Being tired is awful, you have my sympathies. Are there other symptoms? Have any other symptoms been alleviated by HRT? Have you had a proper full thyroid panel, checked Vit D, B12 & full iron panel? After those I would check cortisol levels. Are you tired upon waking or as the day wears on? Is sleep ok? Sorry for all the questions but I’ve had fatigue and lots and lots of doctor visits about it so these help determine cause.