Dr. Jocelyn Wittstein

Like they're, you know, had a...

Obviously, as we get towards menopause.

So they have lower estradiol levels.

Yeah, yeah.

They have like, you know, less, you have less cycles, but people have like this longer period of more spread out cycles for the people who lose more bone and perimenopause.

So it's like, you know, that prolonged decreased frequency of cycles is kind of a marker for being a fast bone loser and perimenopause.

So this study showed...

that if you were at least at 60 picograms per ml, you had the greatest reduction in those markers.

So suggesting you're having the least bone loss.

And then once you got to 90 or higher, there was no difference, which makes sense because 80 is the level and luteal phase of many women who are menstruating.

So why would you need to be higher than 80?

than that.

Probably not.

So that sort of led to, I think, has made people think, oh, we need to be at least 60.

But on the other hand, there is also data that comes from all of the studies of Menostar, which is the ultra low dose transdermal estrogen, the 14 microgram dose, showing that using that and even people not even exceeding a level of 20 picograms

per milliliter protects bone and reduces bone loss and even increases density in the lumbar spine by like two and a half percent.

And so I think that kind of leads to this confusion of where do we need to be is more better.

Yeah.

And I don't want to, like, overstep my boundaries or my sphere of practice.

No, no, no.