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Hormonal treatment for transgender people is prescribed to encourage the development of secondary sexual characteristics of the desired gender and to reduce the phenotypic expression of the undesired sex. Data in the literature suggest an increase in cardiovascular morbidity and mortality in this population, but the results are inconclusive because there are no long-term prospective studies that include control subjects. Assessment of cardiovascular health in transgender people and preventive actions should integrate several aspects, such as discrimination-related stress, psychological factors, social stigmatization, lifestyle, and access to care. Current health system priorities include improving access to care for this population and improving the skills of health professionals, as well as implementing clinical and basic research studies.