Effects of HRT: Alone, in Combination or Sequencing

@mayblin
Congrats on your amazing results! I had similar scores in my Lumbar spine (-3.6) and hip (-1.6) in Jan 2023. I was shocked as my lifestyle contraindicated any thoughts of bone loss. However age, time since menopause (18 yrs) and my personal biology had other ideas. I delayed starting anything until Jan of 2024 while I researched any alternative other than pharmaceuticals..... then I chose Tymlos. It seems Tymlos, Forteo and Evenity were the only way to build bone, as exercise, weight lifting, and diet did not prevent bone loss for me. I've never taken HRT as I'm in the generation who was steered away from it based on the now outdated and flawed study from the early 2000's. I'm anxiously awaiting my next Dexa scan which will be next week. Also seeing a new endocrinologist at that time with hopes of starting HRT. I have no idea what her opinion of HRT is yet, but am hopeful. My current PCP, rheumatologist and 2 previous endos were not in favor. There is so much positive research to support HRT now that I'm not sure why it is still outside the mainstream for osteoporosis treatment. You would think that loss of hormones during perimenopause and menopause, directly related to bone loss over time, would be a first course of ONGOING research and study. Not outside the mainstream.

I agree with you that this forum has been an invaluable resource of support and information. Without it I would never have learned about almost everything I now know to question my drs about. I hope you see continued improvement and progress in your journey and look forward to seeing your results over time.

Good results to us all no matter what path is choosen!!!!

I am only 4 months into using bhrt. I am in the same boat trying to figure my own bone journey. Some of the others will have more to share than I.

Hi @kisu I am using estradiol (generic for Vivelle Dot) 0.025mg/day transdermal patches and micronized progesterone (generic for Prometrium) 100mg gelcap to be taken orally before bedtime. No testosterone - since the cardiologist whom I sought for 2nd opinion advised me not to use testosterone due to my existing mild CAD (I have a cac score of 38).

Thank you. I wonder if the suppression of bone remodeling played a role in my fracture. I was heavily active during the period I was on Fosamax, lifting heavy weights and increasing exercise in the belief that stressing my bones would lead to building more bone. I did not know that bone remodeling eventually stops on alendronate.

Thanks, Mayblin for replying. Would you say he has more concerns about testosterone than estrogen? I wonder why he thought a small amount of testosterone would be bad. There is so much conflicting information from doctor to doctor. It's like you must know more than your doctor and take your health into your own hands.
I have CAD, a CAC of 79, and osteopenia. I asked my Cardiologist if it was ok to use my 0.05 estradiol patch for my osteopenia. He said, "Sure, but it causes breast cancer." I started to say there was new information, but he interrupted me and doubled down, "It causes breast cancer." I also told him I'm also using 4mg of topical testosterone cream a day, and he said fine. My dilemma is can I trust him at all because he told me estrogen causes breast cancer?

I had Evenity May June 2024, but quit due to extreme breathing problem. Started HRT in Aug 2024; had Reclast Sept 2024. Here are my two dexa scans. I'm really pleased with the results and will stay on HRT with Reclast again around Oct 2025.
12-2023 Spine -3.1 (0.708) Femoral Neck left -2.8 (0.540) Total Hip Left -3.1 (0.568)
01-2025 Spine -2.0 (0.832) Femoral Neck left -2.7 (0.545) Total Hip Left -2.7 (0.609) new Forearm left -3.2 (0.499)

I was in disbelief that my regular cardiologist approved my estrogen use the same day via inter-department message to my obgyn without seeing me. Now thinking back, he probably knew my cvd risk well enough to give the approval right away. Not fully sure at the time, I went for a second opinion but testosterone use wasn't in my plan. This second cardiologist at a different institution went through all my labs/tests in the past and didn't hesitate to give a green light, although she set a new target of LDL-c below 55 and HbA1c at normal level (I was borderline prediabetic). She was the one mentioning "stay away from testosterone", which I think was based on my existing cad but I didn't ask further. Now I'm curious and will ask her at next appointment.

The risk for breast cancer probably is still derived from WHI, about 0.8 more cases per 1000, although data were based on CEE and MPA. The mortality rate did not increase because of it as data showed. I had obgyns assessing my bc risk. Even with a low risk profile, the decision was still a hard one. I've discussed with family members with a plan in place should bc happen to me.

Hope you get your risk vs benefit sorted out soon. Maybe seeking an opinion from a obgyn for breast cancer risk?

After conducting thorough research, I’m not concerned about my breast cancer risk. I’m part of the "Wisdom" breast cancer study, which is open to women 74 and under. The study includes genetic testing for 29 mutations associated with breast cancer, and I don’t have any of these mutations. In 2012, I had a 23andMe test for BRCA1 and BRCA2, and I’ve since had it redone through the Wisdom study. I’ve always maintained healthy habits.

My main concern is my heart health. I have cardiovascular disease (CVD) and, not surprisingly, 15 genetic risks for CVD (such as Apo(a), APOB, APOE4, thin caps, etc.). I’m worried because my cardiologist is not up-to-date on hormone knowledge. He believes estrogen causes breast cancer, but I know that’s incorrect. Given that he’s misinformed on this topic, I’m unsure if I can trust his advice about using a .05 estrogen patch and 4mg of testosterone. Does he fully understand the risks of hormone replacement therapy (HRT) for someone with my cardiovascular risks?

It’s possible he wasn’t educated about women’s hormones and their relationship to cardiovascular health during medical school. I could seek a third opinion, but what if that cardiologist also advises against HRT? How do I know which doctor to believe? I had to wait five months for an appointment with my current cardiologist and four months for my first one. Should I wait another five months for a third opinion?

It took me two and a half years to find a doctor willing to prescribe HRT. Navigating the healthcare system, staying informed about current HRT options, osteopenia/osteoporosis, and the latest CVD research has felt like a full-time job. If it weren’t for forums and knowledgeable doctors sharing information through social media podcasts, I would feel lost and alone.

I find some reassurance in knowing that cardiovascular events for older women who begin HRT usually occur in the first year of use and tend to diminish after that. I’m currently in my ninth month of HRT.

I acknowledge that this is a tough decision, especially since the risks and benefits for women over 70 starting hormones are not well understood. I appreciate everything you’ve shared and am grateful for forums like this one.