Inclusion Criteria:  Female transgender patients between the ages of 18 to 30 years of age who are seen at the Washington University Transgender Center. Patients must have met the eligibility and readiness criteria for gender-affirming hormone therapy.  Exclusion Criteria:  GnRH agonist for the last 12 months History of liver disease Dyslipidemia requiring treatment Cigarette smoking Body mass index >30 kg/m2