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Transdermal HRT

Osteoporosis & Bone Health | Last Active: Nov 8 1:50pm | Replies (113)

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@teb

yes, I believe those breast cancer statistics are correct but keep in mind that those statistics were extracted from the WHI study which used oral estrogen so risks might be even lower with transdermal. We really don't know. I don't have the statistics handy on CVD risks but my understanding is that risks are highest in the first year of use and then moderate. My mother had heart disease and ultimately, multiple strokes so I was really concerned about my CVD risks. I've had pretty extensive testing to evaluate my current state and for now, my risk appears to be low. My cholesterol has always been quite high but I've always refused statins preferring to modulate as best I could through diet and exercise. Due to my supposed genetic predisposition, I wanted to get a better picture of my personal risk before going on HRT and I did that by getting a more in depth cholesterol panel and having a high resolution CT angiogram. My calcium score was zero meaning no arterial plaque detected. I tested my LPa level which is a genetic marker. Mine was thankfully very low so no inherent genetic risk. You do that test once in your lifetime and you have the information you need to assess. I also had my oxidized LDL and APOB tested. Both are a bit high but in combination with the rest of my test results, I feel comfortable enough to continue on with my diet, exercise and HRT regimen.

In my experience, conventional doctors don't really monitor your risks. You kind of have to figure out your personal risks on your own, evaluate whether HRT is right for you and then advocate with your doctor. Annually, I request a full panel of bone marker tests and bloodwork from my endo. I'm just not sure he would be as thorough if I didn't request these tests. I think he'd just go by my dexa and prescribe fosamax. But once I ask, he's willing to do it and then we go over it together to figure out if I am actively losing bone and what my plan should be moving forward (which for him, always includes a conventional osteo pharmaceutical). As patients, we need to figure out our own bodies, risks and tolerances. In the 15 minutes our doctors spend with us, they do a quick eval and then prescribe the basics.

I do not use prometrium as it contains peanut oil and artificial dyes which I don't think are particularly healthy. I get micronized progesterone from a compounded pharmacy. It is bioidentical, clean and reasonably priced. Prometrium is available from your local pharmacy and a less expensive alternative so some may prefer this option but for me, I'd rather have something that is pure.

I went on HRT a few months after concluding my Forteo treatment. I found it hard to navigate the system so it took a little longer than optimal to get that going.

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Replies to "yes, I believe those breast cancer statistics are correct but keep in mind that those statistics..."

@teb thank you so much for sharing your experience! I really envy the position that you are in. I'm diving deeper to transdermal HRT as the door is closing on me... I'm just 10 years past menapause, similar to you when you started HRT. The main concern to me in regards to HRT is cvd risk. Unlike you, I don't have any genetic predisposition, no cvds in 4 generations. But, I have a small positive cac score discovered accidentally.. This tells us the power of epigenetic forces. My ldl would get down to 100 with a heart healthy diet but a small dose of statin brought it to 60, below the target that my cardiologist is happy about. They did CIMT and peripheral vascular screening, came back clear. They checked LPa also and it's at lower part of the normal range. Will be eager to hear what my cardiologist, ob/gyn think of transdermal HRT and my risk. Im going to look into oxidized ldl, which you've been tested. I'm sure that you are aware that target ldl is revised from 130 to 100 as normal, and below 70 if you have 1 risk factor.

Thanks a lot for the suggestion of micronized progesterone! I found this article reviewing cvd risk with estrogen therapy. micronized progesterone is also mentioned and preferred form.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612533/#:~:text=The%20impact%20of%20estrogen%20may,the%20risk%20of%20cardiovascular%20diseases.
Out of curiosity, do you see a drop of CTx after you start HRT, if it's appropriate for you to disclose? Would monitor btm every 6 mo better than once a year, because you get dexa yearly anyway?

Best,