You didn't mention the MG your current estradiol transdermal patch is. I am also 74 and healthy (according to my blood workups). I take one medication a day, a low dose of 10mg of simvastatin to manage my high cholesterol. My lipid panel and Chol/HDL are all within normal limits. I understand that .05 mg is the lowest "effective" dosage for bioidentical transdermal estrogen for osteopenia/early osteoporosis. The 2000 Women Health initiative used .625 mg ( a synthetic and 12x more than .05) and ran into problems. Transdermal estrogen patches are recommended at an intervention stage for osteopenia and early-stage osteoporosis in "certain" circumstances.
It's been 30 years since I had my partial hysterectomy due to endometriosis. Four years after my hysterectomy I started bioidentical transdermal bioidentical estradiol patches. In 2005 I stopped due to inaccurate news from the Women's Health initiative. If I had the accurate correct information I would have never stopped. After that, I switched to bioidentical vaginal "Estrace" estrogen. When I was 64 (2014) I used a topical systemic bioidentical compounding cream combination of estrogen and testosterone for a year. For the past 10 years, I have only used compounding vaginal estrogen. I have yearly blood hormone lab work-ups done for levels of estrogen. All of my lab results showed a negligible amount of estrogen. None of the "local" vaginal estrogens were systemic.
On 6/21/2022 I had a Dexa scan that showed I had a T score of -2.5 Osteopenic. T score of the left femoral neck is -1.7 and T score of the left hip is -1.4. I live in a state that is 2nd to the last worst state for health care due to a severe shortage of doctors. It has taken me 2 years to find a doctor and then go through long wait times to see one. I have a good endocrinologist now. She says after having a full workup of my health she has no concerns about giving me transdermal bioidentical estrogen to treat osteopenia and early osteoporosis. She started me off at 0.025 estradiol transdermal patch. She said she couldn't start with the .05mg because she needed to get a baseline and start slow. In 3 months hormone lab work will be done ( .025 mg, only trace systemic amounts) She will move me up to the .05 RX. I get my two-year DEXA scan on June 24th. She said it didn't matter what age you started estrogen it depends on your health circumstances, whether you have a uterus or not, have diabetes or prediabetes, heart disease, have had cancer etc. She also said there is no age that you have to stop taking estrogen. The Women Health initiative says using a bioidentical transdermal estrogen patch lower than .625 has not shown any correlation with strokes, cancer, or blood clots.