I was on 6 out of 8 clicks for 2 months or so and have been on 7 clicks for 10 months. My doc was pleased with even 6 but lower than that, I think, might not be effective. Check with your doc. In my experience you should be able to work your way up to a therapeutic dose while minimizing side effects by ramping up as tolerated.

I only did 3-4 clicks in the first few days to get used to the medication and the whole process, but I doubt this dose was therapeutic, and my endocrinologist was very adamant that I try to reach a therapeutic dose as soon as possible. I kept going up to get the most benefit from the treatment. I have been stuck at 6 clicks for a few weeks because although side effects have greatly diminished, I still feel nauseous and tired for a few hours every day (and have occasional leg cramps or back and hip pain, although very tolerable). I'm waiting a little more to see if that diminishes so that I can try 7 clicks. I don't want to go through all this for nothing.

@lnl, I am on 4 clicks and plan to stay at this level. I am very sensitive to all medications and petite. I have been on Tymlos for 5 1/2 months and started at 2 clicks. I recently learned that I can't just buy the pens every 2 months. I started my third pen the other day and the side effects all came back on the same 4 clicks. I can tell that the medicine is so much stronger than what I was taking before, even though I always refrigerated it.

I am also learning that all 3 of the anabolics, Tymlos, Forteo and Evenity, appear to only help trabecular bone and make cortical bone porous. I broke my 2nd metatarsal in my foot. After 11 weeks it still has not healed on Tymlos. This is the 4th fracture in less than 2 years and all others have healed quickly. I wonder if the problem is the Tymlos. My endo wants me to keep taking it for my back (which has never fractured but has poor density according to my DEXA scan). My orthopedist suggested not taking it for a couple weeks to see if it helps. I am scared to do that. Does anyone know how soon you have to take a bisphosphonate after Tymlos?