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Effects of HRT: Alone, in Combination or Sequencing
Osteoporosis & Bone Health | Last Active: Feb 27 9:19am | Replies (86)Comment receiving replies
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.
Replies to "After conducting thorough research, I’m not concerned about my breast cancer risk. I’m part of the..."
I can understand your concerns about your cardiologist prescribing hormones when he doesn't seem knowledgeable. HRT is tricky, particularly for older women. Wondering why your doctor put you on testosterone and not progesterone. Do you no longer have a uterus?
I think it's important to seek out a specialist in this area. If you are in the states, take a look at The Menopause Society list of practitioners in your area:
https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
If you live in SoCal by chance, Dr Felice Gersh is located in Irvine and very knowledgeable about hormones. She's been doing it for decades and keeps up with the latest research. If you are not local, she will still see you but first visit has to be in person (by law) and subsequent visits can be telehealth. She is very expensive but I found it helpful to see her for 2 appts and then navigate on my own through my others docs.
A third and very basic option is to get a consult with Alloy Health, again if you are in the states. You fill out an intake form and a physician who specializes in HRT will review and make a recommendation. I did their intake to see how their prescription aligned with my other doctors and the advice was the same. At the time I did it, I think the cost was $25 for the review. You don't have to order anything from them (I did not as they are a bit more expensive than insurance), you can just pay for a consult and choose not to move forward. If I remember correctly, after the intake, there was a bit of a back and forth conversation by email to get my questions answered.
Wow, you've done a fair amount of work for an informed and shared decision.
I've only done LPa for ASCVD genetic testing, and thought APO-E is for neurodegenerative risk. My understanding is LPa and APO-B are most atherogenic where high LPa is not treatable. But since LDL-c is routinely tested it became the "proxy" for atherogenic burden although for some people the two may not correlate to each other. Please correct any misunderstanding here from your knowledge base.
Which calculation method do you use for your 10 year cvd risk? I've used MESA which takes cac score into account. The calculated risk is below 2%. But this calculated risk is based on the LDL-c level that was controlled below target value by a statin and heart healthy diet. I have a feeling cardiologists know this very well based on labs/tests, medical history and family history.
You are at a unique position to use HRT for your osteopenia to prevent/stop bone loss. I wonder how often you get dexa scan and if you monitor bone markers. I'm keen to see how testosterone in the mix would affect bone markers. If you test them and could share, it will be great to to observe testosterone effect, even at the very low dose you are getting,
I'm sorry I keep saying CVD when I mean CAD. They are not the same.
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Look up Menopause Taylor on YouTube. She is a gyno who has done hundreds of videos on HRT and women's health.