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<a href=https://tadalafil.top>where to buy cialis online safely</a> The gender differences in PAH are likely mediated at least in part by biologically relevant effects of sex hormones, evidenced by studies demonstrating a high prevalence of exposure to hormone replacement therapy HRT in women with PAH 154; genetic alterations in estrogen metabolism enzymes and estrogen receptors ERs in various forms of PAH 4, 131, 134; correlations of estrogen levels with RV function in healthy postmenopausal HRT users 176; and, finally, absence of hemodynamic differences between male and female PAH patients who are older than 45 yr 177