10 Signs Your HRT Is Not Working
You started hormone replacement therapy hoping to feel better. But weeks or months later, you're still exhausted, still having hot flashes, still not yourself. Here's how to know if your HRT needs adjustment—and what to do about it.
Warning Signs Your HRT Isn't Working
If you're experiencing any of these issues, your hormone therapy may need to be reassessed.
Symptoms Haven't Improved After 8-12 Weeks
Most women should see noticeable improvement in hot flashes, sleep, and mood within 2-3 months. No change at all suggests something isn't right with your protocol.
You Feel Worse Than Before
New symptoms or worsening of existing ones—increased anxiety, headaches, breast tenderness, or mood swings—may indicate hormone imbalance from incorrect dosing.
Hot Flashes and Night Sweats Continue
These should be among the first symptoms to improve. Persistent hot flashes often mean your estrogen dose is too low or you're not absorbing it properly.
Sleep Is Still Terrible
Properly balanced hormones significantly improve sleep quality. If you're still waking up multiple times or can't fall asleep, something is off.
Brain Fog Hasn't Lifted
Mental clarity usually improves with optimized hormones. Persistent brain fog may mean your estrogen, thyroid, or progesterone needs adjustment.
Libido Is Still Missing
While libido can take longer to return, complete absence after 3+ months often indicates testosterone isn't being addressed—yes, women need it too.
Weight Keeps Climbing
Optimized hormones should make weight management easier. Continued weight gain, especially around the midsection, suggests hormones aren't balanced.
Energy Levels Are Still Low
Fatigue should improve significantly with proper HRT. Persistent exhaustion may mean thyroid isn't being addressed or doses need adjustment.
You're Only on Estrogen
Estrogen-only therapy without progesterone (if you have a uterus) or without considering testosterone often produces incomplete results.
Your Provider Won't Adjust Your Protocol
If you're reporting symptoms and nothing changes, or your concerns are dismissed, you may need a provider who takes a more personalized approach.
Why HRT Fails: Common Reasons
Understanding what's going wrong is the first step to fixing it.
Wrong Dose
Too low and symptoms persist. Too high and new symptoms appear. Most protocols are based on averages, not your individual needs.
Wrong Delivery Method
Oral, patches, creams, pellets—each works differently. Some women don't absorb creams well. Others do better with steady pellet levels.
Incomplete Protocol
Estrogen without progesterone. No testosterone consideration. Thyroid ignored. A complete approach addresses all relevant hormones.
No Follow-Up Testing
Starting HRT without retesting is flying blind. Blood levels must be monitored to know if your protocol is working.
Absorption Issues
Gut health, liver function, and genetics all affect how you metabolize hormones. The same dose affects different women differently.
Lifestyle Factors
Poor sleep, chronic stress, alcohol, and certain medications can interfere with hormone balance and reduce HRT effectiveness.
When to Expect HRT Results
A realistic timeline for symptom improvement with properly optimized HRT
Questions to Ask Your Provider
If your HRT isn't working, these questions can help guide the conversation.
What are my current hormone levels, and what are we targeting?
Have we tested progesterone and testosterone, not just estrogen?
Is my thyroid being fully evaluated (Free T3, Free T4, not just TSH)?
Would a different delivery method work better for me?
How often are we retesting to see if the protocol is working?
Are there lifestyle factors that could be affecting my results?
How We Approach HRT Differently
At Highland Longevity, we believe HRT should make you feel dramatically better—not marginally less miserable. Our approach:
- Comprehensive testing of all relevant hormones, not just estrogen
- Optimal level targets based on how you feel, not just lab ranges
- Multiple delivery options to find what works for your body
- Regular monitoring with labs every 6-12 weeks during optimization
- Testosterone included when appropriate—it matters for women too
- Thyroid fully evaluated with Free T3 and Free T4, not just TSH
If your current HRT isn't working, we offer second opinion evaluations to review your protocol and suggest improvements.
Learn more: Women's HRT | HRT Fort Worth
Frequently Asked Questions
Give HRT at least 8-12 weeks to see significant results. However, you should notice some improvement in sleep and mood within 2-4 weeks. If you've been on HRT for 3+ months with no improvement, or if symptoms are getting worse, it's time to reassess your protocol.
Absolutely. Oral estrogen can cause issues that transdermal (patches, creams) doesn't. Some women don't absorb creams well. Pellets provide steady levels but can't be adjusted once inserted. The "best" method varies by individual—what works for one person may not work for another.
Feeling worse on HRT usually indicates a problem with dosing, delivery method, or hormone balance. Common causes include estrogen dominance (too much estrogen relative to progesterone), doses that are too high or too low, poor absorption, or an underlying issue that wasn't addressed. This is fixable with proper evaluation.
Don't stop abruptly—consult with your provider first. The goal should be to find WHY it's not working and fix it. Often the solution is adjusting doses, changing delivery methods, or addressing other hormones. Stopping may just return you to square one.
Signs of too-high doses include breast tenderness, headaches, mood swings, fluid retention, and anxiety. Signs of too-low doses include persistent hot flashes, fatigue, low libido, and brain fog. Blood tests combined with symptom assessment help determine optimal dosing.
Yes, significantly. Poor sleep, chronic stress, alcohol, and certain medications can interfere with hormone balance. Gut health affects hormone metabolism. Optimizing lifestyle factors alongside HRT often produces the best results.
HRT Not Working? Get a Second Opinion.
We'll review your current protocol, test your levels, and create a plan to help you finally feel better.
4801 Golden Triangle Blvd Suite 121, Fort Worth, TX 76244