I'm not 100% clear on the question so please forgive me if I'm going the wrong direction with it. As far as the increased risk of clots, estradiol is metabolized and eliminated by the liver and one of the byproducts of this process is an enzyme that signals clot factor. We bypass a lot of this risk by getting it through injection, dissolving it through the mucous membrane under the tongue or through transdermal patches. There is still the action of the liver at work, but by skipping the digestive tract we achieve higher circulating levels with lower doses. Rather than going through the stomach and intestines and liver, with only a fraction of the initial amount surviving to do any good while adding tons of risk, putting it straight into the bloodstream skips the initial destruction and clot enzyme production by the liver to a great degree.
Also, the use of bioidentical estradiol is a big thing. Estrogen made from horse pee is not bio identical, so when our bodies break it down there are strands of junk left over which it doesn't know what to do with. Bioidentical estradiol can be broken down completely because it is identical to human estradiol.
As far as the risk comparison, I think that's subjective. Remember a genetic girls estradiol never touches her liver or digestive tract, at least not to the extent that it touches ours. I would imagine that's why we see a statistical difference in risk factor, but when you factor in things like quitting smoking (duh), decent diet and a reasonable amount of exercise the risk floor drops out.
I understand your fear of cardiovascular events. Last October I became the oldest genetic male in my family to not have had a heart attack. Really, as long as you follow the smoking and exercise guidelines you should be golden. There are horror stories all over that will scare the crap out of you, but this is do or die after all. I have a friend who works as an EMT and won't drive his family on the freeway because of all the carnage he sees up there almost daily. For every person that dies on the freeway though thousands pass by and hundreds were saved by their seatbelts. You kinda have to look at it that way or you'll be a nervous wreck and think your'e going to die every time you get a muscle cramp.
I read the other day that doctors are saying that hormone therapy doesn't shield women from heart disease like they initially thought, but I don't think that applies to us. I think we prolly see a drop in our overall inclination for cardiovascular ailments into the female risk categories.
This is all just talking about estradiol, where it gets really interesting is when you get into the chemistry of antiandrogens.
