@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