Thank you so much for this information! I was diagnosed with osteoporosis 5 years ago and am 70 years old. I asked my internist doctor about taking HRT and she said “why?..at this point!” She prescribed alendronate. Took that for 3 years…not much improvement. I will look into the estradiol further!
Im was just diagnosed with osteoporosis. He wanted me to start infusing immediately. I called a wellness clinic and asked if she treats osteoporosis with bioidentical hormones. She said absolutely. Go back to check levels in 3 months. Dont let the drs scare you into infusions ladies
The excellent book Estrogen Matters (and podcasts with the authors) broke down the fallacies and missteps of the WHI and made me feel confident in my choice, as a middle-aged thin, white female, to take estrogen.
It takes a lot of bandwidth to get through that book, but it definitely calmed my fears about estrogen. I didn't agree with the author regarding Vitamin D. Of course, the doctor didn't differentiate btw D and D3 and the importance of having it as the same time as K2. It is essential to have it for a healthy immune system.
I'm 47 white thin woman who was just diagnosed with osteoporosis and taking estrogen. I had a total hysterectomy, and it really messed me up. What form and how much are you taking?
@@heathermunoz6282 When was the last time that you had a hormone panel done? How long ago did you have a hysterectomy? If you had it when you were pre-menopausal, it likely sent you into menopause earlier than you would have gone through it. It's important to know what your estrogen levels are. Find a doctor who specializes in female hormones. If you go on You Tube there are videos on this.
@@heathermunoz6282 Keep in mind that dose, route and type all matter. Blood testing to identify optimized levels is the only way to know if you bones are getting protected.
Great topic! I have been taking HRT for decades. It is unfortunate that these studies used things like oral horse estrogen and progestin. I never have taken either except Progestin for maybe a few weeks. until I got smart and got prescribed a more natural product. It has always been Estradiol, and switched to patches years ago vs. oral, and always oral Progesterone. My primary care doctors have regularly given me warnings, but gynecologists seem hip to the benefits and have suggested I continue years after menopause. No, it has not cured my osteoporosis, and I am also dealing with later life scoliosis. I have not become worse in over a decade per MRI and DEXA scans. I feel and look so much younger than my peers cognitively, energetically, as well as physically, outside of limitation with scoliosis that are being addressed. I have never needed to go the bioidentical route either and think that a lot of health care providers in traditional systems are more and more accepting of prescribing these hormones through a regular pharmacy that are reasonable in cost.
Thank you for sharing! You have found a nice balance which is great. I find that the estradiol patches don't provide adequate estradiol for bone health and I like estriol for estrogen balance, detox and breast health. Compounded micronized progesterone is the same product as the commercial product BUT the dose can be adjusted to hit areas between the 100 and 200mg available commercially. So, yes BHRT is more expensive but there is a reason to use it. If levels are great with commercial products and the 200mg is tolerated of progesterone I'm open to commercial but I don't see it often.
@@Dr_DougLucasInteresting take, Dr Lucas. I have studied this topic extensively (as a layperson) and I haven’t come across any studies using estriol for bone health! To my knowledge, estriol is exclusively produced during pregnancy (by the placenta) and has no “job” in a woman’s body at other times. Estradiol replacement in (post) menopause on the other hand has extensive data of its protection against bone loss, and decrease of fracture risk. Yes, the dosage needs to be adequate and can vary based on absorption of estradiol through the skin, for example. But knowledgeable and experienced bone specialists should have no problem with this, or refer the patient to a menopause specialist to get to the appropriate dose of estradiol, balanced with body identical progesterone or a progestin, if necessary. Due to the unjustified and pervasive fear of estrogen in both patients and doctors, caused by the WHI study, ever lower dosages of estradiol patches have come on the market. Together with considerable inter individual differences in absorption, it is possible that some women miss out on the bone protective effect of estradiol. I will google it, but I don’t think estriol is an adequate substitute for estradiol in this case. Time to shake the fear! Estradiol is not a carcinogen. We have been fooled.
@@cm1906 I agree with you except that estriol is present throughout a woman's life. There is always conversion from estradiol to estriol and vice versa. It has not been studied directly with bone as far as I know. However, estriol does serve other roles in women that has been studied. It stimulates estrogen receptors in a different way than estradiol. We use it because brings back optimal levels of the two hormones and our patients do really well. We DO use estradiol in case that wasn't clear.
I worked as MA for ob-gyn doctors for 11 years, and they said something that made sense to me. They didn't think that something that women have in our bodies for most of our lives was all of a sudden bad for us.
That’s not a common statement from an OBGYN. Usually, they subscribe to ACOGs recommendations of “as little as possible for as short as possible” in order to minimize risk. I agree with your employer though. Why would it all of a sudden be bad for us?
@dylbrody…. The “hormones we had in our body are suddenly bad.” Difference is that these hormones were natural, produced by our bodies; they were not synthetically produced hormones.
Thank you for your willingness to honestly discuss osteoporosis and the risks and benefits of various treatments. Based upon personal experience, my confidence in the medical & pharmaceutical industries is battered. I now do my own research so I can better advocate for myself and not be coerced into accepting the kind of profitable "healthcare" that is largely responsible for my brittle osteoporosis.
Just downloaded the kindle book you described. Your advice is wonderful as I cannot get my doctors locally to discuss or take an interest in anything despite continual fractures, ribs wont mend in a year, thought they were mended, but one normal cough and they all exploded again.
Thank you for your support! Sorry to hear that, checkout my next free Bone Foundations Masterclass Session if you haven't been to one yet. It could be beneficial to you! You can find the details here --> www.optimalbonehealth.com/bone-foundations-master-class
Hello, My sister is 69 years old and her doctor tells her that it’s too late for her to be on estrogen. She said she was too old for it now and it would not do any good. She does have osteoporosis, but she’s maintaining. I shared your channel with her. Is she too old to go on the estrogen? I myself have been on estrogen, testosterone and progesterone for many years. I have no bone loss and no problems. Thank you, I love your channel. It’s very educational. I have been sharing.
Thank you! Estrogen at 69 carries risks and they likely outweigh the benefits. This is a controversial area but depending on the age of menopause 69 is likely not a good starting point for estradiol but other options could be considered.
Bioidenticals can be used safely at all ages. It is never too late unkess cancer issues prevent it. Protects not only bones but prevents dementia and all her cells benefit. Please don't tell women they are too old at 69. That's old thinking. Personal experience tells me otherwise. A female endocrinologist really is best person to help older women. Men just can't get it. Women have more than just bone health to deal with. Stay off the meds, they just make it worse..just my non-med opinion..
I have just been put on HRT and have been so scared! I also have osteoporosis and found out the hard way at 50 by getting a fracture from doing “nothing” … You have given me a lot to think about and I am so thankful ❤
Just found you. My PA at AFC asked me to research. She did just start me on an estrogen patch and 150 mg Progesterone 150 mg capsule 1/2 hr before bedtime. My Naturopath had put me on Testosterone 25 mg 2 months ago. Continuing it. Naturopath also put me on OsteoForce and Ultra K2. Definitely plan to finish what I have on hand but will be checking with my PA as to whether she thinks continuing to take those as well. I am old. 78 but I have been extremely active. The last few weeks I have been having more bone issues. Had 2 MRI'S last Thursday. Pelvis and Lumbar spine. My PA has several patients that are doing well on what she prescribed. Including her 75 year old mother. I am glad I listened to this video. PA had asked me to do my own research. I had a hysterectomy when I was 30. Never felt like I had menopausal symptoms. Osteoporosis and Osteo-Arthritis now are major issues for me.
Thank you so much for sharing all of this. It sounds like you could benefit from the next free Bone Foundations Masterclass we have coming up if you have not attended one before. You can find more information here -->www.optimalhumanhealth.com/build-bone
Great informative video! I guess the next question would be, what is the minimum dosage of estradiol/estrogen for effective positive impact on osteoporosis / bone health? Would love to hear more on this … Learning so much from your videos, Dr. Lucas!
Great question. There is evidence to support a minimum serum level of 40pg/mL to slow down osteoclasts. The problem with commercial preparations is that they often don't get you there.
@@Dr_DougLucas My patch is .075, my doc doesn't believe in testing serum levels so I have no idea what mine is. Do you think my patch dose is strong enough to slow down my osteopenia?
Thank you so much! I had a complete hysterectomy at the age of 32 in 1972. My dr put me on premarin at that time and it was 3 weeks on and 1 week off. I have experienced many changes in hormone therapy in the last 50 years. At the time of the Women’s Health study my Dr wanted me to go off hormones and l did. More hot flashes , bone loss, poor sleep etc. Finally a new young Dr took over her office and she allowed me to go back on the patch. At the age of 83 l use as little as possible - only enough to keep the hot flashes away. From your lecture l think l will continue until l die! Is there a problem with my thinking?
Controversial for sure. The anti-aging community would say that’s the right approach. OBGYN, endocrine society and others would say that increases risk. I don’t have a timeline for stopping BHRT for my patients.
I plan to do the same thing as long as possible if possible. Had TH as well and have OP at 47. If you're looking at quality of life, then I believe that moderating your estrodial allowance makes complete and utter sense. Lack of sufficient sleep alone will massively shorten life span.
Fantastic video!!! I’d love to know your position on BHRT for older women. I went through menopause at age 47. Started topical BHRT AT 57. Stopped at 63 and restarted estradiol/estriol/testosterone cream and oral micronized progesterone (generic prometrium) at 68. I’ve heard from some it’s too late. Others it’s never too late. I’m very thin and have OP and feel comfortable taking it. I’m low risk for breast cancer. Thoughts for older women restarting or starting BHRT?? Thanks for this very informative video.
Hello, Sensitive topic but yes we do support using BHRT in women well past menopause. Starting after the 10 year mark requires a discussion of cardiovascular risk but we have an algorithm for that and do it regularly.
@@Dr_DougLucas Im 71 .just diagnosed with osteoporosis T 2.5 so my NP ckd hormone levels and just prescribed BIHR cream. Im too go back in 3 months for labs. Im on warfarin for a renal embolism in 2015. I test my INR at home weekly. What are your thoughts? I also have hemochromtosis and see oncologist every 3-6 months. At my age im trying to weigh the risks/ benefits for fall fractures. Drs want to push infusions that l reduse to do. You seem very knowledgeable and concerned. Thank you
Can you do a video for those of us ladies who are Breast Cancer survivors and now on Anastrozole or other AIs, in relation to what we can do to manage or stave off osteoporosis and or manage our bone health 🙏 Thank you and much appreciated!
@@mirapavlovic1960 I'm sorry to hear that you developed breast cancer. Some forms of HRT do increase the risk of breast cancer but estradiol and estriol have been shown to be protective. It's important to remember that developing a disease while on a drug or hormone does not mean that the drug or hormone caused it. Developing breast cancer with hormones vs because of hormones. I wish you the best on your journey.
Very interesting article. I am 60 years old & have osteprnia, i was never given hrt until last year & the difference its made to my aching joints and bone health is amazing. GP has now taken me off this few weeks ago re my age & perceived risks. I am in so much pain in my joints now and am convinced the estrogen was helping me. I am going to insist i go back on this treatment as benefits for me outweigh the risks.
I am 58 I have been on BHRT well supervised by a doctor who specializes in hormones. I have been on for 5 years and never see a time I will go off. Estrogen is protective for so many things in addition to bone health, including heart and brain. I suggest you look for a better informed Dr.
You should not go off HET, if you do, you will lose all heart/brain/bone benefits you had gained. I plan on staying on HRT for life, especially since I only just started on it at 60 years old. Good luck.
Thank you for this informative video Dr. Lucas! I have Osteoporosis AND have taken BHRT. I am 62 and have my uterus, so I have used Estradiol/Estrol Cream and Patches, Progesterone (Micronized Pill, cream and suppositories), and Testosterone Cream. I have been on these forms of BHRT 12 years ago and then again for a year now. I have been through ALL methods of creams, pills and patches. Anytime I have used Progesterone, micronized, creams or suppositories, I have had terrible reactions such as severe acne, bloating and swelling in my hands and stomach. I simply can not take Progesterone. I NEEEED Estrodial for my bones! I did see improvement in the Estradiol patches over cream, but my Progesterone blood tests never improved from a
Love your videos. So informative and from a common sense perspective. Have you considered putting them into a podcast version? I’d love to listen to them as I’m driving. Not sure if I can do that via RUclips (listen while driving.)
Checkout our free Bone Foundations Masterclass if you have not attended one before! You can find details here --> www.optimalbonehealth.com/bone-foundations-master-class
Thankyou for sharing your thoughts on HRT. I thought I would take bio-identical hormones for my severe osteoporosis. For 2 1/2 years I took the estrogen cream with testosterone, and a progesterone pill every night. My bone density was greatly improving, and I was so happy. But after 2 1/2 years of this treatment plan, I started having very strange symptoms with my brain, about every 10 days to 2 weeks. My brain would feel like it had a sudden attack, a numb feeling, then a strange numb, tingling sensation went down through my whole body to my finger tips and toes. It only lasted a short time, but I could hardly walk and function during that short time. My husband being a doctor recognized what was happening to me finally, and said "I think you might be having TIA's". I remembered that the literature that came with my medicine suggested the possibility of stroke, so I stopped the HRT, and the brain symptoms stopped. I thought you might want to know my experience on bio-identical hormones.
I tried Premarin back in the 80s, and it made me feel TERRIBLE. Then I found out how components are harvested and declined it on moral grounds. I have osteoporosis, started taking Evista in 1998 with good results and no side effects, but have developed unacceptable menopausal symptoms in the past 10 years. I'm 74 and have the markers of a healthy 20-year-old. I'd like to take transdermal estrogen and progesterone to start feeling better, but cannot as long as I'm taking Evista. Looking into Prolia but am vain about my teeth, so would worry about jaw necrosis. I also know a woman who took Prolia and broke a leg while just unlocking her car door. There's a lot to consider, and I'll use information in your videos to make up a spreadsheet. Thanks for presenting such an array of valuable information.
I am struggling w osteporenia. I use an estrogen patch, and pill progesterone. I didn't even know there Was a progesterone patch. I have lived problems. Medications delivered transdermally bypass the liver. I 'm asking my dr to switch.Amazing lecture and info. I take Dexilant, and have for years. I know these r being linked now to osteoporosis
I like this video very much . Very Helpful ! I download already and will be listened again later. I also shared with other people with similar situation. We are looking forward for hearing your lectures regarding how long the HRT can be used and also if over 60 years old is still helpful to continue use?
Dr. Lucas: This episode was very helpful! I appreciate your videos I have two questions: 1. What dosage do you usually start a post menopausal woman (no uterus or ovaries) estradiol patch? 2. Do you think melatonin has any beneficial characteristics for bone production? Thank you very much!
Great questions! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Thank you Dr Doug for a very informative presentation. I was diagnosed with Osteoporosis 5 years ago after falling on an extremely slippery floor and breaking one of my wrist bones. On my Doctor’s advice, I had 3 yearly infusions of Zoledronic acid. My Spinal T-Score didn’t change in 4 years( it’s still -3.3). My doctor is now advising having a 6 monthly injection of Prolia( Denosumab). I’m very reluctant to start this as I’ve heard you have to keep taking this for ever( or a bisphosphonate ). I’m a 68 year old man, very fit( I do resistance training 3 x a week, HIIT once a week, walk up and down a hill 5 x a week and play table tennis regularly). I eat very healthily ( lots of protein, fruit and vegetables). I’m retired, not stressed at all and sleep okay( not great). What would you recommend?
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
Thank you so much Dr. Lucas for sharing all this valuable information. Quick question, being 57 and having gone through menopause 7 years ago, is there any data to suggest benefit from starting HRT after the 5 year window from the onset of menopause? It’s so upsetting that at 50 I didn’t insist on a bone density test. I asked but the doc said since I didn’t shrink it wasn’t necessary. I also showed him my hormone blood work and he said if I wasn’t having symptoms they weren’t necessary either. So then at 56 I shrink and have been diagnosed with severe osteo in spine (-3.2) and high osteopenia in hip (-2.4). Thanks again so much for helping so many of us!
Hi Debbie, Absolutely there is benefit. The problem is in our current medical system that hormones are mostly prescribed for symptoms of menopause. Estradiol is FDA approved for osteoporosis, but rarely used. If you are within 10 years from the onset of menopause, the benefits of hormones frequently, will outweigh the risks.
Great video and information Dr. Lucas, thank you! I used to take bio identical hormones ( both biest and progesterone )but stopped when I reached 60. I now have osteoporosis. I am at risk of DVT from my bad varicose veins and previous phlebitis. Is it possible just to take transdermal or micronized progesterone to help the osteoblasts without much risk?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Sure, whole food plant based diets studied in population cohorts will show all kinds of benefits but remember what this is showing. An association of a restrictive diet compared to a standard western diet. Low bar. These studies cannot get around the health use bias.
I had BC I use transdermal estrogen I feel so much better. Chemo put me in menopause at age 43. I have osteoporosis meds did not help like fosamax . So I work out with weights exercise every day still osteoporosis. So I break my wrist they put me on forteo for 2 years bone markers up good back into osteopenia. Next prolia . I’m still using E-3 estrio it helps with sex drive my bladder etc. F breast cancer I only hone boob left so I have to live. Do for you it’s your body .
Hi dr Lucas,I am watching this from Australia. I am 64 osteoporosis woman. I use estriol for 5 yrs now I want to take HR. Please answer my question thank you.
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
Great talk on estrogen and bone health. I am a 68 year old women considering bioidentical hormone treatment. Is it enough to test with saliva for hormone levels or should it be in conjunction with a urine test. I have heard saliva is enough of an evaluation. Please advise.
Blood tests are the gold standard. We use urine metabolites for safety and estrogen breakdown patterns. Never saliva. Saliva, finger stick and urine all measure different things. Topical hormones are best tested in blood.
So interesting. Ihad a mastectomy for invasive lobular and invasive ductal carcinoma. A PET and CT did not show any active cancer cells or tumors. I have osteoporosis so declined hormone therappy and radiation. My integrative DO is testing me for horne levels. I feel that what I have listened to in your video meshes well with what you have said. The oncologist didnt test for levels of estrogen, etc. Just said I shouldnt have any as my BC was est dependent.
I have ostiosporosis (righ femur) and ospinia on (left femur). I've watch you videos and I'm doing resistance trading to build muscle but I take metforming.
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Can I ask why the new WHI studies from 2020 were not spoken about? They were positive studies. Also do you follow @Dr Mary Claire Haver? She is a board certified obgyn on the same page as you.
Wow! So helpful. I was just 1 week ago prescribed vaginal AND oral estradiol by a regular gyn. I’m 61. Would you be able to recommend someone in my area who treats like you do? Las cruces, New Mexico.
Your explanations of the research on this topic was excellent and easy to understand. I see your next masterclass is at 3pm September 20. Do you ever rotate the day of week that you present on zoom or offer it a bit later? I am central time. Thank you
Hi Kara, we try to keep these around the same time but we do send a replay link to your email after the masterclass is complete so that you can watch it at your convenience. As long as you are registered at this link you will be good to go! -->www.optimalbonehealth.com/bone-foundations-master-class
I'm 59, have osteopenia, using a transdermal estradiol with a Mirena IUD for progesterone. What dose of estradiol patch is best for bone density? My doc doesn't believe in testing serum levels.
It’s variable. That’s why you test. I hear that often. Docs that don’t believe in testing are generally dosing at the lower end of the range. IUDs won’t provide systemic progesterone and will have no impact on bone health.
@@user-EinsteinSarge All three play a role. Estrogen is the most studied followed by testosterone in men. Progesterone shows benefits for bone health but only in concept not through intervention studies as a unique independent variable.
I’d like more studies for people that don’t do the HRT but high risk for osteoporosis or even diagnosed with osteopenia and people being followed at different approaches like a natural approach of a diet plan that they been educated on to use along with a exercise plan course diet I know it’s more difficult, but maybe something they eat exactly like that
What are safe options for older women > than 10 years post-menopause? I feel betrayed by believing the WHI recommendations at a time when I needed to continue estrogen. My doc indicates that vaginal estrogen is safe - but obviously less effective. Can use of vaginal estrogen be increased to help the bones?
Great question. I sympathize with you on your trust of the recommendations. I see it every day in my practice. Women in this age group who weren’t even offered HRT as if it was not worth the discussion. Now they have osteoporosis and are at risk of something more likely and more deadly. There are options to consider but are in the grey zone of health optimization. Off label testosterone, progesterone or estrogen alternatives like Raloxifene can be considered. Even estrogen may be considered >10 years out from menopause in the right candidate.
I fought for nrt since meno at 46. To the point i got kicked out of drs office for refusing horse urine. I am 66 still on therapy. Fractured l4 disc at 56. Still have osteo in neck.
Thank you for sharing this, our free bone foundations masterclass could be beneficial to you if you have not attended one yet. You can find details at this link --> www.optimalbonehealth.com/bone-foundations-master-class
My understanding from another channel on this topic is that estrogen has no benefit for women after about 10 years post menopause because the body no longer has an effective/viable receptor mechanism, and that estrogen therapy for bone density for those women who go on the therapy earlier than that can work but the bones revert back after the treatment is stopped (a bit like other treatments whether drugs, exercise or diet I suppose)?
I looked into it as well, and that seems to be the general consensus. I was thinking of taking DHEA, which the body uses to produce the hormones testosterone and estrogen, but clinical evidence to support its use is very weak, especially the older we are and the further away from menopause.
@@gracenotes818 If I may ask, did you begin taking estrogen right after menopause and continued to take it ever since, or did you wait 20 years before taking it? My concern is that since I didn't begin taking estrogen right after surgical menopause in my late forties, that it's too late to help me since I'm now I'm in my sixties.
I started BHRT 10 years after menopause. Stopped 6 years later. Restarted 5 years later. I’m not sure if I’m benefiting but I’m sticking with it. There are differences of opinion. But It’s good for other things as well.
Sorry if already addressed. I am a 56 year old male with osteoporosis. My endocrinologist believes from decades of low testosterone. I was on TRT (gel) for 18 months when I suffered 2 vertebral fractures. Now I continue on TRT and started Forteo. What role might estrogen, progesterone or estradiol have for me? I am trying to get my estradiol level up to about 40 (undetectable before TRT and now sitting at 26).
Hi there. Great questions. For men, estradiol comes mostly from conversion from testosterone. Replacing testosterone is the way to get adequate testosterone. If you aren't converting enough my first step would be to evaluate your total levels and your free T as well as SHBG. I find gels generally don't get you there. We use injections or creams but injections for 95% of our men on TRT.
The traditional approach for a woman with a uterus is to use a progesterone as well as estrogen. This is our approach as well, but this video specifically is on estrogen.
I was diagnosed with osteoporosis and it was brushed off as mild with a directive, “just take some calcium…” If HRT isn’t an option since it was not offered when I was in menopause and it’s been almost ten years since onset, do I have options that will help?
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
What about growth hormone? I have hypopituitarism due to radiation treatment by lazer for a benign tumor and have been on hormone replacement for 28 years. In France, where I was living at the time, growth hormone is part of the hormone replacement therapy. In Canada it isn't (where I now live). So, how does growth hormone affect bone health?
I’m an adult probably not directly. GH is available in the US but only for pituitary v Conditions. We use growth hormone mimicking peptides to impact muscle growth which secondarily will impact bones but we don’t use GH itself.
Three Aunts dead from breast cancer all took HRT no family history of breast cancer on either side of my family. Cousin just died from breast cancer she took bioidentical HRT. Two friends my age and younger I am 58 dead from breast cancer both on bioidentical HRT. Just watched a woman on RUclips that just had to get both breasts removed due to breast cancer her doctor told her it was her use of HRT so needless to say she is no longer taking HRT.
Hi there. As much as I sympathize with your many experiences of family death and am sorry for all of the loss anecdotal experience does not trump well designed clinical trials. I have hundreds of patients on HRT and between me and my peers we have thousands. Our collective experience is that rates of breast cancer seem to be lower in this group. Perhaps because of the self selected group or because of the protection from testosterone. Again, sorry for your losses.
There are tons of risks we find out a lot of times the drugs don’t even work down the road it’s all just a moeny and MAKING game. Sadly, we need to look at more natural ways to treat things and head on up ahead of time before we get diagnosed we need to teach doctors to look for Graves’ disease so people don’t end up having issues becsue of incompetence!
A month ago, my doctor reluctantly prescribed for me an estradiol patch .025 mg/day (I also have Mirena IUD) to help both with bone loss and hot flashes. This is what she told me….one in eight women get breast cancer. If you develop breast cancer while on HRT you will be feeding that cancer and there will be a greater chance it will become more invasive before detected than if you were not on HRT. This is pretty scary and is making me rethink my decision. However the patch has already provided incredible relief from hot flashes, and I have high hopes to reverse osteoporosis in my spine (-2.7) combined w nutrition, supplements and a progressive weight resistance training program. I am 59, thin, and it has been less than 5 years since onset of menopause. Is there any evidence in the literature to support the concern that women on HRT get diagnosed w breast cancers that are more advanced or invasive? What are your thoughts on this? I don’t know what to do.
This is a conversation I have often with patients. I understand the fear. Your doctor is kind of right. Invasive versus non invasive isn’t the right terminology but her point is correct in that estrogen sensitive breast cancers may grow faster if on estrogen. However, there isn’t actually evidence to support this that I’ve seen. It’s a logical theory though. So, we evaluate risk thoroughly and make a decision together. There is risk in treatment. There is risk in no treatment. Together we just have decide which risk we want to face.
Hi Dr lucus dexa test says i have osteopenia T-1.7 my ist fracture is T 11spine specalist wants me get a kyphoplasty and go on meds wot would you suggest bit iffy about meds but dont want another fracture like this he says dexa can give a lower score and i maybe be further on into osteoporosis than thectest suggests
Fragility fracture tells a better story than DEXA. Meds are indicated in that scenario BUT I still prefer a comprehensive approach and we have been able to get people out of the danger zone without meds.
What do you use to test hormone levels? My doctor prefers saliva sampling over serum (and urine) saying it shows what the tissues are actually being bathed in. My saliva levels of estrogen and progesterone both are so high, even through the roof for the progesterone and I think menstrual levels for estrogen (or higher) even though I'm post menopausal and yet serum tests show the opposite. It really becomes so hard to know what to do or what is needed and to me that the levels or EXTREMELY radically different on serum and saliva sampling makes no sense. I have no idea what can be trusted and what is accurate. My P1N1 is HIGH (I have no idea why) and CTX is too high, 808, so I hope you can do a video on what to do to slow down osteoclasts. Is taking estrogen the only option ? which is challenge if I'm high risk breast cancer and saliva samples show estrogen levels to be quite good, so wondering about options.
Hi there. My training and experience discourages me from using saliva samples. They are inaccurate and inconsistent. Serum is the gold standard and what we use unless we want to view breakdown of estrogen for which we use urine metabolite testing (DUTCH). I have some new videos on P1NP and CTX coming out so take a look at those.
Been doing oral HRT for 4 years now for OP but want to transition to BHRT but they require me to be off my current HRT for 10 days so they can test hormone levels w labs. Will going off HRT cold Turkey be okay and result in any bone loss during those 10-15 days? Thank you LOVE your videos!!!!
Hi there. You probably won't see much loss in 10 days but here's the question I woul ask them. If you're post menopausal, what do they expect to see in the blood results. They should know the answer. You don't have any sex hormones. Your levels will be nearly zero. Why put you through that?
Somebody, please help me figure this out. I had a total hysterectomy 1 year ago at 46. I now have osteoporosis. The bioidentical topical cream wasn't giving me the estrogen I needed, so I started using the 1mg patch. Well, I still don't think I'm getting enough to help my bones. My gyno and endocrinologist seemed to think it's fine, but I know it's not because I got osteoporosis. Any suggestions???
Hi there. I sense frustration and urgency in your question. Hopefully this will help ease your anxiety a bit. Remember that osteoporosis usually takes years to develop. The amount of bone loss in one year from a surgically induced menopause should not be dramatic. It’s there for sure but it’s in line with natural menopause numbers. So, HRT should help and estradiol levels can be tested to verify if the patch is adequate. 1mg may be but not necessarily. However, the fact that you got a diagnosis of osteoporosis while on the HRT is only an association. We don’t know starting point or trajectory of BMD. Does that help?
@OptimalBoneHealthwithDrDoug I see. So, they're not completely to blame. I guess why I'm playing the blame game is because I went from being in no pain to being in chronic pain. I am healthy and fit but small boned. My doc waited 2 months to put me HRT and thyroid. Then the compounding shop told me to do 1 pump instead of 2. So I got half what I was supposed to be getting for 4 months. No bloodwork is done. Meanwhile, no sleep (well, hardly none) due to being miserable from inflammation in every part of my body. I ended up going to a Rheumatologist and my ANA's were hitting the ceiling. She put me on Hydroxychloroquine and a few weeks later, I finally started feeling less pain. I didn't test positive for an auto immune, but she said let's see if it helps, and months later, I stopped taking it, and I feel fine but have osteoarthritis that is tolerable.
@OptimalBoneHealthwithDrDoug Btw, my doctor would ask me during my appointments. "Um, you still have your ovaries, right?" I said, nooo, they took them at MD Anderson, remember??? Happened at each appointment. I actually scheduled my own DEXA scan. Results to the doc, and they never called me. I finally called and asked about it. Nurse said, "ohhh, well, we received your report 3 weeks ago, and huh, well, you have osteoporosis." Nurse said, "Well, that's the way it goes." Anyways, thank you for your reply, Dr. Doug. I appreciate being heard and answered wisely.
@@heathermunoz6282 Wow, that's unfortunate. I hope you are using this as a resource to create the program you need to improve your bone health! If you haven't been to our masterclass that's a great option too.
Great question. Estradiol or Bi-Est creams are more flexible. The commercial products have a range but that range is designed for symptom relief from menopause, not to obtain ideal blood levels for bone health. I find that a 50mcg dose is not adequate to achieve optimal blood levels but everyone's different.
I unfortunately, got caught up in the knee jerk reaction to the WHS back in early 2000's. I had a complete hysterectomy in 1999 and had been on estrogen from day one. My VA doctor in 2005 said I had to come off of it because of the risks she said were identified in the WHS. Fast forward 2 years and my osteopenia advanced to osteoporosis. It took another couple of years after that to find a doctor who would prescribe Estrogen again. All of my other doctors kept pushing Osteoporosis drugs which, luckily I guess, I had negative reactions to. I simply refuse to take them now. Recently, a doctor told me that because of my age 69, I should think of coming back off of Estrogen. Sheesh. I am low risk for the heart/stroke issues, but even if I weren't why aren't they suggesting transdermal? So frustrated.
It's old dogma. Use as little as possible for as short as possible is what these doctors were trained to do. In the healthspan space we look at it differently. We use it off label to optimize multiple aspects of life, including bones.
I've been on HRT for two years after having really horrible hot flashes and other menopause symptoms. It's vastly improved my life and I don't care if it increases my risk of breast cancer, which I don't think it does. I'd rather feel good and have a great quality of life and be able to do all rhe things I enjoy than feel horrible because I'm scared of cancer. I think the WHI did a gigantic disservice to all women. If HRT improves my bone health that's an added bonus. If it doesn't that's ok too.
In the meta-analysis, I review in some of my talks, there are two big studies on oral versus transdermal. However, there is a meta-analysis that looks at all of the transdermal all of the oral studies which met criteria of which there are dozens.
I have recently transitioned off of Premarin to the estradiol patch/.05, anyone know what levels of estradiol and progesterone is sufficient to prevent further bone loss? My estradiol level came back 77 pg/ml and progesterone was 110 ng/dL. Thanks so much!!!
I was recently diagnosed with osteopenia in my gynecologist up my dose of estradiol that is used vaginally I did not realize it doesn't help with bone health! How should I be taking estradiol for my bone?
I’ve been learning about menopause and it’s so confusing. There are different camps with different perspectives that contradict each other. I’m not afraid of HRT. I want it for my bone, brain and heart health. I’m in perimenopause (50 yrs old) with regular cycles. I have osteopenia. My main symptoms are insomnia and anxiety. I’ve been told since I still have regular cycles, I either take birth control pills or nuvaring. I don’t want this option since I don’t want oral pills or progestins. I’m told HRT dosages are too low for me. So do I have to wait till menopause to get bhrt estradiol patch snd micronized progesterone? In peri, does bhrt estradiol just add onto my existing production? Im afraid my bone density is getting worse while I wait fir menopause to arrive? I know I can lie that I’m experiencing hot flashes and night sweats and they’ll happily prescribe them but this is right approach?
Hello, I'm a fan of integrity and honesty so I wouldn't suggest lying to your providers. We use blood tests to determine levels of estradiol and if a women is getting abnormal cycles or estrogen deficient it can be added but not until then. If it's there we don't need to add it. Remember it's bioidentical so there is no need to do more of it if it's there. Progesterone and testosterone though CAN be added to a cycling women's hormone replacement. That is not often done in the traditional medical space.
Barbara Taylor, M.D. (also known as Menopause Barbie) has developed a full array of menopause services to help you with every aspect of menopause. About Menopause Taylor · One-on-one consultations · RUclips video tutorials
I am 67 I was offered to take premarin when I was in my 30s. I didn't take it not when I found out that was made from horses urine now way and still don't take anything doing fine I do have some bone loss but women loss bone early and nothing you can do except try to slow it down eating right and exercise.
In Europe they don’t use synthetic progestin , it’s normally bio identical product, So why would Denmark do research on synthetic progestin? It doesn’t make sense? Is the media been honest with us?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
For a 53 y/o woman recently diagnosed with osteoporosis who already has Lobular Carcinoma In Situ and been told that she’s not a candidate for hormone replacement, what can you do to assist or is this just the case that needs to take Boniva or similar type medication?
This is unfortunately not uncommon. We work with patients with breast cancer and survivors to create comprehensive programs with or without drugs. They are not always required but verifying that bone loss is not rapidly occurring is critical!
@@Dr_DougLucas How do you verify that bone loss is not rapidly occurring? Probably nearing or in menopause, my understanding is that is to be expected to start losing bone rapidly.
@@Dr_DougLucas So if bone loss is rapidly occurring, especially due to menopause, then I have little options than to be on a bisphosphonate type medication?
I went through my regular Medicare Advantage Plan HMO and was fortunate to find a group, Had moved to different state and needed to find a new provider. Very receptive to me continuing with Estradiol patches and progesterone. I have found, over decades, that primary care providers in general only try to scare you with the risks while gynecologists are in general very open to this option.
Very difficult challenge. As stated above the traditional medical system has lots of tools but they are all going to be in the traditional medical system. You'll get the same options.
You didn't address the menopause onset. My ex-girlfriend became menopausal at the age of 36. That's a very different situation from a woman who enters menopause at 51. Most gynaecologists seem to agree that HRT is beneficial to prevent osteoporosis in early menopause. Unfortunately most studies keep focusing on fractures instead of showing actual bone scans, preferably QCT. There's much more to osteoporosis than fracture risk. How about herniated discs and stenosis? Stenosis in particular is a direct result of osteoporosis, and much more severe than a once-in-a-lifetime fracture.
Hello, Yes, these are all important factors. If I addressed every perspective of the issue it would be a 90 minute documentary. However, I’ll respond to on comment for clarity. I think it’s more important to focus on fracture risk rather than bmd. Lots of people have low bmd, low fracture risk and don’t need treatment. Fracture risk on the other hand is important to quantify because it helps us decide on treatment. Quantitative CT is great but the radiation dose is too high to perform on a regular basis.
@@Dr_DougLucas Thanks for your reply. I still don't understand why severe issues that affect nearly everyone who has osteoporosis are left out. Herniated discs, lordosis and stenosis are 100 times more common than fractures, and they affect patients on a daily basis. They prevent people from leading a normal life. While not every herniated disc, stenosis or lordosis is caused by osteoporosis, nearly everyone with osteoporosis is affected by one or more of the above conditions. If you're a statistician working for the government and don't understand the real world, you will probably focus on fractures because they are countable. If you are a doctor you focus on all health aspects that result from osteoporosis. Fractures account for 1% of these issues. Overlooking the other 99% is almost criminal neglect.
@@jacquesmertens3369 I'm not sure what you are looking for here. There isn't much for me to say about these consequences of poor bone quality. I'm trying to improve bone quality.
@@Dr_DougLucas OK, let me try to explain: every time I see an endocrinologist to discuss bone quality I get the reply "have you broken any bones yet? No ? OK, then you don't have a problem." Every research is focused on fractures, when in reality 99% of the health issues you experience are not related to fractures. As a result I don't get the right treatment. If more was published on the other consequences of osteoporosis, then maybe patients would get the right care.
@@synnvetorbjrnsen558 It's debatable terminology. It is the identical molecule as what is made endogenously but it is made synthetically as are all hormones.
I went through an early, natural menopause at age 43. Apparently, it may be hereditary as my daughters also went through menopause in their early 40s. I had no high risk factors at all and took hormone replacement until age 67. I stopped because I also have migraines and by my mid-60s I was having constant migraines and auras. Ending the HRT stopped that. But, in a couple of years my hair begin thinning and my skin became extremely dry and I (don't laugh) actually started getting wrinkles. I think if you are healthy with no risk factors or bad side effects HRT is not a problem. No, it didn't help my bone density I don't think. My bone scans always did show minimal bone loss even into my early 70s. But, that might be other factors too. I really believe it's all on a very individual basis and should be treated as such.
Thank you so much for this information! I was diagnosed with osteoporosis 5 years ago and am 70 years old. I asked my internist doctor about taking HRT and she said “why?..at this point!” She prescribed alendronate. Took that for 3 years…not much improvement. I will look into the estradiol further!
Thank you for sharing this!
Im was just diagnosed with osteoporosis. He wanted me to start infusing immediately. I called a wellness clinic and asked if she treats osteoporosis with bioidentical hormones. She said absolutely. Go back to check levels in 3 months. Dont let the drs scare you into infusions ladies
Thank you for sharing this!
Infusing?
Yes, drs will try to pressure & put fear into you to get your to give in! Stand your ground! I’m glad I did! 😄🙏
The excellent book Estrogen Matters (and podcasts with the authors) broke down the fallacies and missteps of the WHI and made me feel confident in my choice, as a middle-aged thin, white female, to take estrogen.
Thank you for sharing this!
It takes a lot of bandwidth to get through that book, but it definitely calmed my fears about estrogen. I didn't agree with the author regarding Vitamin D. Of course, the doctor didn't differentiate btw D and D3 and the importance of having it as the same time as K2. It is essential to have it for a healthy immune system.
I'm 47 white thin woman who was just diagnosed with osteoporosis and taking estrogen. I had a total hysterectomy, and it really messed me up. What form and how much are you taking?
@@heathermunoz6282 When was the last time that you had a hormone panel done? How long ago did you have a hysterectomy? If you had it when you were pre-menopausal, it likely sent you into menopause earlier than you would have gone through it. It's important to know what your estrogen levels are. Find a doctor who specializes in female hormones. If you go on You Tube there are videos on this.
@@heathermunoz6282 Keep in mind that dose, route and type all matter. Blood testing to identify optimized levels is the only way to know if you bones are getting protected.
Great topic! I have been taking HRT for decades. It is unfortunate that these studies used things like oral horse estrogen and progestin. I never have taken either except Progestin for maybe a few weeks. until I got smart and got prescribed a more natural product. It has always been Estradiol, and switched to patches years ago vs. oral, and always oral Progesterone. My primary care doctors have regularly given me warnings, but gynecologists seem hip to the benefits and have suggested I continue years after menopause. No, it has not cured my osteoporosis, and I am also dealing with later life scoliosis. I have not become worse in over a decade per MRI and DEXA scans. I feel and look so much younger than my peers cognitively, energetically, as well as physically, outside of limitation with scoliosis that are being addressed. I have never needed to go the bioidentical route either and think that a lot of health care providers in traditional systems are more and more accepting of prescribing these hormones through a regular pharmacy that are reasonable in cost.
Thank you for sharing!
You have found a nice balance which is great. I find that the estradiol patches don't provide adequate estradiol for bone health and I like estriol for estrogen balance, detox and breast health. Compounded micronized progesterone is the same product as the commercial product BUT the dose can be adjusted to hit areas between the 100 and 200mg available commercially.
So, yes BHRT is more expensive but there is a reason to use it. If levels are great with commercial products and the 200mg is tolerated of progesterone I'm open to commercial but I don't see it often.
@@Dr_DougLucasInteresting take, Dr Lucas. I have studied this topic extensively (as a layperson) and I haven’t come across any studies using estriol for bone health! To my knowledge, estriol is exclusively produced during pregnancy (by the placenta) and has no “job” in a woman’s body at other times. Estradiol replacement in (post) menopause on the other hand has extensive data of its protection against bone loss, and decrease of fracture risk. Yes, the dosage needs to be adequate and can vary based on absorption of estradiol through the skin, for example. But knowledgeable and experienced bone specialists should have no problem with this, or refer the patient to a menopause specialist to get to the appropriate dose of estradiol, balanced with body identical progesterone or a progestin, if necessary.
Due to the unjustified and pervasive fear of estrogen in both patients and doctors, caused by the WHI study, ever lower dosages of estradiol patches have come on the market. Together with considerable inter individual differences in absorption, it is possible that some women miss out on the bone protective effect of estradiol. I will google it, but I don’t think estriol is an adequate substitute for estradiol in this case. Time to shake the fear! Estradiol is not a carcinogen. We have been fooled.
@@cm1906 I agree with you except that estriol is present throughout a woman's life. There is always conversion from estradiol to estriol and vice versa. It has not been studied directly with bone as far as I know. However, estriol does serve other roles in women that has been studied. It stimulates estrogen receptors in a different way than estradiol. We use it because brings back optimal levels of the two hormones and our patients do really well. We DO use estradiol in case that wasn't clear.
@@Dr_DougLucasjh
I worked as MA for ob-gyn doctors for 11 years, and they said something that made sense to me. They didn't think that something that women have in our bodies for most of our lives was all of a sudden bad for us.
That’s not a common statement from an OBGYN. Usually, they subscribe to ACOGs recommendations of “as little as possible for as short as possible” in order to minimize risk. I agree with your employer though. Why would it all of a sudden be bad for us?
Agreed!! That was my thought exactly. :)
@dylbrody…. The “hormones we had in our body are suddenly bad.” Difference is that these hormones were natural, produced by our bodies; they were not synthetically produced hormones.
Thank you for your willingness to honestly discuss osteoporosis and the risks and benefits of various treatments. Based upon personal experience, my confidence in the medical & pharmaceutical industries is battered. I now do my own research so I can better advocate for myself and not be coerced into accepting the kind of profitable "healthcare" that is largely responsible for my brittle osteoporosis.
Thank you for sharing this!
Just downloaded the kindle book you described. Your advice is wonderful as I cannot get my doctors locally to discuss or take an interest in anything despite continual fractures, ribs wont mend in a year, thought they were mended, but one normal cough and they all exploded again.
Thank you for your support! Sorry to hear that, checkout my next free Bone Foundations Masterclass Session if you haven't been to one yet. It could be beneficial to you! You can find the details here --> www.optimalbonehealth.com/bone-foundations-master-class
Hello,
My sister is 69 years old and her doctor tells her that it’s too late for her to be on estrogen. She said she was too old for it now and it would not do any good. She does have osteoporosis, but she’s maintaining. I shared your channel with her. Is she too old to go on the estrogen?
I myself have been on estrogen, testosterone and progesterone for many years. I have no bone loss and no problems.
Thank you, I love your channel. It’s very educational. I have been sharing.
Thank you! Estrogen at 69 carries risks and they likely outweigh the benefits. This is a controversial area but depending on the age of menopause 69 is likely not a good starting point for estradiol but other options could be considered.
Thank you for responding . Hopefully she will contact your office in time.
Thank you for sharing and your continued support!@@AngelwithAttitude7
Bioidenticals can be used safely at all ages. It is never too late unkess cancer issues prevent it. Protects not only bones but prevents dementia and all her cells benefit. Please don't tell women they are too old at 69. That's old thinking. Personal experience tells me otherwise. A female endocrinologist really is best person to help older women. Men just can't get it. Women have more than just bone health to deal with. Stay off the meds, they just make it worse..just my non-med opinion..
what risk? @@Dr_DougLucas
I have just been put on HRT and have been so scared! I also have osteoporosis and found out the hard way at 50 by getting a fracture from doing “nothing” …
You have given me a lot to think about and I am so thankful ❤
Thank you for sharing and watching!!
This doctor is amazing. This is one of the most impressive explanations I’ve heard on this issue. Thank you.
Thank you!
Dr Doug
Just found you. My PA at AFC asked me to research. She did just start me on an estrogen patch and 150 mg Progesterone 150 mg capsule 1/2 hr before bedtime. My Naturopath had put me on Testosterone 25 mg 2 months ago. Continuing it. Naturopath also put me on OsteoForce and Ultra K2. Definitely plan to finish what I have on hand but will be checking with my PA as to whether she thinks continuing to take those as well. I am old. 78 but I have been extremely active. The last few weeks I have been having more bone issues. Had 2 MRI'S last Thursday. Pelvis and Lumbar spine. My PA has several patients that are doing well on what she prescribed. Including her 75 year old mother. I am glad I listened to this video. PA had asked me to do my own research. I had a hysterectomy when I was 30. Never felt like I had menopausal symptoms. Osteoporosis and Osteo-Arthritis now are major issues for me.
Thank you so much for sharing all of this. It sounds like you could benefit from the next free Bone Foundations Masterclass we have coming up if you have not attended one before. You can find more information here -->www.optimalhumanhealth.com/build-bone
Great informative video!
I guess the next question would be, what is the minimum dosage of estradiol/estrogen for effective positive impact on osteoporosis / bone health? Would love to hear more on this …
Learning so much from your videos, Dr. Lucas!
I would like to know this too.
Great question. There is evidence to support a minimum serum level of 40pg/mL to slow down osteoclasts. The problem with commercial preparations is that they often don't get you there.
@@Dr_DougLucas thank you for the reply -appreciate it.
Thank you so much for all the support.@@sna7142
@@Dr_DougLucas My patch is .075, my doc doesn't believe in testing serum levels so I have no idea what mine is. Do you think my patch dose is strong enough to slow down my osteopenia?
Thank you so much!
I had a complete hysterectomy at the age of 32 in 1972. My dr put me on premarin at that time and it was 3 weeks on and 1 week off. I have experienced many changes in hormone therapy in the last 50 years.
At the time of the Women’s Health study my Dr wanted me to go off hormones and l did.
More hot flashes , bone loss, poor sleep etc.
Finally a new young Dr took over her office and she allowed me to go back on the patch. At the age of 83 l use as little as possible - only enough to keep the hot flashes away. From your lecture l think l will continue until l die! Is there a problem with my thinking?
Controversial for sure. The anti-aging community would say that’s the right approach. OBGYN, endocrine society and others would say that increases risk. I don’t have a timeline for stopping BHRT for my patients.
I plan to do the same thing as long as possible if possible. Had TH as well and have OP at 47. If you're looking at quality of life, then I believe that moderating your estrodial allowance makes complete and utter sense. Lack of sufficient sleep alone will massively shorten life span.
Fantastic video!!! I’d love to know your position on BHRT for older women. I went through menopause at age 47. Started topical BHRT AT 57. Stopped at 63 and restarted estradiol/estriol/testosterone cream and oral micronized progesterone (generic prometrium) at 68. I’ve heard from some it’s too late. Others it’s never too late. I’m very thin and have OP and feel comfortable taking it. I’m low risk for breast cancer. Thoughts for older women restarting or starting BHRT?? Thanks for this very informative video.
Hello,
Sensitive topic but yes we do support using BHRT in women well past menopause. Starting after the 10 year mark requires a discussion of cardiovascular risk but we have an algorithm for that and do it regularly.
I'm a breast cancer survivor and was put on letrozol bcuz of positive estrogen cancer. I'm now osteoporosis. Is there any hormone therapy for me?
@@Dr_DougLucas
Im 71 .just diagnosed with osteoporosis T 2.5 so my NP ckd hormone levels and just prescribed BIHR cream. Im too go back in 3 months for labs. Im on warfarin for a renal embolism in 2015. I test my INR at home weekly. What are your thoughts? I also have hemochromtosis and see oncologist every 3-6 months. At my age im trying to weigh the risks/ benefits for fall fractures. Drs want to push infusions that l reduse to do. You seem very knowledgeable and concerned.
Thank you
@@sallieb.2421great point as this is common in cancer patients
My mother and great grandmother died of breast cancer so no doctor will give me HRT and I have OP. Any possibility for me?
Can you do a video for those of us ladies who are Breast Cancer survivors and now on Anastrozole or other AIs, in relation to what we can do to manage or stave off osteoporosis and or manage our bone health 🙏 Thank you and much appreciated!
That's a great topic. I'll put it on my list.
You took the words out if my mouth. Thank you!
Thank you for your support.@@shellyditzhazy9705
I believe HRT gave me breast cancer...they increased in size and tenderness and something went wrong along the way...
@@mirapavlovic1960 I'm sorry to hear that you developed breast cancer. Some forms of HRT do increase the risk of breast cancer but estradiol and estriol have been shown to be protective. It's important to remember that developing a disease while on a drug or hormone does not mean that the drug or hormone caused it. Developing breast cancer with hormones vs because of hormones. I wish you the best on your journey.
Very interesting article.
I am 60 years old & have osteprnia, i was never given hrt until last year & the difference its made to my aching joints and bone health is amazing.
GP has now taken me off this few weeks ago re my age & perceived risks. I am in so much pain in my joints now and am convinced the estrogen was helping me.
I am going to insist i go back on this treatment as benefits for me outweigh the risks.
Thank you for sharing this!
I am 58 I have been on BHRT well supervised by a doctor who specializes in hormones. I have been on for 5 years and never see a time I will go off. Estrogen is protective for so many things in addition to bone health, including heart and brain. I suggest you look for a better informed Dr.
@@KT-ml1sy Well said.
Try Evernow online. They’ll help. People are stupid about hormones and you need experts In menopause care.
You should not go off HET, if you do, you will lose all heart/brain/bone benefits you had gained. I plan on staying on HRT for life, especially since I only just started on it at 60 years old. Good luck.
Very complex and controversial topic!! Thank you for such aa great video as always!
Thank you for watching!
Thank you for making a video on this crucial topic!
Thank you for watching!
Brilliant, as always. Thanks.
Glad you enjoyed it!
Great information. I’m looking forward to the Masterclass tomorrow.
Thank you for watching, see you there!
Excellent information! Thank u!
Thank you for watching!
Thank you for this informative video Dr. Lucas! I have Osteoporosis AND have taken BHRT. I am 62 and have my uterus, so I have used Estradiol/Estrol Cream and Patches, Progesterone (Micronized Pill, cream and suppositories), and Testosterone Cream. I have been on these forms of BHRT 12 years ago and then again for a year now. I have been through ALL methods of creams, pills and patches. Anytime I have used Progesterone, micronized, creams or suppositories, I have had terrible reactions such as severe acne, bloating and swelling in my hands and stomach. I simply can not take Progesterone. I NEEEED Estrodial for my bones! I did see improvement in the Estradiol patches over cream, but my Progesterone blood tests never improved from a
Consider an IUD that your OBGYN can put in! Protects your uterus from estrogen but only locally.
Love your videos. So informative and from a common sense perspective. Have you considered putting them into a podcast version? I’d love to listen to them as I’m driving. Not sure if I can do that via RUclips (listen while driving.)
Hi there! You can listen to them as a podcast! I have a podcast as well but it's on Health Optimization in general. It's called the Dr. Doug Show.
So onboard with what you said. Your practice is where i wish i could go.
Checkout our free Bone Foundations Masterclass if you have not attended one before! You can find details here --> www.optimalbonehealth.com/bone-foundations-master-class
Very interesting info. Doctor! I will definitely be raising questions with my endocrinologist. Thank you!
Glad it was helpful!
Thankyou for sharing your thoughts on HRT. I thought I would take bio-identical hormones for my severe osteoporosis. For 2 1/2 years I took the estrogen cream with testosterone, and a progesterone pill every night. My bone density was greatly improving, and I was so happy. But after 2 1/2 years of this treatment plan, I started having very strange symptoms with my brain, about every 10 days to 2 weeks. My brain would feel like it had a sudden attack, a numb feeling, then a strange numb, tingling sensation went down through my whole body to my
finger tips and toes.
It only lasted a short time, but I could hardly walk and function during that short time. My husband being a doctor recognized what was happening to me finally, and said "I think you might be having TIA's". I remembered that the literature that came with my medicine suggested the possibility of stroke, so I stopped the HRT, and the brain symptoms stopped. I thought you might want to know my experience on bio-identical hormones.
Thank you for sharing your story!
Were you on HRT or BHRT?
I tried Premarin back in the 80s, and it made me feel TERRIBLE. Then I found out how components are harvested and declined it on moral grounds. I have osteoporosis, started taking Evista in 1998 with good results and no side effects, but have developed unacceptable menopausal symptoms in the past 10 years. I'm 74 and have the markers of a healthy 20-year-old. I'd like to take transdermal estrogen and progesterone to start feeling better, but cannot as long as I'm taking Evista. Looking into Prolia but am vain about my teeth, so would worry about jaw necrosis. I also know a woman who took Prolia and broke a leg while just unlocking her car door. There's a lot to consider, and I'll use information in your videos to make up a spreadsheet. Thanks for presenting such an array of valuable information.
Thank you for sharing this!
I am struggling w osteporenia. I use an estrogen patch, and pill progesterone. I didn't even know there Was a progesterone patch. I have lived problems. Medications delivered transdermally bypass the liver. I 'm asking my dr to switch.Amazing lecture and info. I take Dexilant, and have for years. I know these r being linked now to osteoporosis
Thank you for sharing this!
Very interested in hormone replacement! Thank you for the excellent presentation.
Glad it was helpful!
Very helpful Dr. Doug.
Glad it was helpful!
So helpful Dr. Lucas! Thank you! I will definitely be looking in to your other resources.
Thank you for watching!
I like this video very much . Very Helpful ! I download already and will be listened again later. I also shared with other people with similar situation. We are looking forward for hearing your lectures regarding how long the HRT can be used and also if over 60 years old is still helpful to continue use?
Glad it was helpful, thank you for sharing!
Thank you so much Dr Lucas.
Thank you for watching!
Thank you. At 72, they say Im too old. Shouldn't that be up to me? I want to take it. Looking for a Dr.
Love your channel.
Right! Thank you for watching!
Very infirmative
Glad it was helpful!
I am on an estrogen blocker because of having had breast cancer and now have an osteopenia.
You are not alone! Our approach is to pull every lever possible to support bones during this process.
I had chemo therapy 2 years ago for breast cancer and was put on an oestrogen blocker and now have osteopenia. What can I do to support my bone health
Dr. Lucas:
This episode was very helpful! I appreciate your videos
I have two questions:
1. What dosage do you usually start a post menopausal woman (no uterus or ovaries) estradiol patch?
2. Do you think melatonin has any beneficial characteristics for bone production?
Thank you very much!
Great questions! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Thank you Dr Doug for a very informative presentation. I was diagnosed with Osteoporosis 5 years ago after falling on an extremely slippery floor and breaking one of my wrist bones.
On my Doctor’s advice, I had 3 yearly infusions of Zoledronic acid.
My Spinal T-Score didn’t change in 4 years( it’s still -3.3).
My doctor is now advising having a 6 monthly injection of Prolia( Denosumab).
I’m very reluctant to start this as I’ve heard you have to keep taking this for ever( or a bisphosphonate ).
I’m a 68 year old man, very fit( I do resistance training 3 x a week, HIIT once a week, walk up and down a hill 5 x a week and play table tennis regularly). I eat very healthily ( lots of protein, fruit and vegetables). I’m retired, not stressed at all and sleep okay( not great).
What would you recommend?
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
Thank you so much Dr. Lucas for sharing all this valuable information. Quick question, being 57 and having gone through menopause 7 years ago, is there any data to suggest benefit from starting HRT after the 5 year window from the onset of menopause? It’s so upsetting that at 50 I didn’t insist on a bone density test. I asked but the doc said since I didn’t shrink it wasn’t necessary. I also showed him my hormone blood work and he said if I wasn’t having symptoms they weren’t necessary either. So then at 56 I shrink and have been diagnosed with severe osteo in spine (-3.2) and high osteopenia in hip (-2.4). Thanks again so much for helping so many of us!
Hi Debbie,
Absolutely there is benefit. The problem is in our current medical system that hormones are mostly prescribed for symptoms of menopause. Estradiol is FDA approved for osteoporosis, but rarely used. If you are within 10 years from the onset of menopause, the benefits of hormones frequently, will outweigh the risks.
Great video and information Dr. Lucas, thank you! I used to take bio identical hormones ( both biest and progesterone )but stopped when I reached 60. I now have osteoporosis. I am at risk of DVT from my bad varicose veins and previous phlebitis. Is it possible just to take transdermal or micronized progesterone to help the osteoblasts without much risk?
That's a conversation we'd have to have in person. Possible but the risk part needs a thorough discussion.
Thank you!!
Thank you for watching!
What's the window following last period?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
what is name of your hrt company ?
What about the influence of diet on study outcomes. Whole Food plant based diets are usually associated with lower cancer and stroke risks
Sure, whole food plant based diets studied in population cohorts will show all kinds of benefits but remember what this is showing. An association of a restrictive diet compared to a standard western diet. Low bar. These studies cannot get around the health use bias.
I had BC I use transdermal estrogen I feel so much better. Chemo put me in menopause at age 43. I have osteoporosis meds did not help like fosamax . So I work out with weights exercise every day still osteoporosis. So I break my wrist they put me on forteo for 2 years bone markers up good back into osteopenia. Next prolia . I’m still using E-3 estrio it helps with sex drive my bladder etc. F breast cancer I only hone boob left so I have to live. Do for you it’s your body .
Thank you so much for sharing your story!
Hi dr Lucas,I am watching this from Australia. I am 64 osteoporosis woman. I use estriol for 5 yrs now I want to take HR. Please answer my question thank you.
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
Great talk on estrogen and bone health.
I am a 68 year old women considering bioidentical hormone treatment. Is it enough to test with saliva for hormone levels or should it be in conjunction with a urine test.
I have heard saliva is enough of an evaluation. Please advise.
Blood tests are the gold standard. We use urine metabolites for safety and estrogen breakdown patterns. Never saliva.
Saliva, finger stick and urine all measure different things. Topical hormones are best tested in blood.
From your video's its obvious that every patient is unique in their needs. I wondered if you would ever recommend HRT to women who have had BC?
It’s possible but requires a thorough discussion of risk/benefit and the cooperation of oncology which is rare.
So interesting. Ihad a mastectomy for invasive lobular and invasive ductal carcinoma.
A PET and CT did not show any active cancer cells or tumors. I have osteoporosis so declined hormone therappy and radiation. My integrative DO is testing me for horne levels. I feel that what I have listened to in your video meshes well with what you have said. The oncologist didnt test for levels of estrogen, etc. Just said I shouldnt have any as my BC was est dependent.
Thank you for sharing this!
I have ostiosporosis (righ femur) and ospinia on (left femur). I've watch you videos and I'm doing resistance trading to build muscle but I take metforming.
Thank you for watching, glad to hear you are incorporating resistance training!
So what is the test for estrogen, progesterone and testosterone?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
What are your thoughts on TRT for males with osteoporosis?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Can I ask why the new WHI studies from 2020 were not spoken about? They were positive studies. Also do you follow @Dr Mary Claire Haver? She is a board certified obgyn on the same page as you.
I did discuss the WHI in detail. I'll check out Dr. Haver.
Wow! So helpful. I was just 1 week ago prescribed vaginal AND oral estradiol by a regular gyn. I’m 61. Would you be able to recommend someone in my area who treats like you do? Las cruces, New Mexico.
We are a nationwide telehealth company. You can chat with our team at www.optimalbonehealth.com/schedule
Your explanations of the research on this topic was excellent and easy to understand. I see your next masterclass is at 3pm September 20. Do you ever rotate the day of week that you present on zoom or offer it a bit later? I am central time. Thank you
Hi Kara, we try to keep these around the same time but we do send a replay link to your email after the masterclass is complete so that you can watch it at your convenience. As long as you are registered at this link you will be good to go! -->www.optimalbonehealth.com/bone-foundations-master-class
When I go to the website there's a message that it's under construction?
I'm 59, have osteopenia, using a transdermal estradiol with a Mirena IUD for progesterone. What dose of estradiol patch is best for bone density? My doc doesn't believe in testing serum levels.
It’s variable. That’s why you test. I hear that often. Docs that don’t believe in testing are generally dosing at the lower end of the range. IUDs won’t provide systemic progesterone and will have no impact on bone health.
@@Dr_DougLucas I thought it was the estradiol that impacts bone health, not progesterone?
@@user-EinsteinSarge All three play a role. Estrogen is the most studied followed by testosterone in men. Progesterone shows benefits for bone health but only in concept not through intervention studies as a unique independent variable.
Wow! Which doctor do you have ?
I don't understand the question. I am the doctor.
I’d like more studies for people that don’t do the HRT but high risk for osteoporosis or even diagnosed with osteopenia and people being followed at different approaches like a natural approach of a diet plan that they been educated on to use along with a exercise plan course diet I know it’s more difficult, but maybe something they eat exactly like that
That would be an amazing study! Unfortunately, we are unlikely to see that study ever funded or performed.
Bone is 40% protein. The human body needs more protein as we age not less. Animal based protein is unbeatable.
@@olderandwiser127 Couldn't agree more.
What are safe options for older women > than 10 years post-menopause? I feel betrayed by believing the WHI recommendations at a time when I needed to continue estrogen. My doc indicates that vaginal estrogen is safe - but obviously less effective. Can use of vaginal estrogen be increased to help the bones?
Great question. I sympathize with you on your trust of the recommendations. I see it every day in my practice. Women in this age group who weren’t even offered HRT as if it was not worth the discussion. Now they have osteoporosis and are at risk of something more likely and more deadly. There are options to consider but are in the grey zone of health optimization. Off label testosterone, progesterone or estrogen alternatives like Raloxifene can be considered. Even estrogen may be considered >10 years out from menopause in the right candidate.
I fought for nrt since meno at 46. To the point i got kicked out of drs office for refusing horse urine. I am 66 still on therapy. Fractured l4 disc at 56. Still have osteo in neck.
Thank you for sharing this, our free bone foundations masterclass could be beneficial to you if you have not attended one yet. You can find details at this link --> www.optimalbonehealth.com/bone-foundations-master-class
My understanding from another channel on this topic is that estrogen has no benefit for women after about 10 years post menopause because the body no longer has an effective/viable receptor mechanism, and that estrogen therapy for bone density for those women who go on the therapy earlier than that can work but the bones revert back after the treatment is stopped (a bit like other treatments whether drugs, exercise or diet I suppose)?
I looked into it as well, and that seems to be the general consensus. I was thinking of taking DHEA, which the body uses to produce the hormones testosterone and estrogen, but clinical evidence to support its use is very weak, especially the older we are and the further away from menopause.
I would be interested to know this too please Dr Lucas
Can only speak for myself. Am in my 70's and it is beneficial to me. I notice quite a difference without.
@@gracenotes818 If I may ask, did you begin taking estrogen right after menopause and continued to take it ever since, or did you wait 20 years before taking it? My concern is that since I didn't begin taking estrogen right after surgical menopause in my late forties, that it's too late to help me since I'm now I'm in my sixties.
I started BHRT 10 years after menopause. Stopped 6 years later. Restarted 5 years later. I’m not sure if I’m benefiting but I’m sticking with it. There are differences of opinion. But It’s good for other things as well.
Sorry if already addressed. I am a 56 year old male with osteoporosis. My endocrinologist believes from decades of low testosterone. I was on TRT (gel) for 18 months when I suffered 2 vertebral fractures. Now I continue on TRT and started Forteo. What role might estrogen, progesterone or estradiol have for me? I am trying to get my estradiol level up to about 40 (undetectable before TRT and now sitting at 26).
Hi there. Great questions.
For men, estradiol comes mostly from conversion from testosterone. Replacing testosterone is the way to get adequate testosterone. If you aren't converting enough my first step would be to evaluate your total levels and your free T as well as SHBG. I find gels generally don't get you there. We use injections or creams but injections for 95% of our men on TRT.
How do you feel about bio identical hormones?
Love them. It’s what we use and do. There are risks but in general most people with osteoporosis would benefit.
Interested in the estrogen but wondering why progesterone was not included…do we not have to take progesterone along with estrogen?
The traditional approach for a woman with a uterus is to use a progesterone as well as estrogen. This is our approach as well, but this video specifically is on estrogen.
I read the comments only to see who asked this question.
@@Dr_DougLucas Thank you for your reply!
@@amygiles1727 Thank you for watching :)
Is it a big a risk as Bisphosphonates?
Varies per person!
What angers me is the lack of knowledge of doctors. I cant tell u how many drs lectured me against my bio identical hormones.
I am sorry to hear that. Thank you for sharing this!
I was diagnosed with osteoporosis and it was brushed off as mild with a directive, “just take some calcium…” If HRT isn’t an option since it was not offered when I was in menopause and it’s been almost ten years since onset, do I have options that will help?
Thank you for sharing this, unfortunately I cannot provide specific recommendations through this platform, I would need to know a little bit more about you as well. Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. You can find more information here --> www.drdouglucas.com/healthspan
Triple negative here 10 years ago. Wondering if HRT would be possible for me on my journey back to healthier bones.
Very debatable. Conventional medicine would say no. Some providers would say yes but with clear understanding of the known risks/benefits.
@@Dr_DougLucas thank you. I am learning from your videos
Thank you!@@conniemcdonald4678
What about growth hormone? I have hypopituitarism due to radiation treatment by lazer for a benign tumor and have been on hormone replacement for 28 years. In France, where I was living at the time, growth hormone is part of the hormone replacement therapy. In Canada it isn't (where I now live). So, how does growth hormone affect bone health?
I’m an adult probably not directly. GH is available in the US but only for pituitary v
Conditions. We use growth hormone mimicking peptides to impact muscle growth which secondarily will impact bones but we don’t use GH itself.
Three Aunts dead from breast cancer all took HRT no family history of breast cancer on either side of my family. Cousin just died from breast cancer she took bioidentical HRT. Two friends my age and younger I am 58 dead from breast cancer both on bioidentical HRT. Just watched a woman on RUclips that just had to get both breasts removed due to breast cancer her doctor told her it was her use of HRT so needless to say she is no longer taking HRT.
Hi there. As much as I sympathize with your many experiences of family death and am sorry for all of the loss anecdotal experience does not trump well designed clinical trials. I have hundreds of patients on HRT and between me and my peers we have thousands. Our collective experience is that rates of breast cancer seem to be lower in this group. Perhaps because of the self selected group or because of the protection from testosterone. Again, sorry for your losses.
There are tons of risks we find out a lot of times the drugs don’t even work down the road it’s all just a moeny and MAKING game. Sadly, we need to look at more natural ways to treat things and head on up ahead of time before we get diagnosed we need to teach doctors to look for Graves’ disease so people don’t end up having issues becsue of incompetence!
Thank you for sharing this!
Why is progesterone bad? I am currently on both Estrogen and Progesterone HRT.
Progesterone isn’t bad. Progestins (synthetic progesterones) are dangerous. Make sure you know which one you are taking.
A month ago, my doctor reluctantly prescribed for me an estradiol patch .025 mg/day (I also have Mirena IUD) to help both with bone loss and hot flashes. This is what she told me….one in eight women get breast cancer. If you develop breast cancer while on HRT you will be feeding that cancer and there will be a greater chance it will become more invasive before detected than if you were not on HRT. This is pretty scary and is making me rethink my decision. However the patch has already provided incredible relief from hot flashes, and I have high hopes to reverse osteoporosis in my spine (-2.7) combined w nutrition, supplements and a progressive weight resistance training program. I am 59, thin, and it has been less than 5 years since onset of menopause.
Is there any evidence in the literature to support the concern that women on HRT get diagnosed w breast cancers that are more advanced or invasive? What are your thoughts on this?
I don’t know what to do.
This is a conversation I have often with patients. I understand the fear. Your doctor is kind of right. Invasive versus non invasive isn’t the right terminology but her point is correct in that estrogen sensitive breast cancers may grow faster if on estrogen. However, there isn’t actually evidence to support this that I’ve seen. It’s a logical theory though.
So, we evaluate risk thoroughly and make a decision together. There is risk in treatment. There is risk in no treatment. Together we just have decide which risk we want to face.
Thank you for this channel. All the information and analysis. For being here for us. And your replies to our questions. You really do get it.
Thank you so much for your support.@@RainSkyWillowKiwi
Hi Dr lucus dexa test says i have osteopenia T-1.7 my ist fracture is T 11spine specalist wants me get a kyphoplasty and go on meds wot would you suggest bit iffy about meds but dont want another fracture like this he says dexa can give a lower score and i maybe be further on into osteoporosis than thectest suggests
Fragility fracture tells a better story than DEXA. Meds are indicated in that scenario BUT I still prefer a comprehensive approach and we have been able to get people out of the danger zone without meds.
I was put on a medication which actually blocks estrogen. How an that be helpful for osteoporosis?🤔
It's not. Are you sure it was for osteoporosis or is an estrogen blocker? OR is it a SARM like tamoxifene?
Do you have a cut off age for subscribing HRT?
No hard age but after 10 years post menopause the risk/benefit discussion gets more difficult.
@@Dr_DougLucas oh oh 😮.
What do you use to test hormone levels? My doctor prefers saliva sampling over serum (and urine) saying it shows what the tissues are actually being bathed in. My saliva levels of estrogen and progesterone both are so high, even through the roof for the progesterone and I think menstrual levels for estrogen (or higher) even though I'm post menopausal and yet serum tests show the opposite. It really becomes so hard to know what to do or what is needed and to me that the levels or EXTREMELY radically different on serum and saliva sampling makes no sense. I have no idea what can be trusted and what is accurate. My P1N1 is HIGH (I have no idea why) and CTX is too high, 808, so I hope you can do a video on what to do to slow down osteoclasts. Is taking estrogen the only option ? which is challenge if I'm high risk breast cancer and saliva samples show estrogen levels to be quite good, so wondering about options.
Hi there. My training and experience discourages me from using saliva samples. They are inaccurate and inconsistent. Serum is the gold standard and what we use unless we want to view breakdown of estrogen for which we use urine metabolite testing (DUTCH). I have some new videos on P1NP and CTX coming out so take a look at those.
Been doing oral HRT for 4 years now for OP but want to transition to BHRT but they require me to be off my current HRT for 10 days so they can test hormone levels w labs. Will going off HRT cold Turkey be okay and result in any bone loss during those 10-15 days? Thank you LOVE your videos!!!!
Hi there.
You probably won't see much loss in 10 days but here's the question I woul ask them. If you're post menopausal, what do they expect to see in the blood results. They should know the answer. You don't have any sex hormones. Your levels will be nearly zero. Why put you through that?
Thank you, that is a fantastic point bc the symptoms of going off can be rough! I appreciate your response and guidance!@@Dr_DougLucas
Somebody, please help me figure this out. I had a total hysterectomy 1 year ago at 46. I now have osteoporosis. The bioidentical topical cream wasn't giving me the estrogen I needed, so I started using the 1mg patch. Well, I still don't think I'm getting enough to help my bones. My gyno and endocrinologist seemed to think it's fine, but I know it's not because I got osteoporosis. Any suggestions???
Hi there. I sense frustration and urgency in your question. Hopefully this will help ease your anxiety a bit. Remember that osteoporosis usually takes years to develop. The amount of bone loss in one year from a surgically induced menopause should not be dramatic. It’s there for sure but it’s in line with natural menopause numbers. So, HRT should help and estradiol levels can be tested to verify if the patch is adequate. 1mg may be but not necessarily. However, the fact that you got a diagnosis of osteoporosis while on the HRT is only an association. We don’t know starting point or trajectory of BMD. Does that help?
@OptimalBoneHealthwithDrDoug I see. So, they're not completely to blame. I guess why I'm playing the blame game is because I went from being in no pain to being in chronic pain. I am healthy and fit but small boned. My doc waited 2 months to put me HRT and thyroid. Then the compounding shop told me to do 1 pump instead of 2. So I got half what I was supposed to be getting for 4 months. No bloodwork is done. Meanwhile, no sleep (well, hardly none) due to being miserable from inflammation in every part of my body. I ended up going to a Rheumatologist and my ANA's were hitting the ceiling. She put me on Hydroxychloroquine and a few weeks later, I finally started feeling less pain. I didn't test positive for an auto immune, but she said let's see if it helps, and months later, I stopped taking it, and I feel fine but have osteoarthritis that is tolerable.
@OptimalBoneHealthwithDrDoug Btw, my doctor would ask me during my appointments. "Um, you still have your ovaries, right?" I said, nooo, they took them at MD Anderson, remember??? Happened at each appointment. I actually scheduled my own DEXA scan. Results to the doc, and they never called me. I finally called and asked about it. Nurse said, "ohhh, well, we received your report 3 weeks ago, and huh, well, you have osteoporosis." Nurse said, "Well, that's the way it goes."
Anyways, thank you for your reply, Dr. Doug. I appreciate being heard and answered wisely.
@@heathermunoz6282 Wow, that's unfortunate. I hope you are using this as a resource to create the program you need to improve your bone health! If you haven't been to our masterclass that's a great option too.
I’m using Estradot 50 to manage my OP, is estrogen cream more efficacious? Thanks
Great question. Estradiol or Bi-Est creams are more flexible. The commercial products have a range but that range is designed for symptom relief from menopause, not to obtain ideal blood levels for bone health. I find that a 50mcg dose is not adequate to achieve optimal blood levels but everyone's different.
Are you balancing that with progesterone?
I unfortunately, got caught up in the knee jerk reaction to the WHS back in early 2000's. I had a complete hysterectomy in 1999 and had been on estrogen from day one. My VA doctor in 2005 said I had to come off of it because of the risks she said were identified in the WHS. Fast forward 2 years and my osteopenia advanced to osteoporosis. It took another couple of years after that to find a doctor who would prescribe Estrogen again. All of my other doctors kept pushing Osteoporosis drugs which, luckily I guess, I had negative reactions to. I simply refuse to take them now. Recently, a doctor told me that because of my age 69, I should think of coming back off of Estrogen. Sheesh. I am low risk for the heart/stroke issues, but even if I weren't why aren't they suggesting transdermal? So frustrated.
It's old dogma. Use as little as possible for as short as possible is what these doctors were trained to do. In the healthspan space we look at it differently. We use it off label to optimize multiple aspects of life, including bones.
I've been on HRT for two years after having really horrible hot flashes and other menopause symptoms. It's vastly improved my life and I don't care if it increases my risk of breast cancer, which I don't think it does. I'd rather feel good and have a great quality of life and be able to do all rhe things I enjoy than feel horrible because I'm scared of cancer. I think the WHI did a gigantic disservice to all women. If HRT improves my bone health that's an added bonus. If it doesn't that's ok too.
Thank you for sharing this!
Is a discussion on Raloxifene possible?
On our list! Hopefully in a few weeks.
How many studies look at transdermal compared to oral route??
In the meta-analysis, I review in some of my talks, there are two big studies on oral versus transdermal. However, there is a meta-analysis that looks at all of the transdermal all of the oral studies which met criteria of which there are dozens.
I have recently transitioned off of Premarin to the estradiol patch/.05, anyone know what levels of estradiol and progesterone is sufficient to prevent further bone loss? My estradiol level came back 77 pg/ml and progesterone was 110 ng/dL. Thanks so much!!!
If you transitioned off your levels will fall to nearly 0. Blood levels of 40 pg/ml have shown benefit for osteoclast inhibition.
Thank you so much!@@Dr_DougLucas
I’m on Estradiol cream vaginally. Does this have any benefit for osteoporosis?
Not usually. Vaginal creams frequently do not cause systemic levels to rise of estradiol.
I was recently diagnosed with osteopenia in my gynecologist up my dose of estradiol that is used vaginally I did not realize it doesn't help with bone health!
How should I be taking estradiol for my bone?
I’ve been learning about menopause and it’s so confusing. There are different camps with different perspectives that contradict each other.
I’m not afraid of HRT. I want it for my bone, brain and heart health. I’m in perimenopause (50 yrs old) with regular cycles. I have osteopenia. My main symptoms are insomnia and anxiety.
I’ve been told since I still have regular cycles, I either take birth control pills or nuvaring. I don’t want this option since I don’t want oral pills or progestins. I’m told HRT dosages are too low for me.
So do I have to wait till menopause to get bhrt estradiol patch snd micronized progesterone? In peri, does bhrt estradiol just add onto my existing production? Im afraid my bone density is getting worse while I wait fir menopause to arrive?
I know I can lie that I’m experiencing hot flashes and night sweats and they’ll happily prescribe them but this is right approach?
Hello,
I'm a fan of integrity and honesty so I wouldn't suggest lying to your providers.
We use blood tests to determine levels of estradiol and if a women is getting abnormal cycles or estrogen deficient it can be added but not until then. If it's there we don't need to add it. Remember it's bioidentical so there is no need to do more of it if it's there.
Progesterone and testosterone though CAN be added to a cycling women's hormone replacement. That is not often done in the traditional medical space.
My doctors didn’t prescribe anything and I’m post menapause now.
@@Portia620 That's not surprising. There is no urgency in the traditional medical system when it comes to HRT.
Is there an age limit for taking estrogen and progesterone?
Not a hard age limit but time since menopause is relevant for a risk discussion.
Should not start estradiol after 60. Studies show bigger risks. Natural progesterone no time limit.
Barbara Taylor, M.D. (also known as Menopause Barbie) has developed a full array of menopause services to help you with every aspect of menopause.
About Menopause Taylor · One-on-one consultations · RUclips video tutorials
Thank you for sharing this!
She is FANTASTIC!!!!
I am 67 I was offered to take premarin when I was in my 30s. I didn't take it not when I found out that was made from horses urine now way and still don't take anything doing fine I do have some bone loss but women loss bone early and nothing you can do except try to slow it down eating right and exercise.
Thank you for sharing this!
The fear is real. I took estrogen for PCOS, then got breast cancer. Triple positive.
I am so sorry to hear that. Thank you for sharing this!
In Europe they don’t use synthetic progestin , it’s normally bio identical product, So why would Denmark do research on synthetic progestin? It doesn’t make sense? Is the media been honest with us?
Great question! Checkout our health span nation if you have not yet, you get exclusive access to me and a community of people pursuing health and longevity. These are things that we discuss in there and it allows us to go into detail rather than doing short chats through this platform. You can find more information here --> www.drdouglucas.com/healthspan
Is use of estrogen relevant to post menopausal women?
Absolutely! It is actually most relevant for postmenopausal women.
For a 53 y/o woman recently diagnosed with osteoporosis who already has Lobular Carcinoma In Situ and been told that she’s not a candidate for hormone replacement, what can you do to assist or is this just the case that needs to take Boniva or similar type medication?
This is unfortunately not uncommon. We work with patients with breast cancer and survivors to create comprehensive programs with or without drugs. They are not always required but verifying that bone loss is not rapidly occurring is critical!
@@Dr_DougLucas How do you verify that bone loss is not rapidly occurring? Probably nearing or in menopause, my understanding is that is to be expected to start losing bone rapidly.
@@ballerbrosmedia We use biomarkers like CTX to verify bone loss.
@@Dr_DougLucas So if bone loss is rapidly occurring, especially due to menopause, then I have little options than to be on a bisphosphonate type medication?
@@ballerbrosmedia Still depends on the situation but an antiresorptive drug may be a reasonable choice in such situations.
How do I find a doctor near me?
I went through my regular Medicare Advantage Plan HMO and was fortunate to find a group, Had moved to different state and needed to find a new provider. Very receptive to me continuing with Estradiol patches and progesterone. I have found, over decades, that primary care providers in general only try to scare you with the risks while gynecologists are in general very open to this option.
The menopause society has a list of approved providers on their website.
Very difficult challenge. As stated above the traditional medical system has lots of tools but they are all going to be in the traditional medical system. You'll get the same options.
You didn't address the menopause onset. My ex-girlfriend became menopausal at the age of 36. That's a very different situation from a woman who enters menopause at 51.
Most gynaecologists seem to agree that HRT is beneficial to prevent osteoporosis in early menopause.
Unfortunately most studies keep focusing on fractures instead of showing actual bone scans, preferably QCT. There's much more to osteoporosis than fracture risk. How about herniated discs and stenosis? Stenosis in particular is a direct result of osteoporosis, and much more severe than a once-in-a-lifetime fracture.
Hello,
Yes, these are all important factors. If I addressed every perspective of the issue it would be a 90 minute documentary. However, I’ll respond to on comment for clarity.
I think it’s more important to focus on fracture risk rather than bmd. Lots of people have low bmd, low fracture risk and don’t need treatment. Fracture risk on the other hand is important to quantify because it helps us decide on treatment.
Quantitative CT is great but the radiation dose is too high to perform on a regular basis.
@@Dr_DougLucas Thanks for your reply. I still don't understand why severe issues that affect nearly everyone who has osteoporosis are left out. Herniated discs, lordosis and stenosis are 100 times more common than fractures, and they affect patients on a daily basis. They prevent people from leading a normal life. While not every herniated disc, stenosis or lordosis is caused by osteoporosis, nearly everyone with osteoporosis is affected by one or more of the above conditions.
If you're a statistician working for the government and don't understand the real world, you will probably focus on fractures because they are countable.
If you are a doctor you focus on all health aspects that result from osteoporosis. Fractures account for 1% of these issues. Overlooking the other 99% is almost criminal neglect.
@@jacquesmertens3369 I'm not sure what you are looking for here. There isn't much for me to say about these consequences of poor bone quality. I'm trying to improve bone quality.
@@Dr_DougLucas OK, let me try to explain: every time I see an endocrinologist to discuss bone quality I get the reply "have you broken any bones yet? No ? OK, then you don't have a problem."
Every research is focused on fractures, when in reality 99% of the health issues you experience are not related to fractures.
As a result I don't get the right treatment.
If more was published on the other consequences of osteoporosis, then maybe patients would get the right care.
What is «micronized» progesterone ?
micronized progesterone is the form used in commercial and compounded forms now.
Thank you. So synthetic then ?@@Dr_DougLucas
@@synnvetorbjrnsen558 It's debatable terminology. It is the identical molecule as what is made endogenously but it is made synthetically as are all hormones.
you need to talk about bio identical hormones...no one should be on progestin or oral estrogen.. that is not bio identical
That's what I'm talking about.
But who, as a pensioner, can afford bio identical?
I went through an early, natural menopause at age 43. Apparently, it may be hereditary as my daughters also went through menopause in their early 40s. I had no high risk factors at all and took hormone replacement until age 67. I stopped because I also have migraines and by my mid-60s I was having constant migraines and auras. Ending the HRT stopped that. But, in a couple of years my hair begin thinning and my skin became extremely dry and I (don't laugh) actually started getting wrinkles. I think if you are healthy with no risk factors or bad side effects HRT is not a problem. No, it didn't help my bone density I don't think. My bone scans always did show minimal bone loss even into my early 70s. But, that might be other factors too. I really believe it's all on a very individual basis and should be treated as such.
Thank you for sharing this!
Is your trans dermal estrogen an estradiol? Or is it a More Natural version like your progesterone?
Oh you mentioned estriol…. Is that lab created?
Estradiol and estriol is my preferred topical. They are “bioidentical.”