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admin | Office Exercises | 22.01.2014
Male-to-female (MTF) transgender women have an increased risk for HIV infection[1,2,3,4]. A thorough discussion of cross-hormonal and surgical reassignment protocols is beyond the scope of this article, but some clear principles of management have been established[9,10]. Most transgender women will transition with either estrogen alone or in combination with an antiandrogen such as spironolactone (Aldactone).
Many options for estrogen therapy exist for use in hormonal reassignment therapy, and the doses used are generally at least 2-3 times higher than doses used for hormone replacement therapy in postmenopausal women (Figure 3. Anti-androgen agents are often used in combination with estrogens in hormonal reassignment therapy to further decrease male secondary sexual characteristics (Figure 4. Regardless of the exact regimen chosen, all patients receiving cross-sex hormone treatment require close monitoring to minimize the risks of therapy. In addition to hormonal therapy, transgender women require routine primary care specific to both their biologic and acquired genders.
The main pathway of metabolism for estrogens occurs via the cytochrome P450 enzyme system, and thus a potential drug-drug interaction can exist with estrogens and any medication (including antiretroviral agents) that also undergo metabolism via the cytochrome P450 system. These include social isolation, fear of exposure, denial of insurance coverage, competing priorities (such as housing and employment), stigma of going to a gender reassignment clinic, a lack of clinical research and medical literature related to transgender individuals, as well as provider ignorance regarding the care of these patients.
Estrogen Preparations for Use in Male-to-Female Gender Reassignment Therapy">Figure 3).
Anti-androgen and Progestin Use in Male-to-Female Gender Reassignment Therapy">Figure 4). Recommended lab monitoring includes baseline and intermittent measurement of complete blood count, liver panel, renal panel, lipid profile, fasting glucose and prolactin level. CONTACT OUR PHYSICIANS TODAY First name Last name Email address Phone Message Growth Hormone Therapy Low Testosterone Treatment HGH Therapy Benefits Testosterone Therapy Benefits How to Get HGH & Testosterone What Is Growth Hormone Deficiency What Is Low Testosterone Where Can I Get Testosterone Injections What Are The Benefits Of Testosterone Injections Where Can I Buy HGH Injections What Are The Benefits Of HGH Injections What Is The Cost Of HGH Therapy What Is The Cost Of Testosterone Therapy HGH Therapy In Texas By they time they have reached the relatively young age of forty-five it has been estimated that up to 30% of all adult men and women will have lost a significant amount of their body’s supply of growth hormone, along with all of the youthful vitality it provides.
More detailed descriptions of specific hormonal gender reassignment protocols and recommended monitoring can be found in published literature[9,10], as well as through the Tom Waddell Health Center Transgender clinic protocols (Figure 5. However, the availability of HGH therapy in Texas means that adults who live in the Lone Star State who fall into that 30% are able to do something about replenishing their seriously deficient growth hormone levels. Recommended Monitoring for MTF Transgender Persons Taking Hormonal Reassignment Therapy">Figure 5). In contrast, the non-nucleoside reverse transcriptase inhibitors (NNRTIs) and the protease inhibitors (PIs) can interact with estrogens; most of the available data related to interactions between antiretroviral drugs and estrogen have involved studies with oral contraceptives (Figure 6. Hormone replacement therapy in TX has definitely come of age, and men and women alike can now take advantage of its ability to diminish and even reverse the symptoms of premature aging that are directly related to low HGH levels. Oral estrogen, either ethinyl estradiol (Estinyl) or conjugated equine estrogen (Premarin), is the most commonly used formulation, as it is relatively inexpensive and easily titrated. This makes it possible for thousands of people living all across the state of Texas to be able to totally reclaim the youthfulness and peak vitality they had when they were ten to twenty years younger. This real life experience should include maintaining employment (or performing volunteer work), documenting awareness of their cross gender identity by people other than therapist, and acquiring and using a new gender appropriate first name. Potential beneficial effects of estrogen therapy in this context include breast development, redistribution of body fat, softening of the skin, loss of erections, testicular atrophy and slowing of scalp hair loss. Similar trends in interactions would likely occur with gender reassignment estrogen therapy and antiretroviral medications, with the exception that more pronounced interactions may take place because of the higher levels of estrogens used with gender reassignment hormonal therapy. Hormone Replacement Therapy in TXThe irrefutable results of a breakthrough research project on adult growth hormone deficiency (AGHD) that was performed by an endocrinologist nearly twenty years ago established the groundwork for today’s state of the art human growth hormone treatment in TX. Ideally, cross-gender hormonal therapy should be undertaken in conjunction with a provider experienced in its use. Most experts recommend spironolactone as the anti-androgen agent of choice for patients living in the in the United States. Although numerous antiretroviral medications can alter estrogen levels, the effect of estrogen compounds on antiretroviral medication levels appears to be limited to a few antiretroviral medications, namely amprenavir (Agenerase) and the amprenavir pro-drug fosamprenavir (Lexiva).
In recognizing that something more than just the passage of time was responsible for the physiological and psychological decline that many adults experience as they age, this project received serious attention from numerous scientists, doctors and other health care professionals. Although the main goal of hormonal therapy is to improve quality of life, frequent medical monitoring of cross-gender hormone therapy can also improve adherence with treatment for chronic illnesses commonly encountered in this population, such as HIV infection, depression, and substance abuse, as well as to increase opportunities for preventive health care. Transdermal estradiol patches (Alora, Climera, Esclim, Estraderm, Vivelle, Vivelle-Dot) produce fewer changes in hemostatic variables than ethinyl estradiol and are associated with a lower risk of venous thromboembolic disease[14].

Spironolactone is typically started at 25 mg PO bid, and increased after several weeks to a typical maintenance dose of 50 mg PO bid; the maximum dose is 200 mg PO bid.
Co-administration of amprenavir and ethinyl estradiol to 10 patients for 28 days resulted in significant decrease in serum concentrations of amprenavir[22], suggesting that this drug combination may lead a loss of virologic control and possible amprenavir resistance.
In the two decades that have passed since then, the explosion of interest in hormone replacement therapy in TX as well as virtually every other state was something that nobody could have foreseen. Factors Independently Associated with HIV Seropositivity in MTF Transgender Women in San Francisco, 1997">Figure 1). Potential benefits of spironolactone therapy include mild to modest breast development, the softening of body and facial hair, decreased progression of male pattern baldness, and decreased erections.
Amprenavir has been largely replaced by fosamprenavir, but the drug interaction issues are presumably the same. Yet through word of mouth and an ever-expanding array of digital communication channels, the general public has become increasingly aware of the exciting possibilities presented by HGH therapy. Medical providers must consider the gravity of the psychological need for hormone therapy in these patients and should make every effort to manage potential risks in order not to restrict access to hormonal gender transition.
Although this combination has not definitively been shown to lead to virologic failure in the treatment setting, the DHHS Antiretroviral Therapy Guidelines recommend that oral contraceptives and amprenavir (or fosamprenavir) not be co-administered.
Use of progesterone does not contribute significantly to feminization and is not generally recommended for gender transition. For patients with wasting syndrome or who might otherwise require megestrol acetate (Megace), progesterone may be a useful alternative.
At every visit the clinician should review the warning signs of deep venous thrombosis and pulmonary embolism with the patient. The hormonal balance provided human growth hormone replenishment also helps to balance cholesterol levels by increasing HDL and decreasing LDL. Those individuals with loss of scalp hair may benefit from finasteride (Propecia), topical minoxidil (Rogaine), or a combination of both. For post-surgical patients, care of the neovagina, including consistent dilation to prevent stenosis, adequate use of lubrication, and barrier protection during sexual intercourse should be addressed. In addition, HGH therapy provides adults with medically deficient levels greater physical resilience, more effective metabolic activity and improved brain function.
Cyproterone, testosterone uptake inhibitors, and growth hormone releasing antagonists are not widely use for gender transition. Some transgender women harbor the misconception that the neovagina is resistant to HIV, but dilation and sexual activity can cause micro-tears in the neovagina, creating ideal conditions for HIV transmission. The board certified doctors who prescribe HGH in Texas, such as though affiliated with Kingsberg Medical, have successfully treated scores of men and women with a clinical deficiency and the results have proven to be extremely consistent. In addition, some providers prefer the use of injectable estrogen in the initial transition period.
Moreover, a thorough sexual history should be taken at each visit, and sexually transmitted diseases screening should be carried out as appropriate for the reported risk behaviors. Interactions Between Estrogens and Drugs Commonly Used by HIV-Infected Persons">Figure 7). While the greater percentage of patients tends to fall within the 35 to 55 age group, it is not uncommon for adults who are in their sixties, seventies, or even their eighties to be using a physician prescribed therapeutic program. There are no data to suggest the natural history of HIV infection differs in transgender women compared with age-matched controls.
There is no known significant drug-drug interaction between the most commonly used anti-androgen, spironolactone, and any anti-retroviral agent or other medication commonly used to treat HIV-infected individuals. It all depends on what the results of an IGF-1 blood test indicate.Local HGH Doctors in TexasFor any adult in Texas whose low HGH levels are preventing an active and healthy lifestyle, just having a simple yet comprehensive blood test for growth hormone deficiency performed can be a life-changing revelation. To finally be able to identify the root cause of troubling symptoms and then learn what can be done about it is liberating experience for most people.
Risks and benefits must be reviewed with these patients, but for many, the need for estrogen therapy will outweigh the potential risks even in the context of chronic illness. A clinical diagnosis of human growth hormone deficiency, based on the evidence of low IGF-1 levels, is an opportunity to regain maximum vitality and rejuvenation with the capable assistance of local HGH doctors in Texas. Today’s therapeutic programs are not difficult or complicated follow, and the latest prescription treatments are simple and painless to self-administer.

The doctor oversight and incremental testing that supports the success of any hormone replacement program can be performed locally and thanks to the Internet, where to get HGH in Texas is never a logistical problem.
The process for receiving HGH therapy is a streamlined and convenient one that makes it possible for any adult with hormonal deficiency to use the only treatment that works.HGH Prescription in TexasWhat does it take to get an HGH prescription in Texas?
If it is determined that a medically treatable growth hormone deficiency exists, then and only then is when a physician can legally issue a prescription for human growth hormone injections. The leading manufacturers of bio-identical therapeutics include Eli Lilly Humatrope, Sandoz Omnitrope, Pfizer Genotropin, and Novo Nordisk Norditropin among others. However, before physicians will prescribe any of these treatments, they will require the results of an IGF-1 blood test for HGH levels in Texas and a recent physical examination. Even adults who had all but given up on ever again being in top form, either because of stubborn fat accumulation or muscle deterioration, are astonished by the reappearance of the leaner and more toned physique of their younger years. Being able to buy injectable HGH in Texas with a prescription gives people a choice in how they want to deal with the biologically instigated changes that accompany aging. Not everyone with hormonal deficiency chooses to use HGH replacement therapy, but those who do are typically very pleased with the choice they have made.Where to Get HGH in TexasAlleviating the symptoms caused by hormonal imbalance was the driving force for the creation bio-identical hormone therapy. Yet the physicians who initially prescribed it for their patients quickly observed the other benefits of treatment. The additional long-term health benefits that doctors have discovered are another reason why it is a distinct advantage to know where to get HGH in Texas if an adult wants to experience these benefits. Because online technology is now used to facilitate many aspects of HGH therapy, adults living anywhere in Texas can use the Internet to order their prescription treatments for prompt shipping and delivery to a home or business address.How to Buy HGH Injections in TexasMost of the established nationwide HGH therapy providers such as Kingsberg Medical provide obligation-free, cost-free consultation to adults who are considering a treatment program.
As compassionate health care providers, they understand that when people have specific questions about how to buy HGH injections in Texas or any else that is related to therapy, they would often prefer to speak to an experienced professional directly. Even though the biochemistry involved in hormone replacement therapy is complex, it is not difficult to understand the basic concepts of effective treatment and the HRT clinical advisors at Kingsberg Medical are known for their expertise as well as their helpfulness. Many doctors believe that leaving the symptoms of hormonal deficiency untreated poses a far greater risk than receiving an HGH prescription in Texas for treatment.
In fact, the overall safety of hormone replacement therapy has been the subject of numerous studies over the past decade and it has been shown repeatedly that it offers minimal risk to the overriding majority of adults who use it.Which Doctors Prescribe HGH Injections in Texas? It is not all unusual for some adults to feel less than confident about discussing HGH therapy with their primary health care provider for a variety of reasons. Yet when that happens, it would undoubtedly be very helpful to know which doctors prescribe HGH injections in Texas. Not all physicians have the same degree of knowledge or experience in the specialized field of hormone replacement therapy, so it follows that not all of them will share the same comfort level in discussing a patient’s medical options. Just as it is appropriate to see any specialist regarding a specific problem or health care issue, it is an excellent idea to seek help from local physicians or local HGH clinics in Texas that specialize in AGHD whenever a man or woman wants to eradicate the unwelcome signs of hormonal decline.
An adult using human growth hormone treatment in Texas can expect a substantial improvement in their symptoms within the first month of their program. Among the very first results that many adults experience are increased mental clarity, higher energy levels and better sleep, which automatically provide a substantial boost to overall well-being. Benefits like these continue to build in consistency and intensity as the treatment protocol continues, which is all expedited by knowing how to buy HGH injections in Texas. Naturally, no two people will experience exactly the same results at the same time but in general terms, after completing a six-month course of therapy virtually all patients experience an extremely significant improvement in their physical appearance and performance along with greater emotional fulfillment. Often referred to as an IGF-1 (insulin-like growth factor 1) blood test, the results will indicate whether HGH levels are too low, too high or fall within the normal range.
Typically the patient will be instructed to abstain from exercise, food and beverages for ten hours prior to the test. Since there are certain medications that can affect the test results, the doctor who has ordered the test may advise the patient to stop taking medications in advance of the test. A blood sample will be drawn from a vein in the arm and delivered to the testing laboratory.
After careful consideration of all the pertinent factors, the doctor will be ready to prescribe the optimal therapeutic program and the patient will then be ready to buy injectable HGH in Texas to administer in the privacy and comfort of their own home.

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