It sounds like your sister may need to be referred to a Psychiatrist. If the Estrogen Patch has had very little effect on her, the hormone imbalance may not be the problem and she may benefit from anti-anxiety medications. I could be wrong and she may have other hormonal imbalances, in which case she should consider the Endocrinologist- but her Gynecologist may be limited in what he can do for her. It is also important to remember that a lot of medications take about two weeks until she finally starts to feel like they're working (this is particularly true of antidepressants and other mood stabilizers). If you and her believe that it is truly a hormonal issue, then consider the Endocrinologist first and keep us posted on how she is doing.