Metabolic and Physiologic Responses to Hormone Therapy in Transgender and Gender Diverse People

Inclusion Criteria: * age 18-40yrs * BMI 18.5-38 kg/m2 * Fasting glucose \< 100 mg/dL * No gender affirming gonadal surgery We seek to enroll 6 patients in each group who have been on GAHT for more than 10 months with minimal interruptions in treatment. Exclusion Criteria: * Pregnancy * Use of hormonal forms of birth control within the previous 3 months * Use of glucocorticoids, estradiol, testosterone, progestin, antiandrogens, or antiestrogens besides those received as part of a supervised hormone therapy. * Gender-affirming gonadal surgery * Prior use of gonadotropin releasing hormone (GnRH) analogues during puberty * Coronary artery disease or heart failure. * A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples: * Inpatient psychiatric treatment in the past 6 months * Presence of a known adrenal disorder * Abnormal liver function test results (Transaminase \>2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function * Abnormal renal function test results (calculated GFR \<45 mL/min/1.73m2); testing required for subjects with diabetes duration of greater than 5 years post onset of puberty * Active gastroparesis * If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, lack of stability on the medication for the past 2 months prior to …