HRT Safety

@debbie1956 ok, thanks.

@mayblin , could you share the list of labs and tests used for your evaluation? Gosh, I don't remember how old my mother was.. maybe in 70's? I don't know the specific type. I do know she had a lumpectomy so I'm guessing it was minor. Do you have a online link to the Tyrer-Cuzick model? Thanks

@leeosteo, @loplady

Here are the labs and tests that were part of my evaluation. Keep in mind that my doctors were reviewing an existing diagnosis of coronary artery disease established 2yrs prior to my HRT consultation, so my list might be more extensive than what is required for someone with a clean scan:
Labs: full lipid panel, ApoB (Apolipoprotein B), Lp(a) -a genetic marker, HbA1c, hs-CRP, and CMP
Tests: Echocardiogram, CAC Scan (my score is 38), ultrasound of the carotid artery, AAA (Abdominal Aortic Aneurysm), and peripheral arteries (all negative).

I did not do a CCTA or any type of stress tests since both specialists felt they weren't necessary in my case. My situation is a bit ironic: I have no family history of CVD or metabolic disease, but my past diet habits led to this early plaque built-up and calcification. You, on the other hand, have a clean CAC score at an older age despite your family history.

HRT-related cardiovascular risk follows a 'timing hypothesis': clinical trials suggest it is safest and most beneficial when started within 10 yrs of menopause (or before 60). Breast cancer risk, however, is primarily driven by the duration of use, dosage, and the type of hormone prescribed based on large observational studies.

Family history of breast cancer isn't an automatic contraindication. For example, triple-negative breast cancer isn't hormone-sensitive, so HRT doesn't carry the same concern. There are also multigene panels beyond just BRCA1&2 available nowadays. Seeking a specialist well-versed in detailed risk assessment (like a medical oncologist or NAMS-certified menopause specialist) might be the key.

Here is the link for Tyler-Cuzick: https://magview.com/ibis-risk-calculator/

Good luck!

p.s., my LDL-c has been maintained under my specialists' target (under 50) for a number of years now. This, combined with my -ve ultrasounds, lack of family history and other notable medical conditions, was likely a major factor in getting the "green light" for HRT despite of a +ve cac score and being 61 at the time.

@blueberre she might’ve been asking for an entirely different reason: to get your insurance to cover the hormone replacement therapy. They don’t cover it for any reason or no reason and that’s the question that is asked in order to get insurance to pay for it.

@blueberre I am with @loriesco on this. One of my doctors looked me straight in the face with raised eyebrows and asked if I had any menopause symptoms. Ignorantly I just said "no" when I should have said, completely honestly, that I had reduced libido, mood swings, and vaginal dryness.

But my next doctor still got me on insurance-covered HRT anyway at age 66 and 20+ years from my 43yo menopause. And the HRT has helped with the symptoms above also.

@kfhoz interesting.

Hi All - I haven't posted in a while, so wanted to share my progress after 1 year on HRT. Some background; I just turned 63 and had a T12 Spine fracture in December, 2024. I was lucky to find a PA at my clinic who was open to prescribing HRT. I'm sharing a lot of data below and hope this helpful to others. I'm am VERY encouraged by the increase in BMD per the REMS scan and really hope this is accurate. I'll have my next DEXA this fall on the same machine and add the TBS score.
One interesting point is the difference in my last DEXA (osteoporosis in Spine/Osteopenia HIP) and REMS showed the opposite. Also, my first CTX/P1NP might have been falsely high due to 5 months post fracture. My 2nd P1NP is lower than I had hoped but my research using AI indicates the drop is normal on HRT.

I wasn't able to paste the excel data here and keep the formatting, so attached a pdf copy. Hope it works!

@kshea2
Also on HRT, my P1NP went lower as well and my understanding is that as bone loss stabilizes the bone building process also slows. Similar to how these numbers would respond to a biophosphate med.

Congrats on numbers moving in positive direction. 😊

@dvargo Can I ask what type of HRT you are on? Do you use topical gel, progesterone pills, testosterone? I'm learning about this now at 63. Thank you!

@bano Topical estradiol and testosterone. Progesterone is a pill. I started at 64, now 67. My bone density increase 5% in one year.