@drsuefowler, i hope my previous reply didn't inadvertently add any anxiety! 1mo is not going to cause a noticeable change in bmd after Tymlos, even while you and your doctors are still determining how you respond to this HRT dose for maintenance.

You are right that the ctx and p1np targets in that study are quite low - and it’s important to note that the study cohort was made up of fracture patients, rather than people specifically transitioning from an anabolic like Tymlos. While this JBMR Plus article explicitly sets those BTM targets, trials such as ACTIVExtend (Alendronate after Tymlos) used strong bisphosphonates to ensure bone turnover is kept low enough to 'lock in' those gains.

Using bone markers for decision making isn't yet standard clinical practice but transitioning to a strong antiresorptive is the go-to strategy for maintenance after anabolic treatment. The availability of various estrogen dosages gives us the advantage of being able to 'titrate' to the desired effects.

I had similar observations as you did - both of my ctx and p1np are very low and they don't change much whether I was active or not. In a way, im having the opposite concern: im not sure if staying in my current low bone turnover state is ideal for very long periods.

To add one more point: if you have extra Tymlos pens and want to use them with Menostar, why not? Those pens are expensive! I actually used my 3 leftover Forteo pens myself with HRT for short periods. Ideally, Id have preferred to wait and use them after at least 1yr break, but the pens were near expiration date. Even though the 3 pens didn't give a huge anabolic signal, my L-spine gained an additional 5%. My endo pointed out that while the estrogen was reducing my turnover, Forteo had likely reached its limits after 22 months anyway. There are several ways to explain that gain or btm, but it clearly helped lock in the progress regardless.