<Li> Risk is greater in transgender men who are obese, smoke, or have COPD (Chronic Obstructive Pulmonary Disease). </Li> <Li> Untreated OSA may have significant adverse effects on the heart, blood pressure, mood, and may cause headaches and worsen seizure disorders . </Li> <Li> Symptoms of OSA are noisy sleeping (snoring), excessive daytime sleepiness, morning headache, personality changes, and problems with judgment, memory, and attention . </Li> <Ul> <Li> Increased red blood cell mass usually from overproduction by the bone marrow . </Li> <Li> Testosterone (frequently in large doses) was previously used to treat anemia from bone marrow failure . </Li> <Li> A transgender man's hematocrit (the percentage of whole blood made up of red blood cells) should be judged against normal age adjusted values for men . </Li> <Li> Therapy is via phlebotomy (periodic therapeutic blood draws similar to blood donation). </Li> <Li> Tendency to become polycythemic worsens with age . </Li> <Li> Worse with injected testosterone (especially with longer intervals between doses) than with oral, transdermal, or Testopel . (Increase in RBCs occurs with the very high peaks from injection . So decreasing dose and interval to 7--10 days instead of 14 may help .) </Li> <Li> Severe polycythemia predisposes to both venous and arterial thrombosis (blood clots) such as: deep venous thrombosis, pulmonary embolism, heart attack, and stroke . </Li> <Li> Aspirin may decrease the risk </Li> </Ul>

What happens to cause a female to begin puberty apex