E levels fluctuate and aren't exactly accurate. One way to more accurately gauge effectiveness is see how you feel and actual physical results like breast growth, skin softening, body fat redistribution, facial changes, etc.
Maturitas, 12 (1990) 171-197
"When the serum concentrations of natural or synthetic sex steroids are measured
at short time-intervals after administration and repeatedly during long-term
treatment, it becomes obvious that there are large intra-individual and interindividual
variations. This holds true for both the contraceptive steroids and the natural
oestrogens and does not apply solely to the oral route. Long-term studies
indicate that an important influence is exerted by predisposing factors, particularly
the metabolic capacity of the liver, on the pharmacokinetics of sex steroids.
Large variations in oestradiol and oestrone levels can be observed in an individual
woman from day to day or from hour to hour, even during transdermal therapy
with oestradiol"
Estradiol levels also fluctuate a lot in ciswomen, during a menstrual cycle, from as low as 20 pg/ml to up to 650 pg/ml (depending on the woman and the lab's values). In pregnancy, they continue rising, to up to 75,000. Every person will respond differently and some need less, some need more.
Aust NZ J ObTtet Gvnaecol 1998. 38: 3: 45
"it is difficult to define a therapeutic drug concentration (...) because patients may vary in their oestradiol requirements, (...). In addition, serum oestradiol levels may not necessarily reflect tissue oestradiol levels."
CLIMACTERIC 2005;8(Suppl 1):3–63
"Even though there is a significant correlation between
the serum concentrations of estradiol and their
clinical effects, e.g. on hot flushes or bone mass,
the serum level of an individual woman does not
predict the therapeutic effect. As shown in Figure 1,
the number of hot flushes differs largely in
patients who showed identical estradiol levels
during transdermal hormone therapy1. This casts
considerable doubts on the usefulness of regular
measurements of hormone levels for the prediction
or control of a therapeutic success."
You can share this concern with your doctor and see what they say.
By the way, you should know two things also. Spironolactone also BLOCKS testosterone so that even if your levels are 69 ng/dl, some of that is also blocked by Spiro and a blood test can't tell you how much. Secondly, Total testosterone includes testosterone that is bound to SHBG and is inactive, does not bind to receptors such that a more accurate mesure would be bioavailable T or free T as this fraction of T more readily binds to receptors, IF not blocked by Spiro.
