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[joziel]

Very interesting. But since testosterone comes from the ovaries (and declines when estrogen declines), how do we know the effect of this is due to testosterone and not due to some women having more estrogen from their ovaries for longer....? I mean, both hormones would decline around the same time....?

[laszla]

Thanks for that Marchlove. I've no doubt that T also plays an important role in BMD and more, and the study suggests that some of T's effects are oestrogen independent (with the ubiquitous caveat that "more studies are needed"!). Now I just have to try and raise my values which are even more reluctant to increase than my estrogen has been... x

[Marchlove]

It’s a difficult one Joziel, testosterone is also made in the adrenals and apparently depending on how healthy they are, testosterone can be the more dominant hormone post menopause, albeit at a lot lower level.

My testosterone seems to have no problem increasing but that is probably because my estrogen dosage is quite low.

No idea whether this is of more benefit to me bone wise as not done enough research, but just going on how I feel.

Of course laszla it is of utmost importance for you to know what hormone will be most beneficial, as you already know that you need as much protection as you can get.

Let’s keep researching x

[Hurdity]

Very interesting thread, thank you laszla.

Just wanted to throw another study into the mix regarding testosterone and it’s effect on BMD. After all, healthy younger women have far higher circulating levels of testosterone than estrogen so it mustn’t be left out of the equation.

https://academic.oup.com/jcem/article/96/4/989/2720846

X

Interesting article hinting at a role of testosterone. However this was an association sutdy and correlation does not equal causation. The key points were at the end of the abstract:

"Mechanistic studies are required to determine whether a causal relationship exists between T, bone, and body composition in this population and the degree to which any T effects are estrogen-independent."

"A causal relationship" is the crucial point here.

Interesting though

Hurdity x

[Hurdity]

Hi again

I don't have time to quote the posts in detail- but this is an interesting discussion of a crucial question which forms the basis of arguments for taking HRT and dosing ie the protection of bones.

I have always understood that the effect of oestrogen on bone turnover to be dose dependent, hence the licensing of medium doses of oestrogen to help protect against osteoporosis - as per the menu on this website where the medium to higher dosages are given an asterisk and lower doses are not.

Secondy that ANY additional oestrogen is going to reduce bone turnover hence the use of the Menostar - but that this cannot be said to be equivalent to higher doses and will not give such a high protection. [incidentally the product info I read some years ago suggested an annual course of progestogen to reduce any potentially thickened lining as I recall].

Having had a quick glance at this paper: And here: https://academic.oup.com/jcem/article/85/12/4462/2852143 the critical point as laszla mentions is that is was carried out in OLDER women, past menopause, and the study says that in these women ( median age 75 or something?) bone turnover rates are much lower anyway.

The discussion highlights how different the situation is for younger women - ie most women on this forum and who are considering HRT, with studies indeed showing dose dependence (I have not looked in detail at the studies just glanced at the points made). In other words, in general, for younger women higher doses give more protection .

Re absolute oestrogen levels - there has been discussion about this and a have no papers to quote, but sometime ago I did find a paper where this was investigated and I do remember the absolute estradiol levels for osteoporosis protection ( and I dont know what markers were used to measure this) were much lower than I thought at something like 165 - 200 pmol/l though this would be a minimum and the oestrogen dose to achieve this would vary between women due to absorption.

That's all  have time for now and hopefully my (hastily made) points are a correct interpretation but thanks for posting all of this...

Hurdity x

[Marchlove]

Very recent study-

Perimenopausal Bone Loss is associated with Ovulatory Activity

https://mdpi-res.com/d_attachment/diagnostics/diagnostics-12-00305/article_deploy/diagnostics-12-00305-v2.pdf?version=1643166935

M x

[joziel]

Marchlove, that's very interesting. It supports what Lara Briden says - she believes that progesterone (body identical!) is really important for bone health and that we need to have ovulatory cycles because only when we ovulate do we then produce those high levels of progesterone. If we don't ovulate, our progesterone stays low and we have an anovulatory bleed instead of a period.

Which in turn supports the idea of using body identical progesterone during perimenopause, since this is when a lot of women stop ovulating regularly - even if they are bleeding regularly, a lot of those bleeds will be anovulatory. Lara Briden recommends supporting with body identical utrogestan during the luteal phase of the cycle, when usually the body would produce progesterone itself, after ovulation.

By the way, this is all very conflictual with the research on combined pills and POPs. Because that research has found that they don't have an impact on bone density - even though they stop ovulation. I looked into this when I first got worried about desogestrel, which suppresses estrogen to a low level. I wanted to check it then didn't affect BMD. And according to research, it doesn't. That makes no sense to me, because it can suppress estrogen to a really low level, like 50pmol or something, and also stops progesterone due to no ovulation - and we know that in peri and menopausal women that would be associated with bone loss.

So I don't understand why stopping ovulation with contraceptives (using synthetic hormones which aren't going to help health and BMD) doesn't cause a loss to BMD but when ovulation stops happening regularly during peri, it somehow does??

I also can't believe that we don't conclusively have these answers to the female body and how it works and it is 2022, we have landed on the moon and developed the internet and can somehow bring dead pigs' brain cells back to life - yet we don't understand how the hormones of 50% of the planet work, on a very basic level. We should all be outraged by this.

[Wrensong]

I also can't believe that we don't conclusively have these answers to the female body and how it works and it is 2022, we have landed on the moon and developed the internet and can somehow bring dead pigs' brain cells back to life - yet we don't understand how the hormones of 50% of the planet work, on a very basic level. We should all be outraged by this.

Well said joziel.
Wx

[Marchlove]

Yes it is very odd Joziel, makes we wonder if the research is done by the pharmaceutical industry or those with conflicts of interest, after all combined pills and POPs must be good money spinners.

Independent research for women is what is required, but who is going to pay for it???

Take testosterone for instance, huge amount of studies showing how it contributes to bone health in men, but I could hardly find any studies for women.

Yes Lara Briden is very much this way of thinking and certainly more ladies on this forum are experimenting with lower doses of estrogen certainly in peri.

[Clarella]

Lara briden shared an article querying of the COP was reducing women’s drive to achieve due to testosterone suppression today - I don’t read it but I did also wonder if it had an affect when I read her books and she talks about ovulation.

Gp was happy earlier with over 200 for bone but I wasn’t as still not feeling great.

I’m sorry to hijack the thread - could continuous utrogestan affect/ stop ovulation? I’m trying it for more consistency. I use vaginally. May try orally - actually could that help bones?!

[joziel]

I'm not totally on board with Lara Briden when it comes to testosterone. She seems quite against it and bangs on about it causing weight gain. I don't know what research that is based on. Surely it depends if your hormones are optimised and if you're taking the correct amount for a woman...

If you are peri, then you might not be ovulating anyway every cycle. That's when we start to get a lot of anovulatory cycles. If you're taking utrogestan, then you're not dependent on ovulation for progesterone from the corpus luteum - you're getting it from utrogestan. If you're only taking it at 100mg continuous, I don't think you will be stopping ovulation - that's not a high enough dose to stop ovulation if you are peri. Which is why you might get breakthrough bleeding. It might be best if you get bleeding to stop it for 3 days a month at least, so you can schedule that bleed.

[Marchlove]

I agree joziel. LB hardly mentions testosterone as a benefit in her books. Indeed quite rightly she makes great mention of PCOS, a much misunderstood condition, which indeed needs far better understanding and treatment.

My research of testosterone regarding its monthly cycle, seems to show that at ovulation it increases inline with estrogen and sort of follows the same natural decline.
It’s diurnal rhythm also shows a peak early morning.
This must all have great significance on our natural ovulation and it makes me wonder if we should be supplementing testosterone somehow in a way that somehow replicates this? X