Transdermal Estrogen in Women with Anorexia Nervosa

Eligibility Criteria

• 1. Female
• 2. 19-45 years of age
• 3. DSM-5 psychiatric criteria for anorexia nervosa
• 4. \<85% of ideal body weight as defined by the 1983 Metropolitan Life Insurance Height and Weight Tables
• 5. Amenorrhea
• 6. T-score of \< -1.0 at spine or hip
• 1. Diseases known to affect bone metabolism, including untreated thyroid dysfunction, vitamin D deficiency, Cushing's syndrome, diabetes mellitus or renal insufficiency (eGFR \< 60)
• 2. Personal history of venous or arterial clot
• 3. History of stroke or myocardial infarction
• 4. History of hypercoagulable disorder
• 5. Personal history or history of a first-degree relative with breast cancer
• 6. History of hereditary angioedema
• 7. Any medication known to affect bone metabolism, including systemic glucocorticoids within three months of the baseline visit, depot medroxyprogesterone within 6 months of the baseline visit, oral bisphosphonates within one year of the baseline visit or IV bisphosphonates within three years of the baseline visit
• 8. Bone fracture within the prior 12 months
• 9. Serum potassium \< 3.0 meq/L, serum ALT \> 3 times the upper limit of normal or Hemoglobin \< 10 g/dL
• 10. Fasting serum triglyceride level \> 150 mg/dL
• 11. Pregnant or breastfeeding (or desiring pregnancy within the next 18 months)
• 12. Active substance abuse
• 13. Elevated PTH level
• 14. 25-OH vitamin D level \< 20 ng/mL
• 15. Low phosphorus level