<p>Gender-affirming hormone therapy (GAHT) is an essential component of the healthcare pathway for transgender individuals. However, prolonged use of hormone-based treatments can lead to significant variations in body weight, body composition, haematological parameters, lipid profile, insulin sensitivity, and thromboembolic and cardiovascular risks. Accurate assessment of the metabolic and cardiovascular risks associated with GAHT is challenging due to the diversity of treatment regimens and numerous confounding factors, such as lifestyle differences (e.g., cigarette smoking), various hormone administration routes, marginalisation affecting gender minorities with reduced access to primary healthcare services, gender-affirming surgeries, and the use of psychiatric medications that can influence weight and appetite. Furthermore, the predominance of retrospective studies with a small number of participants and the lack of long-term prospective studies contribute to an uncertain landscape, with limited reconfirmed evidence. This review aims to summarise the most recent evidence on the metabolic effects of GAHT, categorising the findings for Assigned Male at Birth (AMAB) and Assigned Female at Birth (AFAB) individuals.</p>