The number of children and adolescents seeking gender-affirming care is rising, yet little is known about how hormonal interventions started in early puberty influence long-term kidney health. This project investigates how pharmacological puberty suppression and subsequent gender-affirming hormone treatment may affect kidney development, function, and disease susceptibility. Using established preclinical models that mimic the hormonal treatments in transgender adolescents, we will assess structural and functional kidney changes and explore whether these hormonal manipulations alter susceptibility to kidney damage later in life. Finally, we will identify the cellular and molecular processes involved. The findings will advance our understanding of kidney physiology during adolescent gender transition and help inform future clinical practice.