I'm really not sure, but I do know that eating lots of bread (brown and white), dairy (milk and cheese), sugar, rice (brown and white) causes hrt to not work, and by not work I mean my libido returning from the grave, sebum production increasing, hair loss, my skin looking like sh*t, nipple sensitivity going away, all the telltale signs that HRT is working, cease. Funnily enough, the rash I have on my arm (had it since 14) goes away when HRT works, and when the area starts itching again, I know things are about to flare up. This problem seems to be very specific to me, through research I've not been able to find any similar cases.