An interesting followup would include a pharmacology component. Estrogen has numerous routes of administration: intramuscular, oral, topical, sublingual, and e

An interesting followup would include a pharmacology component. Estrogen has numerous routes of administration: intramuscular, oral, topical, sublingual, and even subcutaneous. Each of these will have various pharmacokinetics, some of which include supernatural serum levels. This is why serum testing is done midway through routes of application that are cyclical. ie to test at the midpoint. It would be entirely unsurprising if brief though still supernatural levels had an etiological contribution.