Transgender and Gender-Diverse (TGD) adolescents face unique metabolic challenges that require careful attention. Increased prevalence of overweight, obesity, and metabolic syndrome has been documented, particularly in Assigned-Female-At-Birth (AFAB) individuals, alongside a higher risk of disordered eating behaviors and prolonged fasting. Hormonal treatments, including LHRH analogs and gender-affirming hormones, may influence body composition. An increased risk of type 1 diabetes in this population has been described. A multidisciplinary approach is crucial to address the specific metabolic and psychological needs of TGD adolescents, ensuring comprehensive and inclusive care.