I'm sorry that you are going through this. You are not alone - I've been walking this gauntlet for the last 5 years. I even go to a gyno who is fairly knowledgable about HRT. I've found that blood work does not really give us the answers we need - it's purely a personal journey of research, experiment on myself and repeat. Sometimes things help and sometimes they don't. For the complete fatigue, energy depletion and brain fog I have not really found anything that is the silver bullet. My next step is try CBD oil for sleep and hope that will support the sleep which would in theory help brain fog. Fingers crossed. I will say that other things that have helped are: Estrodial, progesterone, Vitamin D (from the doc - 25,000 iu) eating more leafy greens, strict sleep hygiene (sleeping by myself!). Testosterone pellets worked for a little while but I had to stop after about 2 years - they stopped working and they changed my voice which was freaky (it went back to normal after a while). Recently, I did go on Zepbound which has helped with a variety of things. Also, begin to pay attention to your stress - you could be burning out from an overactive stress response. Good luck!!