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The cardiopulmonary and strength analysis in gender transition (ChAnGe) project was conceived and is coordinated by Dr Marco Vecchiato, a specialist in Sports and Exercise Medicine. The study is conducted at the University Hospital of Padova, Italy, within the Sports and Exercise Medicine Division. Recruitment of participants who are about to initiate gender-affirming hormone therapy (GAHT) is facilitated by the endocrinology unit, under the supervision of Professor Andrea Garolla, with the clinical support of endocrinology resident Dr Alberto Scala.