One of the questions I hear most often is: “What should my hormone levels be?”
I get it. You want answers. Numbers. Something to tell you, you’re on the right path with your hormone therapy. After all, when you’re investing time, energy, and money into your health, you want to make sure it’s actually working.
Hormones are deeply personal. They’re not like cholesterol or blood sugar, where there’s a hard cutoff for what’s “good” or “bad.” The real goal is to get you feeling your absolute best, and that can look a little different for everyone.
That said… there are some helpful benchmarks we can use as guides.
Optimal Estrogen Levels for Effective HRT
If you’re on estrogen replacement, your levels should ideally be:
Target Estrogen Levels for Bone Health and Hot Flash Relief
- Over 60 pg/mL: This is the minimum threshold to support bone health.
- Over 100 pg/mL: At this level, you should not only get bone protection but also experience relief from hot flashes.
Still having hot flashes even with estrogen over 100 pg/mL? That might mean your progesterone is too low, and things aren’t in proper balance.
Understanding FSH Levels on Hormone Replacement Therapy
FSH stands for follicle-stimulating hormone, and some experts suggest tracking it as a marker of MHT effectiveness.
When your estrogen is low, FSH goes high—it’s your brain yelling, “Hey ovaries, give us more estrogen!”
Why FSH Levels Drop When HRT Is Working
But when you start estrogen therapy, and it begins to work, FSH levels should drop.
Some practitioners suggest that an FSH of 20-25 IU/L is the goal of MHT. That said, FSH is not a reliable stand-alone marker for HRT effectiveness, because:
- Estrogen therapy suppresses FSH production via negative feedback, but the extent of suppression varies.
- Symptom relief and tissue-specific effects (e.g., bone, brain, vaginal tissue) are more clinically meaningful than FSH levels.
- In women on transdermal estrogen, FSH may stay mildly elevated even if estrogen is physiologically effective.
Optimal Progesterone Levels and Hormone Balance
Unlike estrogen, there’s no magic number for progesterone. Instead, it’s more helpful to look at the estrogen-to-progesterone ratio.
Estrogen-to-Progesterone Ratio: The Key to Balance
A good ratio? Somewhere between 100 and 500.
If it’s out of balance, you’ve got two options:
- Lower your estrogen dose
- Increase your progesterone dose
The right adjustment depends on your symptoms and lab results.
Testosterone Levels: What’s Normal on HRT?
When it comes to testosterone, the goal is simple: how do you feel?
Free vs. Total Testosterone: What Matters More
You can look at three key markers:
- Toal testosterone: This is the amount of testosterone your ovaries and adrenals are making
- Free testosterone: This tells you what’s available for your body to actually use.
- Sex hormone binding globulin (SHBG): This little protein acts like a sponge and can soak up your testosterone, making it inactive. If your SHBG is high, you might have a lot of total testosterone on but still feel tired, flat, or have low libido.
Bottom line: numbers matter—but they don’t tell the whole story.
So… What Does “Balanced” Actually Feel Like?
- You’re sleeping well.
- Your energy is steady.
- Your brain is sharp.
- Your mood is stable.
- Your hot flashes are gone (or at least rare).
- You feel like you again.
That’s the goal. And if you’re not there yet, you can work on getting there.
When Your Hormone Levels Are Optimal But You Still Don’t Feel Right
If you’ve ever been told “your labs are normal” but something still feels off, trust that inner voice. Hormones are nuanced, and “normal” doesn’t always mean optimal.
Hormones are complex, but with the right support, they don’t have to be confusing. You deserve answers that make sense and a plan that actually helps you feel like you again.
If you’re ready for real clarity and a personalized strategy to get your hormones working for you, not against you, I’m here to help. I support you like the whole person you are, not a protocol.
Let’s work together to create a plan that fits your body, your life, and your goals. Book your 1:1 consultation now: www.drannagarrett.com/lets-talk
Midlife is not the end of your story. It’s the beginning of your next, most powerful chapter.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultation. Find out more at www.drannagarrett.com/lets-talk
