I found that the approaches to HRT differ quite a bit between your endos and mine. Mine determined HRT is a viable tool in my op management however she left the risk assessments to other physicians (obgyns and cardiologists). Yours determined risks > benefits in your case (without consulting obgyn and cardiologists?). I wonder if their opinions were based on "time hypothesis", which favors starting HRT within 5-6 years after menopause, or at least within 10 yrs post menopause with consideration of cvd risks as a general practice.

Here are a few videos in which menopause specialists (obgyns) talked about when is too late to start HRT:

Seems to me the risk assessments are individual based for those who are post-menopausal more than 10yrs. One physician in the video grouped post menopausal women into 3 groups: within 10yr, 10-20yr and greater than 20 yr post-menopause, she then generalized some risk characteristics for each of these 3 groups.

I'd imagine there is a sizable ob-gyn dept at University of Iowa hospital system, and there may be physicians who specialize in menopause/hormone replacement therapy if luck is on your side. You'd definitely want to hear what obgyn/cardiologist has to say about you risk(s) in using HRT and then circle back to endo(s) to discuss again with the risk assessments from other physicians.

Without an antiresorptive following Tymlos, most people will lose bmd gains gradually within 1-2 years. There was a clinical study done on Forteo cessation which showed most lost bmd gains after 2 years if not follwed up with an antiresorptive. Women lost at a faster rate than men did. If you feel strongly about HRT but don't have enough time to get risk assessments done, you could discuss with your endo the feasibility of taking a 'gentler' bisphosphonate such as risedronate (brand name: actonel or altevia, the latter is delayed release form) or even alendronate for a short period of time then transition to HRT afterwards. If HRT not feasible, then either alendronate or iv reclast is the most probable path. It is very interesting to follow tymlos with prolia. I wonder the rational behind this choice and if this endo had a limited treatment term in mind (to be followed by a bisphosphonate).