Overview

To evaluate the effect of estradiol with or without a prior gonadotropin releasing hormone analogue on insulin sensitivity and vascular function in transgender females compared to cisgender controls.

Eligibility

Inclusion Criteria (transgender females):

• Identify as a transgender female
• Age 13-16 years at the time of enrollment
• If on a gonadotropin releasing hormone analogue, > 6 months exposure
• Plan to start estradiol clinically in < 4 months

Inclusion Criteria (cisgender males and females):

• Males and females ages 13-16 years

Exclusion Criteria:

• Cognitive, psychiatric, or physical impairment resulting in inability to tolerate the study procedures
• Antipsychotic medication use
• Type 1 or 2 diabetes (by medical history)
• Polycystic ovarian syndrome (PCOS for cisgender females)
• Hypertension (resting BP ≥ 140/90 mm/Hg)
• Weight> 400 lbs
• On oral progesterone medications (including oral progesterone or progestin, combined oral contraceptives or etonogestrel implant)
• Pregnancy (for cisgender females)