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doi: 10.1097/gme.0b013e3181865373

Nakazawa T, Nakazawa C, Matsubara A, Noda K, Hisatomi T, She H et al

1 Factors that will affect the choice of the second agent include patient preference, cost, potential adverse effects, impact on weight, efficacy, and risk of hypoglycemia

Testosterone exerts a stimulatory effect on growth hormone secretion at the pituitary level, which is called a push effect. On the other hand, estrogen increases growth hormone secretion only through its inhibitory effect on insulin-like growth factor-I production in the liver with resultant feedback stimulation of growth hormone release from the pituitary: a pull effect (5)

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