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Anyone use HRT as their immediate follow-up to Tymlos or Forteo?
Osteoporosis & Bone Health | Last Active: 1 hour ago | Replies (65)Comment receiving replies
Hi @cliffdweller, have you noticed any correlations between your blood estradiol (E2) levels and the timing of the blood draw in relation to a patch change? I've read that maintaining a consistent blood draw timing relative to patch change is ideal, specifically, drawing right before a patch change to capture the trough level.
Do you monitor your bone turnover markers such as CTX and/or P1NP?
A blood level of E2 reflects the degree of absorption - it can vary significantly from person to person. Even at same E2 levels, different individual can have varied degree of biological responses. Because of this, i think it makes sense to track the impact of HRT on bone health with 3 distinct tiers: 1) serum E2 level - measures delivery and individual absorption; 2) bone turnover markers (BTMs), serve as a proxy for the biological response at one point of time; 3) DXA scan for ultimate confirmation.
For example, I use a 0.025mg/day patch, a low dose, and my trough E2 level was 42pg/ml, indicating decent absorption. I've only had my level checked once as my docs are not keen on monitoring hormone levels (i will push for another lab just for my own curiosity). However, my periodic CTX results have been consistently staying below 120pg/ml, showing a strong biological response. My 1st year with HRT (post-Forteo) DXA remained stable with a 5% BMD increase in L-spine, and my DXA after 2nd year HRT is pending.
Replies to "Hi @cliffdweller, have you noticed any correlations between your blood estradiol (E2) levels and the timing..."
@mayblin
I have wanted to get CTX and P1NP, but haven’t yet. Former primary care didn’t know what they were, crossed her arms and referred me to an endocrinologist who blew me off when I mentioned bone turnover markers. My new primary care, just out of residency, didn’t know what they were, but listened, and says he is willing to revisit this. He’s reluctant to do so now because after recent hip replacement surgery (and anemia after), my labs are all over the place. He did point out that my Alkaline phosphatase (ALP) was not high, which is another marker of bone health. I had just run across that info. so I feel hopeful that he is considering bone health.; hopeful that he will work with me and perhaps step out of the recommended guidelines for testing BTM’s. My most recent DEXA 2 years ago showed osteopenia of the spine (-1.8) for the first time. I have a DEXA with TBS scheduled in the next month or so.
I haven’t noticed any significant correlations with estradiol levels in the timing, because I really wasn’t paying attention to patch changes and timing of the test. I did get a baseline before I was on hormone therapy and it was very low. I believe it was like a 6. I wasn’t even sure what the number meant when I got the test on my own, but i thought it may be useful as I learned more. I had two DEXAs before this, so I know that menopause/lack of estrogen had a huge effect on my bones, and I believe I am in the category of what they call “fast losers” where, without estrogen, I lost bone very quickly.
Besides reading NIH research, I do subscribe to the Substack of menopause experts Dr. Jen Gunther, Dr. Lauren Stricher, and Dr. Mary Claire Haver. I find Gunther to be conservative in her approach. She’s very research based which is good, but doesn’t waver if we don’t have the research to support something. which I think that can miss a lot. Dr. Haver is very knowledgeable, but sometimes leans too far out of the research. And for me, Dr. Stricher is my happy medium and my go to. Very science based and reputable, but willing to consider what we don’t absolutely know because of lack of studies. She does a monthly Ask Me Anything podcast for subscribers that I find very helpful.
That said, I probably won’t continue to chase the perfect estradiol numbers. I won’t say that I will never test again because information changes. But I’ve been getting more information on how so many things effect estradiol numbers and the FDA approved doses in research studies demonstrated that they worked. I did notice that Dr. Stricher had a Substack on estradiol absorption, referencing the study by Louise Newsome; but later changed her view of that and she does not recommend testing estradiol levels, neither does Gunther. Although Gunther’s posts tend to be oppositional in general. Consider checking these out:
https://substack.com/@vajenda/note/c-267173842
https://substack.com/@vajenda/note/p-165788009
https://substack.com/@vajenda/note/p-203003919
https://substack.com/@vajenda/note/p-149954989
https://substack.com/@drstreicher/note/p-207085614
https://substack.com/@drstreicher/note/p-162890954
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@mayblin - I've read of optimal levels of E2 being 60mg/ml or even higher to make an impact on bone health. But your BTM are telling the story that we want to hear even w/lower levels of estradiol!
What T-score did you achieve with Forteo and was there an overlap with HRT for you? If you started HRT after you finished with Forteo, then the increase in the spine and stabilization of the other BMD areas is even more encouraging. I look forward to reading about your results after a 2nd yr of HRT.
My ortho dr is not a fan of chasing BTM and I haven't asked my new gyn if she will test/monitor hormone levels. I do have baseline levels on all those labs, so worse case scenario I will use a self-pay lab to track my progress now that I've finished the Evenity course.