One approach is to start in the middle, let's say four clicks. If that goes well, the next day, try five clicks, and so on. If five clicks really bothers you, go back to four and stay there for a few days, then try again.

In reply to @stress101 "@gently I actually did start to use the pen at .60 (six clicks) and I have..." + (show)
from the archives of windyshores | @windyshores | Oct 3, 2022
I started Tymlos at half and then full dose and ended up in the ER. Had afib, but also was dizzy, headachy, pain all over, nausea- lots of side effects.
I stopped, then met with docs, then restarted at two clicks out of 8 (my idea). I slowly went up over two months, to 7 clicks, where I have stayed for a year. This really minimized side effects. Many days I have none at all.
I have found that hormonal drugs like this (and my cancer med too) have more side effects at first and they change and even lessen. But my full dose attempt created a cardiac side effect that was serious.
With fractures and a committed desire to avoid further pain and disability, I was determined to get back on and have not suffered any significant side effects with this ramp up plan.
That said, Forteo was intolerable for me and does not have an adjustable dose. I have not tried Evenity but that might be an option for you.
Or....you could try two clicks of Tymlos and see what happens, then go to 3, then 4.....and so on!

I started at 8 clicks. 2 days of horrible side effects!!! Headaches. Tiredness. Muscle weakness. Generally feeling like crap
I spoke to my arthritis specialist. He cut me back to 2 clicks for a week. Then 4 clicks for a week and so on til I finally got to 8 clicks after a month. The only side effect I feel now is just being tired. I can tolerate that pretty much.
Good luck to you