i'm still waiting for resorption and turnover markers, but my formation markers are fine - indicating i'm not having difficulty producing bone, at least. i'm going to test gh and igf-1 directly fairly soon, but it doesn't seem to be a problem with calcium or d or thyroid hormones. and, the point of taking estrogen is to protect against resorption, so it makes little sense to think that's what's going on, either - but i'm testing and we'll see.
it's almost certainly that my bones never developed properly, and i initially pointed to malnutrition and smoking (which likely both contributed), but it turns out that poor bone development during adolescence is actually relatively common in pre-treatment transwomen. so, i'm a statistic here - there's a pattern for this.
the idea is that we often don't really go through puberty, so our bones never really develop properly as a result of it. and, did i go through puberty? not really, no. my dad was a man ape, in terms of body hair. that's 100% genes. but, i've never grown a single hair between my belly button and my adam's apple - not even fuzz, not even vellus hair. i had no interest in dating or having sex with anybody at all. and, i had a distinct lack of aggression as a teenager, as well.
these are unreliable markers, granted, and i can't do tests on my long evolved adolescent self to be sure, but they seem to point towards a general picture of incomplete or stunted puberty, likely due to low testosterone development. and, that might be why i was able to suppress it so much when i went on the cyproterone. there were times when they couldn't even measure any serum testosterone with blood tests - it was statistically 0.
what they've found is that the subsequent estrogen therapy often helps increase bone density in pre-treatment transwomen because it's actually undoing the hypogonadism present due to lower than average testosterone.
so, i'm tentatively coming to this diagnosis of low testosterone as a teenager as being the primary cause of poor development, with exposure to smoking and poor nutrition as potentially exacerbating factors. of course, teenage boys convert their testosterone to estrogen to build density. but, if there's no testosterone, there's no estrogen. so, it's another reason to argue that you want to get kids on hormones as young as possible.
and, that means i'm best off going on high dosage injectable estrogen to start, and potentially moving to forteo after it's effects have been measured. if the diagnosis is hypogonadism as a teenager, let's try hypergonadism as an adult to attempt to undo it, as a starting point.