Patches are just as good as gel as far as getting estrodiol into your body so don't cry, some ladies like gel some patches, its an ascetic thing really, you are over thinking this too much.
If the 50 patch is too much cut it in half .
His remark about "western women are prone to being stressed and HRT won't help" is crass (Is he non western, I have found that some are not keen to prescribe HRT) please put it out of your head, you have your patches at least.
Quite honestly I don't think you would get much more help from a menopause clinic ( personally I think they are over rated) a good GP can help just as much or even more.
Please try to get on with your life and try to forget about hormones as you as you say your symptoms are under control. the alternative is not taking hormones at all and suprizingly as it may seem millions of women do get through menopause without adding hormones.
I really wish you well moonbeam and hopefully the patches will be the answer.