You say you’re in menopause and have been taking bioidentical hormones (including testosterone, progesterone, and estrogen) for a while. Your doctor advises going with the lowest dose of supplemental hormones for quality of life, which I generally agree with. But you don’t feel well, you’re achy, and you don’t sleep well. She’s told you the standard for estrogen is 30-60, and you’re at 19.2.
I would agree that an estradiol blood level of 19.2 is likely subtherapeutic. I rarely check levels as I don’t treat to a “lab result”; I more often treat to symptom management. I’ll check levels if I am concerned that a person just doesn’t seem to be absorbing the hormone being used, which happens very rarely.