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Real-time, multiplexed monitoring of sex hormones is essential for managing reproductive health and endocrine disorders. Traditional invasive blood sampling lacks the temporal resolution required to capture the dynamic hormonal fluctuations necessary for personalized clinical insights. Here, we present a wearable microneedle-based electrochemical aptamer platform (WMEP) for the continuous, minimally invasive monitoring of estradiol, progesterone, luteinizing hormone, and testosterone in interstitial fluid. The WMEP integrates a four-channel microneedle electrode array enhanced with gold nanoparticles (∼2.77-fold increase in electroactive area) and a miniaturized wireless potentiostat employing time-staggered acquisition to suppress inter-channel crosstalk. In vivo rat studies demonstrated real-time tracking of hormone dynamics and revealed size-dependent transvascular transport kinetics: small steroids exhibited rapid interstitial partitioning (T_max≈40 min), while luteinizing hormone showed delayed exchange (T_max≈60 min). Quantitative analysis confirmed high concordance with serum ELISA measurements (Pearson's R ≥ 0.932). Clinical validation using 45 human serum samples across healthy controls, pregnancy, polycystic ovary syndrome, and breast cancer cohorts demonstrated robust analytical accuracy. A random forest classifier achieved 95.56% diagnostic accuracy based on multiplexed profiles. Human on-body trials further confirmed the platform's practical utility, reliably tracking testosterone surges during exercise and maintaining signal stability over 5 days of continuous wear. This wearable platform enables personalized, longitudinal endocrine management and decentralized monitoring of reproductive health disorders.