I started HRT all topical about a year ago. I found an integrative DR near me not covered by Insurance.
They ran blood work and DUTCH test to evaluate my current hormone levels and started me on topical estradiol, estriol and progesterone. I have family history of breast cancer as well, so pursuing the topical creams seemsed to be the least risk.
My spine TScore was -3.5 and only area with osteoporosis and no fractures.
I wasn't ready to start the osteoporosis meds so pursued the HRT.
So far it is helping.

Spinal bone is the quickest to remodel and get positive results.
I also didn't feel like I had to rush and took my time to explore options and find the DRs I felt comfortable with. Again Ive not had any factures either so I didn't feel like i had to jump in right away.