AbstractAs more individuals seek to align their physical characteristics with their gender identity, transgender health care is a growing medical field which is no longer the remit of a few selected clinicians. Gender‐affirming hormone therapy (GAHT) is a mainstay treatment in gender reassignment and its medium‐ to long‐term metabolic sequelae are gradually emerging. Although hampered by the scarcity of prospective controlled studies involving large diverse cohorts, evidence suggests a potential adverse impact for at least some cardiovascular disease (CVD) risk factors. If left unmanaged, this could manifest in a higher CVD events rate for this treatment group. Increased vigilance and awareness among health care professionals about the consequential risks of GAHT are important for proactive mitigation of this. Copyright © 2023 John Wiley & Sons.