Effect of Transgender Therapy on Muscle, Fat and Tissue Receptors

Inclusion Criteria: * Diagnosed with gender incongruence by a mental health professional and willing to start gender affirming therapy Exclusion Criteria: * Used hormone therapy in last 6 months, * Pregnancy, * Planning to have biological children in the next one year, * HIV Additional exclusion criteria for transmen: 1) hematocrit \>50% for transmen, 2) transmen with allergy to cottonseed oil (component of intramuscular testosterone injection), 3) uncompensated heart failure, 4) renal failure Additional exclusion criteria for transwomen: 1) allergy to castor oil (component of intramuscular estradiol injection), 2) Known or suspected estrogen-dependent neoplasia, 3) Active deep vein thrombosis, pulmonary embolism or a history of these conditions, 4) Active or recent (e.g., within the past year) arterial thromboembolic disease (e.g., stroke, myocardial infarction), 5) Liver enzymes (AST or ALT) \>3 times the upper limit of normal, 6) Known or suspected pregnancy