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Thank you, that is a really useful, practical response. At general practice level, I don't need or have time to consider the actual research, but I would be interested to know the level of evidence this is based on - whether the highest level of randomised controlled studies, or intermediate level, or the lower level of case series/expert opinion. I am somewhat surprised that age doesn't seem to matter, when in people assigned female at birth there now seems to be a different risk after the age of 65. I don't know if there are sufficient numbers of people assigned male at birth who have been given female hormones for as many years as that would entail?
However, it is very useful to have your recommendations for monitoring so I can ensure my patients have what is needed and are not pestered to come in unnecessarily. Thank you very much.