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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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@cliffdweller, thank you for your reply and for sharing your experience. I really appreciate it, and I hope you have a smooth and speedy recovery!
Was your improvement to a Tscore of -1.8 after being on HRT for a while? That's a wonderful improvement. If you and your doctor are comfortable with a DXA every 1-2 years, BTMs may not add too much beyond that. I find them interesting and potentially helpful, but they are still not considered part of standarded care, and there aren't standardized guidelines for interpreting them.
Like you, I follow Dr. Jen Gunter on Substack. I really enjoy her thoughtful, evidence-based perspective on menopausal hormone therapy. It's valuable to hear from experts we trust who can help put new findings into context. Thanks for sharing those links!
@mayblin
-1.8 (spine) was just over 2 years ago before I started HRT. It will be 2 years coming up in November that I started HRT. Will be interesting to see results. I found a place that does TBS (Simon Med Imaging) and switched my appointment from previous location (Radiology LTD)
. I met with an endocrinologist once a little over a year ago. When I mentioned wanting to try to get a facility with TBS capability, she said TBS was only experimental or used for research or some bullshit like that. She discussed the Osteoboost vibration belt, gave me a pamphlet. told me to look it up and if I decided on it, she would write me an RX for it. I did research it. The only studies on it are from the company that produced it; the evidence is very weak. It is FDA cleared, but not FDA approved for osteopenia. And cost like $1,000. People on Reddit said they ordered it and then waited several months to get it, or wondered if they were getting it at all; difficulty getting a response from company. Makes me think my endocrinologist is getting kickbacks from RX’s for this device.
She also went through diet and emphasized almonds and kale. Sometimes I follow directions too carefully and was eating almonds every day. I didn’t know about oxalates and phytates at the time. My calcium is now low and after hip surgery was anemic. So now I only do almonds occasionally. Looking for a new endocrinologist or may just avoid one altogether. My new primary care is so different from my previous doctor, he actually listens and has some curiosity, so he may be my best bet now for monitoring my bone health.
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Currently doing DEXA every 2 years. Just wondering: How do you get one every year? Is it with Medicare every year? Im too young to get Medicare.