Transdermal HRT

Hi @pennykj , great to hear that your dxa held stable in the past year. May I ask the main reason that your obgyn advices against hrt in your case? Your reduction in ctx is remarkable. What do you think is the main contributing factor? Did you have your p1np tested as well? Thanks a lot!

My gyn pretty much said that I was too old to start (too long past menopause). She thought there was a risk of blood clots. However, she said she would prescribe if I insisted and got clearance in writing from my cardiologist. My p1np was not retested in April 2024, but will be retested in 2025.
I have no idea what was the main contributing factor since I was doing so much (no alcohol, no caffeine, no sugar, Marodyne vibration plate, quality supplements, weight training, yoga, walking, protein powder, collagen, better sleep).

Hi mayblin, I'm starting on a very small dose of .05/0.14 mg per day with a plan to increase it gradually because I have epilepsy. My BTMs were tested in January, and will be done again next month. I'm also on Evenity, so it's being done primarily to monitor that. With the addition of HRT, I'm going to request it again for July. So, I guess, to answer your last question, the BTMs are being done every 3 months.

Hi, @hopefullibrarian It looks like we have chosen a similar path. I had my first Evenity injections in October, and I started the .05 Estradiol patch the next day. I’m curious if you’ve had any bone marker tests since adding the HRT to the mix. If so, would you mind commenting on your results?

Hi newenglandtransplant, I hope your Evenity treatment is going well and you're adapting well to the HRT. I've had baseline bone markers, and then every three months during the Evenity treatment. I'll put all of the test results here for comparison:

P1NP/CTx 11/115 (Jan 2024) 102/355 (Apr 2024) 119/531 (Jul 2024) 92/496 (Oct 2024)

A lot has happened since the last time I posted anything about my treatment and progress, so, while I'm at it, I'll bring things up-to-date.

On October 31st I had my 10th and last Evenity injections. I'm stopping treatment because my insurance policy is changing on Dec 1 making the treatment unaffordable going forward.

Next week I'm changing the HRT treatment to an estradiol patch, and prometrium (oral micronized progesterone). I changed gynos to one willing to prescribe higher does of HRTs to prevent bone loss.

Also next week, I'll be getting a Reclast infusion, 2.5mg accompanied by intraveneous hydration.
In March, I'll test my BTMs again to determine when to move on to the next step which will be Alendronate.

Because my Evenity treatment is over, I got another DEXA and it included TBS.

Chronology of DEXAs and treatments:
Jan 2023 - First DEXA : Spine = -3.7 ; Left femoral hip = -3.2
May 2023 - Prolia injection
Jan 2024 - First Evenity injections
Mar 2024 - Started HRTs (low dose CombiPatch)
Apr 2024 - DEXA: Results N/A. Unfortunately, the radiologist made a mistake.
Oct 2024 - Last Evenity injections (10th treatment)
Nov 2024 - DEXA: Spine = -2.1 ; Left femoral neck = -2.6
Nov 2024 - TBS = 1.265
TBS reference range
> 1.3 = Normal
1.20-1.29 = Borderline bone quality
1.00-1.19 = Impaired bone quality
< 1.00 = Significantly impaired bone quality

I am over the moon with my results, and my specialists are blown away. It's the best results they've seen in such a short space of time.

Hi @hopefullibrarian , congratulations on your great results! If you don't mind, could you share the dose of estradiol that you used during evenity therapy, and the dose you are planning to increase to? Also, do you have tbs information from previous dxa scan report? If you have good article(s) re advantages in combination of a bisphosphonate and hrt, please share. Thanks a lot!

Hi newenglandtransplant, I hope your Evenity treatment is going well and you're adapting well to the HRT. I've had baseline bone markers, and then every three months during the Evenity treatment. I'll put all of the test results here for comparison:

P1NP/CTx 11/115 (Jan 2024) 102/355 (Apr 2024) 119/531 (Jul 2024) 92/496 (Oct 2024)

A lot has happened since the last time I posted anything about my treatment and progress, so, while I'm at it, I'll bring things up-to-date.

On October 31st I had my 10th and last Evenity injections. I'm stopping treatment because my insurance policy is changing on Dec 1 making the treatment unaffordable going forward.

Next week I'm changing the HRT treatment to an estradiol patch, and prometrium (oral micronized progesterone). I changed gynos to one willing to prescribe higher does of HRTs to prevent bone loss.

Also next week, I'll be getting a Reclast infusion, 2.5mg accompanied by intraveneous hydration.
In March, I'll test my BTMs again to determine when to move on to the next step which will be Alendronate.

Because my Evenity treatment is over, I got another DEXA and it included TBS.

Chronology of DEXAs and treatments:
Jan 2023 - First DEXA : Spine = -3.7 ; Left femoral hip = -3.2
May 2023 - Prolia injection
Jan 2024 - First Evenity injections
Mar 2024 - Started HRTs (low dose CombiPatch)
Apr 2024 - DEXA: Results N/A. Unfortunately, the radiologist made a mistake.
Oct 2024 - Last Evenity injections (10th treatment)
Nov 2024 - DEXA: Spine = -2.1 ; Left femoral neck = -2.6
Nov 2024 - TBS = 1.265
TBS reference range
> 1.3 = Normal
1.20-1.29 = Borderline bone quality
1.00-1.19 = Impaired bone quality
< 1.00 = Significantly impaired bone quality

I am over the moon with my results, and my specialists are blown away. It's the best results they've seen in such a short space of time.

Hi mayblin, I'm happy to share. I've been on the 0.05 mg estradiol / 0.14 mg norethindrone acetate Combipatch since last March. My new gyno will start me off on the equivelant dosage of the estradiol patch (0.05 mg) and the oral prometrium (100 mg) then gradually increase the dosage. I have epilepsy, so we have to proceed with caution. She says it's easier to get the dosages where they need to be with these HRTs than it us with Combipatch. To be honest, I didn't ask why that's the case. I'm just happy to have a doctor willing to do it.

I don't have any articles or research to site on the combination of HRTs and bisphosphonates. I've chosen to do both so to counter Evenity rebound with the low dose Reclast infusion while increasing HRT dosage. I'll continue having my BTMs tested every 3 months to determine when to move on to Alendronate. The idea is to improve my bone metabolism while tapering off of osteomeds. I'm making decisions based on my knowledge of how the various treatments work and how my body is responding. So far so good!