CTX at 476 within the context of your bone density and six years of no meds, I'd guess that you have luck . If you were starting the sometimes slow process of vertebral fracture your CTX would be higher. Thats provided that you had an early morning, fasting blood draw.
It is wonderful that you ordered your own test. A P1NP at the same draw would give us more information to guess your status. Testing 2 months into medication treatment would give you an idea if the meds were working.
At -4.0 my advice would be to begin Tymlos as soon as you can. If there aren't other reasons opposing HRT, I'd advise a low dose estrodial patch. Having already seen the endocrinologist, you should be able to make a request for the prescription by phone or message (today). Meanwhile be careful not to fall, don't do heavy lifting and avoid exercises that twist the spine. Be gentle with yourself as if you were fragile.
You should question advice from anyone. I don't see a choice here. But I'm not any expert.
The process for Tymlos or Forteo insurance approval can take a bit of time. Ask your endocrinologist for a free sample pen. And ask that she expedite the process.
And keep us posted remembering that we respect any choice that you make without judgement. Bless your bones.