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Anyone use HRT as their immediate follow-up to Tymlos or Forteo?
I'm 63 and will finish 24 months on Tymlos six months from now. At that time, I'll have 6 final months on my commercial insurance before starting Medicare.
I'm one who is probably above-average motivated to delay using a bisphosphonate to "lock in gains" for as long as possible. I don't want to do it anytime soon because I feel like a lot of changes are afoot in this field and best practices are evolving to where more and more people are going to be "allowed" to stay on anabolics past 24 months. That excites me and I don't want to do a bisphosphonate and then dampen the future efficacy of any anabolics I might be offered.
Anyway, I've been researching new-fangled approaches to drug selection and sequencing for my impending "24-months-on-Tymlos-is-now-complete" phase. Working hard and smart on a Prior Authorization for Evenity after Tymlos intrigues me as one possibility as does the use of late-start (11 years after menopause) HRT alone for my next phase.
When we touched on possibilities for this next phase (as we often do in my appointments) my endo caught me off guard because we had just gone over extra lipid testing I had done (APOB and LIPO(a) ) and when I asked him how he was "feeling" about the eventual possibility of using over-60, late-start HRT for locking in gains he said "I have no problem with HRT for you-- your LIPO(a) is near 0 and your other numbers look good. Why do you want to wait till you're done with Tymlos? Why don't you start now and get the benefits of HRT now?"
This was a 20 minute appointment and time was up and the nurse came in and I got whisked away to get my A1C checked or some such thing. I told him I had a lot more questions and would make a longer appointment very soon--he said great/good idea, that he always forgets I'm one of his only patients who does her own research and has her own ideas (?!) and he welcomed the discussion. He said he was calling in .025 patches and 100mg micronized progesterone that day, anyway, so that I'd have them available if I decided I want to get started now.
TLDR: I believe there a couple of you on here who are using HRT as your Tymlos or Forteo or teriparatide follow-up regime... (?). If so, did any of you get started on the HRT while on the home stretch of your anabolic? Or did you wait till your course of Tymlos, Forteo, etc., was complete?
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@md79 Doing teriparatide (brand Forteo) is the a great choice for where you are based on what I have read. If I had a vertebral fracture then I would be doing exactly that. Most people tolerate it very well, including a friend of mine. But she never got on this discussion site because everything went well. So the discussions here are far more influenced by people looking for info after having side effect issues.
Doing HRT at the same time is also a cool path, and even more cool if HRT then holds in the teriparatide gains after several years. Glad to hear you got your estradiol all set and are not waiting on it.
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1 Reaction@kfhoz Thank you so much for your support. I wish you and all a successful journey in building bone and reversing osteoporosis, "possibly".
@kathleen1314 The pubmed study, unfortunately, only shows that the drug boosted those on HRT. Not that HRT helped the drug. There was no control group with drug only; they may have fared just as well. The lack of research in women’s health in this area is criminal!
Hi to all,
I started my transdermal estradiol patch with the smallest dose, 0.025 mg, a month ago. Before starting, I had a serum estradiol level, which was 23, which is a standard level for a menopausal woman. Plan to increase this dose to 0.05 mg in 3 months, depending on how I feel and my labs.
I am on Teriparatide/Forteo - started 2 days ago. I am experiencing a heavy chest with heart palpitations, and my blood pressure is jumping up and then going back a little bit low in about 4-5 hr. I think this is a side effect of Teriparatide/Forteo, and I hope I will adjust to it.
My experience many years ago doing HRT right after 2 years on Forteo: After 3 years on HRT I had lost all the gains from the Forteo, and then some.
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3 Reactions@tkw1 what did you do next?
@tkw1 - were your blood serum or saliva levels monitored when you were on HRT to see if you were absorbing an adequate amount to impact the bones?
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1 Reaction@tkw1 What estradiol dose and, as @singingbones asks, was your resulting blood serum estradiol level tested? Thanks tkw1y. Sorry to hear about your outcome, and your experience is very useful information.
Here are some excerpts from the below linked article to show why this is important:
"Limited data suggest that up to 20% of women are “poor absorbers” of transdermal estradiol. It is essential that ‘poor absorbers’ with subtherapeutic levels are prescribed higher doses ..."
"... there is substantial interindividual and intraindividual variation in estradiol pharmacokinetics, resulting in up to 10-fold differences in estradiol levels between women using the same dose patch or gel. ..."
Title: The range and variation in serum estradiol concentration in perimenopausal and postmenopausal women treated with transdermal estradiol in a real-world setting: a cross-sectional study
https://journals.lww.com/menopausejournal/fulltext/10.1097/gme.0000000000002459~the-range-and-variation-in-serum-estradiol-concentration-in
Dr. Doug Lucas also explains why dose, and testing for response, matters in this video.
I got mine tested through Jason Health and I was exactly on the mean dose-response for the patches that I was taking. The cost was $55 plus $18 collection fee but I had 3 other tests (incl CTX and P1NP) done at the same time that used the same collection.
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1 Reaction@singingbones, @kfhoz, @daisylou,
This all happened about 15 years ago. I REALLY did not want to go on Reclast, so avoided my endocrinologist, and got the prescription for a .05 Estradiol Combi Patch from my gynecologist. Followup serum testing was not on my radar, nor mentioned.
After discovering the the loss, I agreed to Prolia, had one dose, many side effects, decided to stop, switched endocrinologists, joined an osteoporosis support and information gathering group, and chose to go on Reclast for 3 years. Then a 3 year holiday. I've started Tymlos rather than Evenity because 1) more is known about how it reacts with a cortisone shot 2) the possibility of upcoming surgery, and 3) I still have further teeth issues to address. My spine is T = -4.0 (-3.5 at age 50, first scan), and my TBS corresponds (though my first TBS a year ago showed much better bone quality?). I'm very active outdoors. Falls happen. I had a couple of minor traumatic fractures (wrist, elbow), and an osteoporotic avulsion fracture in my foot, all after stopping Prolia, before Reclast had built up. None since. If my spine T score was less than -3.0 , I would likely try to rely on diet and strength training to improve my density.
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2 Reactions@md79
I have checked estradiol levels a few times without a doctor’s order. However, I am reconsidering that after hearing how estradiol levels are all over the place depending on time of day, time since patch change, and so many other variables that don’t necessarily translate to lack of absorption. The studies show that the recommended fda approved recommended doses of estrogen do help protect bones, with .05 patch bring the standard dose. You can check out:
https://substack.com/@vajenda/note/c-267173842
https://substack.com/@vajenda/note/p-165788009
https://substack.com/@vajenda/note/p-203003919
https://open.substack.com/pub/drstreicher/p/july-2026-ask-me-anything-webinar
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