Dr. Jocelyn Wittstein

But why do you think the hesitation?

There was a trial called the ULTRA trial where, again, looking at Menostar, the 14-microgram dose, where...

If you looked at what level of estrogen women were at, they're all like all these women under 20, which would be typical of menopausal women.

Yes, estradiol level.

Yeah.

But these postmenopausal women, there's even variation within that number under 20.

So some people live like under five.

Yeah.

Some people are at 15, you know, so you could have these quartiles, let's say.

And in the study of the Menastar dosing,

one study found that the people who were in the lowest quartile had the greatest response to the metastar.

So they had the greatest reduction, you know, in their turnover markers.

So I think maybe some of the concern about looking at levels is that people respond differently.

Like some people just live at different levels and then it's a relative change.

So then if you're checking a level, what does the level mean for this person versus that person?

And so I think

That study actually made me think, well, maybe that's why people are hesitant.

But on the other hand, if you look at dosing, I mean, if you look at fem ring, which is systemic estradiol, which can be protective of bone density, or you're looking at transdermal estrogen,

If you compare the 50-microgram doses to 100-microgram doses, there really isn't a significant difference in the increases in bone density.

They're very similar, but they're a little higher with the 100-microgram doses.