@singingbones

Thanks so much for bringing this up - anything about estrogen is absolutely relevant here.

From what I’ve gathered, among the three main forms of estradiol - oral tablets, transdermal patches, gels, or sprays, and vaginal creams, tablets, or rings (mostly for local effect) - transdermal patches generally provide the most consistent systemic hormone levels. Doses typically range 0.025–0.1 mg/day, with 0.05 mg/day being a common clinical standard. Meta-analyses show that bone benefits (maintain or increase BMD) are dose dependent.

I’ve found monitoring bone turnover markers like CTX helpful in gauging dosing adequacy.

Are you currently using MHT alongside Evenity, or did you stop before starting it? And just to clarify, is your cream vaginal or meant for systemic absorption through the skin?

If you’re thinking about MHT after Evenity, it’s important to review form, dose, timing, and monitoring with your endocrinologist. Estrogen usually takes 6–9 months to reach maximal CTX suppression (compared with ~12 weeks for oral bisphosphonates), so timing after an anabolic may affect how well resorption is controlled. The type of anabolic and individual response (to either anabolic or estrogen) can also make a difference.

Please share what you learn, it could help many of us gain insight from newer information and firsthand experiences.