Transdermal HRT

What a great approach to building bones - testosterone. At 76 I still get hot flashes. I used HRT for years after going through menopause, however, it would only work for a few months and then the doctor would have to up the dose. Finally we reached the top of what was available for HRT. Then I was placed on Paxil which did do away with the hot flashes. Now I realize SSRI’s thin the bones (20 plus years on it) and probably was very influential on causing my osteoporosis. I tried taking oral estrogen, even progesterone without any relief and even bio-I dentical creams. Nothing worked. I’ve just gone through the wringer getting off of Paxil and don’t ever want to go back on it, So testosterone might be a good option. Did you get all your hormones tested first? I know it might not help with the hot flashes but at least it will help build bones. Thank you for any information you can give me.

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.

@teb we communicated in another thread about HRT, your experience is very positive one! I have a few more questions to ask you if you don't mind.

The results from most current studies are very supportive for HRT usage for womens general health. And if any of us are lucky, we'd get bone preserving effect from HRT just like you do! As you and other commentors pointed out, blood clots incidences were reduced to minimum by using transdermal; potential risk of uterus hyperplasia/cancer is dealt with using prometrium. From what I understood, breast cancer risk in estradiol + progesterone group has about 1 in 1000 absolute risk increase, is that what you had read? Whats your understanding of HRT on cvd risk? Are they (researchers) looking at clots related or lipid/plaque related cvd incidences (maybe both?)?

During HRT usage, what do your doctors monitor to minimize unwanted consequences?

Last but not least, when did you commence HRT after forteo therapy? I wonder it would take a while for HRT to reach steady state in blood and to be fully effective. Do you get your bone marker(s) monitored while on HRT? If you do, what kind of pattern are you and your doctor looking for to ensure HRT therapy is working?

I'm not in a hurry to know all these or to make a decision, so take your time if you could reply. Sorry this is a long list of questions. Thank you very much in advance!

yes, I believe those breast cancer statistics are correct but keep in mind that those statistics were extracted from the WHI study which used oral estrogen so risks might be even lower with transdermal. We really don't know. I don't have the statistics handy on CVD risks but my understanding is that risks are highest in the first year of use and then moderate. My mother had heart disease and ultimately, multiple strokes so I was really concerned about my CVD risks. I've had pretty extensive testing to evaluate my current state and for now, my risk appears to be low. My cholesterol has always been quite high but I've always refused statins preferring to modulate as best I could through diet and exercise. Due to my supposed genetic predisposition, I wanted to get a better picture of my personal risk before going on HRT and I did that by getting a more in depth cholesterol panel and having a high resolution CT angiogram. My calcium score was zero meaning no arterial plaque detected. I tested my LPa level which is a genetic marker. Mine was thankfully very low so no inherent genetic risk. You do that test once in your lifetime and you have the information you need to assess. I also had my oxidized LDL and APOB tested. Both are a bit high but in combination with the rest of my test results, I feel comfortable enough to continue on with my diet, exercise and HRT regimen.

In my experience, conventional doctors don't really monitor your risks. You kind of have to figure out your personal risks on your own, evaluate whether HRT is right for you and then advocate with your doctor. Annually, I request a full panel of bone marker tests and bloodwork from my endo. I'm just not sure he would be as thorough if I didn't request these tests. I think he'd just go by my dexa and prescribe fosamax. But once I ask, he's willing to do it and then we go over it together to figure out if I am actively losing bone and what my plan should be moving forward (which for him, always includes a conventional osteo pharmaceutical). As patients, we need to figure out our own bodies, risks and tolerances. In the 15 minutes our doctors spend with us, they do a quick eval and then prescribe the basics.

I do not use prometrium as it contains peanut oil and artificial dyes which I don't think are particularly healthy. I get micronized progesterone from a compounded pharmacy. It is bioidentical, clean and reasonably priced. Prometrium is available from your local pharmacy and a less expensive alternative so some may prefer this option but for me, I'd rather have something that is pure.

I went on HRT a few months after concluding my Forteo treatment. I found it hard to navigate the system so it took a little longer than optimal to get that going.

@teb thank you so much for sharing your experience! I really envy the position that you are in. I'm diving deeper to transdermal HRT as the door is closing on me... I'm just 10 years past menapause, similar to you when you started HRT. The main concern to me in regards to HRT is cvd risk. Unlike you, I don't have any genetic predisposition, no cvds in 4 generations. But, I have a small positive cac score discovered accidentally.. This tells us the power of epigenetic forces. My ldl would get down to 100 with a heart healthy diet but a small dose of statin brought it to 60, below the target that my cardiologist is happy about. They did CIMT and peripheral vascular screening, came back clear. They checked LPa also and it's at lower part of the normal range. Will be eager to hear what my cardiologist, ob/gyn think of transdermal HRT and my risk. Im going to look into oxidized ldl, which you've been tested. I'm sure that you are aware that target ldl is revised from 130 to 100 as normal, and below 70 if you have 1 risk factor.

Thanks a lot for the suggestion of micronized progesterone! I found this article reviewing cvd risk with estrogen therapy. micronized progesterone is also mentioned and preferred form.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612533/#:~:text=The%20impact%20of%20estrogen%20may,the%20risk%20of%20cardiovascular%20diseases.
Out of curiosity, do you see a drop of CTx after you start HRT, if it's appropriate for you to disclose? Would monitor btm every 6 mo better than once a year, because you get dexa yearly anyway?

Best,

The endo who prescribed HRT did not do bone marker tests other than once yearly. I'm not sure how rapidly HRT affects those markers.

My LDL is 165. Doctors have been pushing statins on me for decades but I've refused them. I find it interesting that in recent years, they have not recommend them for me even before my CAC score came out to be zero. They seem to become most concerned when an LDL level reaches 195 or higher and now evaluate the total picture, not just the numbers; ratios of triglycerides to HDL, LPa, APOB. My brother developed type 1 diabetes from statins so I'm really adverse to taking them.

Sure, I was just wondering how powerful HRT is.

With ldl 160, my thought is you might want to seek a second opinion from a different cardiologist. After you repeatedly decline a therapy, docs usually charted it and may not ask you again. Mine had been up n down 130-165 and I didn't want a statin until 2 years ago. Even with level of 100 after a healthy diet, cardiologist still wanted it be under 70 in my case so there i went. Some cardiologists think the soft plaques may be more dangerous since they don't have a good way to detect them. CIMT and ultrasound on peripheral vasculature may help a bit to gauge if there are plaques in those places. As far as blood sugar concern while on statins, I don't think it's confirmed regarding the causality yet. I happen to have borderline pre-diabetic (Hba1c 5.7) before statin use. Was controlled via diet and didn't see any worsening. Overall, I feel controlling blood sugar is easiest, next is blood lipids; nothing is as bad as this bone problem that we have 🙁

Sorry I'm off topic. Wish you the best!

Thanks for your reply. I've had a million different docs since I've moved around so much. They don't tend to check my records for denial of statins just evaluate current status and recommend from there. As far as I can tell, the new concerning level is 195 for LDL with an eval of all total values and ratios to determine necessity. Several of my doctors and cardiologists have told me that and a friend of mine who was considering statins was told the same thing (her LDL was 195 and so they strongly recommended). My last eval was with the head of cardiology at OHSU and after an extensive eval he said my risk was "as low as it gets". Honestly, I was shocked by that assessment and I'm just hoping he was right. I do think an ultrasound is still a good idea for me particularly of the carotid artery so I may pursue that in the future. Have to disagree about the association of statin use and risk of diabetes. It's a known risk factor, particularly in men but can occur in women. Doesn't mean it will happen to everyone but with my genetic predisposition (mother and brother), best for me to decline.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546337/
And agree, the bone problem is hardest to navigate and beat!

Hello,
I am 71 and going to start with biote it’s a hormone biodentical pellet that is inserted under your skin and it based on your lab tests. This should also help with my bone density.
I Am on Evenity for my osteoporosis.