If you are using a hormone cream, we recommend you monitor your levels with blood spot or salivary testing. We do not recommend monitoring with serum (blood draw) because the results could be misleading. When hormones are applied topically to the skin, they show up in the capillary blood (measure in a blood spot) and in the saliva—but not in the serum. That means you could be using a hormone cream, have your hormones tested with a blood test, and your doctor will think your hormone levels are still low. That’s dangerous because they may recommend that you use more. The reality is that the hormones are getting into the body, and we can see that with a bloodspot or salivary test.