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Effects of HRT: Alone, in Combination or Sequencing
Osteoporosis & Bone Health | Last Active: 50 minutes ago | Replies (33)Comment receiving replies
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?
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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.