Hormone levels: moving in the wrong direction

I received the results of my blood test from my most recent HRT appointment and the results are not ideal. At my previous HRT appointment three months ago, my hormone levels looked to be very promising. My testosterone levels were nearly in the proper ranges, and my Estradiol levels (E2) were still low but were trending in the correct direction. This was no longer the case at my most recent appointment. Instead, my hormone levels had either stalled or begun to move in the wrong direction. This was not the result that I was expecting.

My current conundrum is what to do about these results, if anything. My HRT provider is unconcerned, telling me that the actual hormone levels matter less than my personal happiness with the results. However, I don’t see this as an either-or situation. I am happy with the current progress, but I also want to get the best results from the hormones. The only method that I have to influence these changes positively is managing my medications to get the proper ranges. Even if I am happy with the results so far, I don’t want to jeopardize future results by accepting poor hormone levels.

This leaves me with the decision about what changes to make. I am currently doing estrogen monotherapy with the plan to start progesterone in a couple of weeks. I would want to increase my estrogen dosage, but my HRT provider is reluctant. I am currently at the maximum level of estradiol that they prescribe, however, their dosage limits are based on the assumption that I am taking an anti-androgen, which I am not. Instead of increasing my estrogen dosage, my provider would prefer that I start taking an anti-androgen, specifically Spironolactone. I would prefer not to take an anti-androgen if possible, but I am firmly set against taking Spiro. If I had to take an anti-androgen, I would want a different medication (such as bicalutamide), however, my provider exclusively prescribes Spiro. Regardless of my personal decision, I am largely at the whim’s of my provider. If they decline to raise my estrogen dosage or prescribe an alternative anti-androgen, my choices will be incredibly limited.