@lurawilson okay, I asked! They noticed no difference in test results. My suggestion is to discuss with your doctor whether they notice any differences in your test results. My doctor (at a big health, research, and educational institution felt we are too much in the "weeds" about what we are trying to get from this. I used some leftover pens before tossing them in the first year, maybe that was the problem. I had to titrate up in the beginning. And I was out of a double cervical spine surgery and the estrogen may have helped in the second year. But honestly, he wasn't so "plus'd" by the lower result in the first year compared to the better result in the second year because we give too much weight to the scoring and results. it is the overall success or failure of the two years that matters.