Your two panels, side by side
November 24, 2025 → May 11, 2026 · about six months on HRT
Current regimen — for context
- Estradiol patch 0.025 mg/day
- Testosterone gel 1.62% — approximately 10 mg/day (half pump) topical
- Progesterone 100 mg vaginal
Important timing context
The May labs were drawn on day 2 of your cycle. That matters for reading the numbers:
- Progesterone 0.9 — completely expected on day 2 (natural progesterone is near zero in the early follicular phase). Your vaginal progesterone is producing exactly the modest serum rise it should. Not a concern.
- Estradiol 7.4 — even accounting for day 2 being the hormonal low point, this is still very low for a 43-year-old who is still cycling AND wearing a patch. A still-cycling woman on day 2 typically shows estradiol of 20–80 pg/mL just from her ovaries, plus whatever the patch contributes. Both sources appear to be underperforming.
- Testosterone — only mildly cyclical, day 2 isn't a notable trough. The free T of 0.3 still needs explaining.
You've been on a real, meaningful HRT regimen for six months. Your anxiety improving lines up beautifully with the progesterone. But your labs are telling us something important: your estradiol and testosterone are not reaching your bloodstream at anywhere near the levels these doses should produce — and your own ovaries may also be contributing less than expected for someone still having periods.
This isn't a "you need HRT" conversation. You're on HRT. It's a "why isn't it working" conversation, plus a "what are my ovaries actually doing" question — both far more actionable than starting from scratch.
The big shifts at a glance
| Marker | Nov 2025 | May 2026 | |
|---|
| Estradiol (pg/mL) | 61.0 | 7.4 | ↓↓ |
| Progesterone (ng/mL) | 0.5 | 0.9 | expected on d2 |
| Total testosterone (ng/dL) | 17 | 14 | ↓ |
| Free testosterone (pg/mL) | 1.0 | 0.3 | ↓↓ |
| TSH (uIU/mL) | 2.24 | 1.29 | ↓ better |
| Free T3 (pg/mL) | 2.9 | 2.8 | stable |
| Free T4 (ng/dL) | 1.48 | 1.39 | stable |
| Reverse T3 (ng/dL) | 18.7 | 19.9 | ~ |
| Vitamin D (ng/mL) | 67.1 | 37.5 | ↓↓ |
| Eosinophils abs (x10E3/uL) | 1.0 H | 0.5 H | ↓ better |
Why the anxiety has eased — this makes complete sense
Vaginal progesterone is working — for anxiety
Progesterone is calming. It metabolizes to allopregnanolone, which acts on GABA receptors — the same calming system that benzodiazepines work on, but gentle and physiological. Even though your serum progesterone reads low (0.9, expected for vaginal route on day 2), the local effect on your brain and tissues is real.
Your thyroid quieted down
TSH dropped from 2.24 to 1.29 — that's the sweet spot most functional doctors aim for. Free T3 and free T4 are stable. Subclinical thyroid pressure causes anxiety in many women, and yours has settled.
Eosinophils halved
From 1.0 to 0.5 — still slightly elevated but cut in half. Histamine and inflammation are anxiety drivers in their own right.
Three independent reasons anxiety would feel better. This is biological, not placebo.
Why your sex drive hasn't come back
Your estradiol at 7.4 is far below where a 0.025 patch should land you
A 0.025 mg/day estradiol patch typically produces serum estradiol of around 25–40 pg/mL on top of your natural levels. Yours is 7.4 — essentially what you'd see without any HRT at all, and even lower than what your own ovaries should be producing on day 2 of a normal cycle.
Two layered questions here: the patch, and your own ovaries. Possible reasons for the patch:
- Adherence — patch falling off, peeling early, or not changed on schedule
- Application site — abdomen often absorbs less than buttock, hip, or lower back; hair, lotion, sweat block absorption
- Same spot repeatedly — site rotation matters
- Dose is genuinely too low for you (0.025 is the lowest available)
- Lab timing — drawn at the very end of a patch cycle when levels naturally trough
And for your ovaries: at 43 with still-regular periods, you should be making some of your own estradiol. The fact that you're not — or not measurably — opens questions about whether your cycles are still ovulatory and what your ovarian reserve looks like (see next-step box below).
Your free testosterone at 0.3 on a meaningful dose of gel is the bigger puzzle
You're using Testosterone Gel 1.62% — the same FDA-approved gel used for male hypogonadism. One full pump delivers 20.25 mg. Half a pump is around 10 mg/day. Female libido dosing is typically 1–5 mg/day, so the prescribed dose is well within or above the female therapeutic range.
At 10 mg/day of a well-absorbed gel, free testosterone should be in the 4–12 pg/mL range, not 0.3. Likely reasons:
- Application site — inner thigh, lower abdomen, back of calf absorb best in women
- Washing off too soon — gel needs 2+ hours to absorb before showering or sweating
- Transferring to clothing — alcohol carrier (74%) needs to fully dry before dressing
- Lab draw timing — topical T should be drawn 2–8 hours after application; before or after that window can show artificially low
- High SHBG eating it — your SHBG was 74.5 in November (high). High SHBG binds testosterone and lowers free T
- The half-pump is less than half — partial pumps on metered male dispensers are imprecise; actual delivery may be 3–5 mg, not 10
Vitamin D fell from 67 to 37
Still in range but down 45%. Worth getting back to 50+ — usually 2,000–4,000 IU/day with K2.
Your next step — what to ask for at the next blood draw
The most efficient way to answer all the open questions in one visit is to schedule a comprehensive draw at the right cycle timing. Specifically:
Timing: Schedule the draw for roughly day 21 of your next cycle (about 7 days after suspected ovulation, or roughly a week before you expect your next period). This timing captures the mid-luteal phase — the most informative point for several of these tests.
Tests to request:
1. Estradiol by LC-MS/MS (liquid chromatography mass spectrometry)
The standard immunoassay used on your last panel is less accurate at low estradiol levels. LC-MS/MS is the more sensitive method. If your estradiol still reads under 10 pg/mL on the better assay, the number is real and we know the patch isn't delivering. If it comes back at 25–30, the assay was the issue. Quest, Mayo, and Labcorp all offer this — just specify "by LC-MS/MS" when ordering.
2. Mid-luteal progesterone
If this comes back >3 ng/mL, you ovulated this cycle and your ovaries are still producing hormones. If under 3, the cycle was anovulatory — you're bleeding but not actually ovulating, which explains low endogenous estrogen and is common in late perimenopause. This single number answers a big question.
3. AMH (anti-Müllerian hormone)
The gold-standard test for ovarian reserve. Tells you how many follicles you have left. Can be drawn any day of the cycle. Normal at 43 is roughly 0.5–2.0 ng/mL. Very low (<0.5) suggests reserve is nearly gone — which informs how much of the estradiol picture is your ovaries vs. the patch.
4. Repeat SHBG
Was 74.5 in November (high). If still elevated, it's binding most of your testosterone and explains the free T crash. High SHBG is treatable: more protein, lower carbs, less alcohol, thyroid optimization.
5. DHEA-S
The adrenal precursor for testosterone and estradiol. If low, supplementing DHEA (10–25 mg over-the-counter) can help. Useful upstream marker.
6. Repeat FSH
Was 7.3 in November (clearly premenopausal). Worth knowing if you've now moved toward perimenopausal range (10–25) or menopausal (>25). Affects HRT decisions.
7. Free and total testosterone — drawn 4–6 hours after fresh gel application
This is the cleanest way to know if your testosterone gel is actually delivering. Apply your normal dose first thing in the morning, draw labs late morning/early afternoon. If free T is still under 2 pg/mL at peak, the gel isn't working. If it jumps to 5+, the gel is fine and your last draw was just badly timed.
What this one visit gives you: whether your ovaries are still functioning (mid-luteal progesterone + AMH), whether your estradiol number is real or an assay artifact (LC-MS/MS), whether SHBG is sabotaging your testosterone, and whether your gel is actually delivering. After that, dose conversations become straightforward.
Things you can do this week, no prescription needed
- Vitamin D — back on 2,000–4,000 IU/day with K2. Retest in 8 weeks.
- Strength training, twice a week — biggest non-pharmaceutical lever on female testosterone and SHBG. Compound lifts beat cardio for this purpose.
- Protein floor of 100g/day — low protein keeps SHBG high.
- Reduce alcohol — raises SHBG and lowers free T even at modest amounts.
- Patch site rotation — alternate buttock/hip/lower back. Press for 10 seconds when applying. Note the day on a phone note.
- Gel application discipline — inner thigh or lower abdomen, wait 2 full hours before showering, let it dry fully before dressing.
The honest summary
Anxiety relief is real and backed by your numbers — keep doing what you're doing. The libido story has two layers: your HRT isn't reaching your bloodstream, and your own ovaries may be contributing less than they should for someone still cycling. Both are answerable questions with one well-timed blood draw. Your prescription is reasonable; the delivery and the underlying biology are the bottlenecks, and both are far more solvable than starting from zero.