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What version of Exchange? I know we've got some detailed deployment guides that include monitors, and I believe I recall the 2016 guide talking about either this scenario or something similar.

Exchange 2016 and 2019, I tried a pearl script from https://discussions.citrix.com/topic/370060-modify-perl-script-for-smtp-monitor/ but I get a "Microsoft ESMTP MAIL service ready" via Port 25 even if the MS Exchange Transport Service is stopped?!

I don't have personal experience with this to know whether it's still relevant, but there is this bit in the 2013 guide that might be worth taking a look at. They don't seem to cover SMTP LB specifically which is a bit odd, though I definitely have customers doing that.

Yes that’s working fine for all HTTPS virtual Exchange channels, but there is no built in healthcheck for smtp so I thought about creating one via adc. Difficult to find sth on the exchange site to request to get an OK or Down / error