirming Hormone Therapy on Vascular Endothelial Function and Metabolic Profiles in Transgender Women

Inclusion Criteria: * Aged 18-40 years old or 50-75 years old * Identify as a transgender woman * Have taken estradiol and spironolactone for at least one year * Currently taking oral or transdermal estradiol Exclusion Criteria: * Don't identify as a transgender woman * Not currently taking estradiol or spironolactone * Have been on estradiol and spironolactone for less than one year * History of orchiectomy * Current tobacco smoker * Current illicit drug use * History of prior or active estrogen-dependent neoplasms * Acute liver or gallbladder disease * Venous thromboembolism * Hypertriglyceridemia \>500 mg/dL * Fasted plasma glucose \>7.0 mmol/L or previously treated diabetes * Resting blood pressure \>140/90 mmHg