@smodesitt

Does your endocrinologist do pellets? That may be a path for you but I wonder if you might have to try a functional medicine practice for that. If you are also adding testosterone you can have a pellet inserted with both estradiol and testosterone. They last about 12 weeks but Medicare does not cover them.
At 78 risk is not not such an issue when I am much nearer death.

@smodesitt
I overlapped Forteo and HRT for about a week at the end of my Forteo treatment - not for any particular reason, and certainly not based on evidence. It ended up working out fine for me. From what I’ve read and from my own experience, it takes about 6 months for HRT to achieve its maximal suppression of bone resorption.

Now that your cardiologist has cleared you, would your OB-GYN (or perhaps another OB-GYN) be willing to prescribe HRT?

Since you’ve had a hysterectomy, you could use estrogen-only HRT (double-check with your physician), and it generally is considered to have a more favorable risk profile than combined estrogen-progestogen therapy. Most OB-GYNs now prefer transdermal estradiol patches - they are bioidentical, FDA-approved, easy to adjust (dose) and typically covered by insurance. If you’re interested, you can look up discussions on preferred HRT formulations, for example, Dr. Jen Gunter has an excellent evidence-based series on MHT on her Substack, including discussions of different formulations and why transdermal estradiol is often preferred.

If you’re also considering testosterone, I’d make sure your cardiologist is comfortable with that as well.

For reference, I pay $20 for a 3mo supply of estradiol patches and a $30 copay for my yearly OB-GYN visit with insurance coverage. My doctors monitor my bone turnover markers (BTMs), which I find helpful for tracking how my treatment is working. If needed, blood estradiol level can be done and covered.