Transdermal HRT

My HRT patch was prescribed by my gyn. She will not prescribe a higher dose. I did still have bone loss and reached out to an OB-GYN bone specialist at Georgetown University. She's recommending Forteo. She said I could stay on my low dose of HRT while I'm taking Forteo. We're scheduled to more fully discuss transdermal HRT. She says there is a greater risk of stroke after the age of 70. I keep reading studies like the one I posted here from ACOG that say otherwise, which is what I want to talk further with her about. We have already talked about it a little but she's adamant about the stroke risk . What I'm curious about is this: is the risk of my having a stroke greater than the risks of the other first-line osteoporosis treatments like: osteonecrosis of the jaw; spontaneous femur fractures; stroke; osteosarcoma; loss of teeth; renal impairment; difficulty swallowing; increase risk of blood clots; digestive disorders, etc etc? It seems like I'm not only still at risk of a stroke, but that I'm adding a number of other terrible side effects to that risk.

I do plan to take Forteo, but am hoping that after that I might be able to just increase my HRT dose a little to maintain whatever gains I get from Forteo. I'm on the lowest dose (.014), 1x a week of Menostar w/100mg of Prometrium 3x a week. Sorry this is long.

I completely agree with your thinking! There are risks to every drug option and I'd rather take the risk with something my body naturally recognizes and offers so many additional benefits aside from bone density maintenance.

That is a super-low dose of estradiol you are on. I didn't even think it was offered at such a low dose. The doses I have seen listed that are helpful to bone start at .025 and I thought that was the lowest dose offered. I've been on .025 transdermal for about 5 years. I've mostly maintained my density (same overall dexa score) with a couple of vertebrae that show loss so that concerns me a little. I've recently seen an integrative gynecologist who is bumping me up to .037, a very small increase. She would definitely go higher but I'm concerned about the potential of increase in breast size. If you are considering increasing your dose (after your course of Forteo sounds like a good plan), it might be a good idea to assess your stroke/CVD risk if that is a concern. I've had my detailed cholesterol numbers done which most doctors don't order. If you ask for them, they might. I've tested LPa (genetic marker and hard to lower. fortunately mine was low), oxidized LDL (whether your particles are small and dense which tend to clump and form plaque), and a CT scan to determine calcium score. My calcium score was 0 which means there was no discernible plaque detected in my arteries as of yet. I'm tweaking a couple of things to try and keep it that way but since my risk appears to be low, I'm comfortable with continuing on the HRT and increasing my dose. Unfortunately, most doctors don't do detailed cholesterol bloodwork to really get a good determination of risks so it's important to ask.

Thank you for sharing. Aside from your concern regarding breast size, did your gyn discuss risks of upping your dosage higher than .037?

I completely agree with your thinking! There are risks to every drug option and I'd rather take the risk with something my body naturally recognizes and offers so many additional benefits aside from bone density maintenance.

That is a super-low dose of estradiol you are on. I didn't even think it was offered at such a low dose. The doses I have seen listed that are helpful to bone start at .025 and I thought that was the lowest dose offered. I've been on .025 transdermal for about 5 years. I've mostly maintained my density (same overall dexa score) with a couple of vertebrae that show loss so that concerns me a little. I've recently seen an integrative gynecologist who is bumping me up to .037, a very small increase. She would definitely go higher but I'm concerned about the potential of increase in breast size. If you are considering increasing your dose (after your course of Forteo sounds like a good plan), it might be a good idea to assess your stroke/CVD risk if that is a concern. I've had my detailed cholesterol numbers done which most doctors don't order. If you ask for them, they might. I've tested LPa (genetic marker and hard to lower. fortunately mine was low), oxidized LDL (whether your particles are small and dense which tend to clump and form plaque), and a CT scan to determine calcium score. My calcium score was 0 which means there was no discernible plaque detected in my arteries as of yet. I'm tweaking a couple of things to try and keep it that way but since my risk appears to be low, I'm comfortable with continuing on the HRT and increasing my dose. Unfortunately, most doctors don't do detailed cholesterol bloodwork to really get a good determination of risks so it's important to ask.

She doesn't anticipate any risks.

You had mentioned previously that Alloy had recommended the next dosage up- .05 for bone health so was surprised that your gyn thought .037 was enough... is it just enough to maintain bone? Did she say that higher doses might build bone?

I think Dr Gersh would prefer I was on .05 but I'm a hold out. I might just stay on the .037, have a dexa in 2 years and reevaluate then. Or if I don't see any breast tenderness, I might increase my dose. It's really a balancing act of keeping risks as low as possible and maintaining bone. When I first went on hormones I was told by several of my doctors that .025 was enough to maintain. Building bone is another story and I think in menopause it's quite difficult. Just think that in our lifetimes, we have estrogen in our bodies generally until our early 50s but we stop building bone by about age 30. So, supplementing with estrogen after menopause will do more to maintain than build but the higher doses may have a greater effect on increasing density. There are still a lot of unknowns about long term use and starting HRT past menopause so I feel most comfortable with the lower dose. That said, .05 is still considered a low dose so I may be considering it.

Here is a great video interview with Dr Risa Kagan, a gynecologist well informed on hormone use. Unfortunately she no longer sees patients. She discusses dosing in the video.
https://gbmc.webex.com/recordingservice/sites/gbmc/recordinghttps://gbmc.webex.com/recordingservice/sites/gbmc/recording/e6111214853f103bbf7e005056811e38/playback

TEB thank you so much for sharing your information. It's so appreciated. Just want you to know that when I went up to the .0375 after being on the .025, my body reacted to the change about a month in. I experienced breast tenderness for a week or so until my body adjusted to the higher dosage. Now I again have no symptoms and after being on the .0375 for several months I will ask to titrate up to the .05 if my ND agrees. That is why I asked if your gyn saw any risk issues going for a higher dosage.... I am looking forward to looking at the video with Dr. Risa Kagan! Thanks again!

My HRT patch was prescribed by my gyn. She will not prescribe a higher dose. I did still have bone loss and reached out to an OB-GYN bone specialist at Georgetown University. She's recommending Forteo. She said I could stay on my low dose of HRT while I'm taking Forteo. We're scheduled to more fully discuss transdermal HRT. She says there is a greater risk of stroke after the age of 70. I keep reading studies like the one I posted here from ACOG that say otherwise, which is what I want to talk further with her about. We have already talked about it a little but she's adamant about the stroke risk . What I'm curious about is this: is the risk of my having a stroke greater than the risks of the other first-line osteoporosis treatments like: osteonecrosis of the jaw; spontaneous femur fractures; stroke; osteosarcoma; loss of teeth; renal impairment; difficulty swallowing; increase risk of blood clots; digestive disorders, etc etc? It seems like I'm not only still at risk of a stroke, but that I'm adding a number of other terrible side effects to that risk.

I do plan to take Forteo, but am hoping that after that I might be able to just increase my HRT dose a little to maintain whatever gains I get from Forteo. I'm on the lowest dose (.014), 1x a week of Menostar w/100mg of Prometrium 3x a week. Sorry this is long.