Help with bloodwork, undetectable E2?

[Raddad]

Hey guys,
Started new protocol end of August and just got labs back. Previously used pellets, then scrotal cream only and switched docs as I was not entirely happy.

Current protocol is 120mg/wk (60mg 3.5 days) 300iu HCG 2x week and 50mg scrotal cream a day (cream also has DHEA and pregnenolone).
Didn’t feel great the 1st few weeks as I adjusted, trouble sleeping, night sweats, heart palps, etc. Started to even out after about a month but still had really sensitive nipples that were getting puffy. Got paranoid about Gyno so after a lot of research I ordered some raloxifene from a peptide company, studies show it was more effective that tamoxifen with less sides and no effect on estrogen. Added that and nipples felt better and I felt better overall with other symptoms. Got labs at 3.5 day trough and looks like dose it a little high but more concerning is the undetectable E2. Raloxifene should not effect E2 like that but being I’m taking a “research chemical” it could be something else.

If my E2 was really crashed I should feel terrible according to those that have experienced that but I feel fine. Maybe lab error? Have consult with doc on Tuesday but the E2 # is worrisome. Thoughts?

 

[Cataceous]

Lab error is possible, especially with the LC/MS E2 test, which can be unreliable. I'd do a retest with both the sensitive and non-sensitive assays. The non-sensitive test is much more reliable, but tends to read a bit high.

I had a recent period with undetectable estradiol from uncertain causes. I wouldn't say I felt terrible, but I felt emotionally flat and had zero libido. Sexual function was ok, though orgasm quality was low.

 

[Vince Carter]

I agree I'd retest that to confirm before I made any changes. What I would recommend to you too is to get that DHEA/Preg out of the cream and eliminate that source of Estrogen if elevated E is indeed a problem for you.

 

[Vince]

Since you're not using an AI, I really douby that your E2 is that low. You may not be feeling good because of your high testosterone levels, along with high estrogen.

 

[xqfq]

Lab error is possible, especially with the LC/MS E2 test, which can be unreliable. I'd do a retest with both the sensitive and non-sensitive assays. The non-sensitive test is much more reliable, but tends to read a bit high.

I had a recent period with undetectable estradiol from uncertain causes. I wouldn't say I felt terrible, but I felt emotionally flat and had zero libido. Sexual function was ok, though orgasm quality was low.

RE the non sensitive test being reliable: I only have non-sensitive E2 from prior to TRT. Can I measure my non-sensitive E2 now and use it as a point of comparison? Like is it “reliably inaccurate?”

 

[Gman86]

RE the non sensitive test being reliable: I only have non-sensitive E2 from prior to TRT. Can I measure my non-sensitive E2 now and use it as a point of comparison? Like is it “reliably inaccurate?”

Ive been testing sens, non sens, and free E2 for years, and the non-sens E2 is either very similar to the sens E2, or more accurate than the sens E2. So if I were you, I would just get the standard E2 test done. You can use it as a better comparison with your pre TRT E2, and ime, it’s more accurate than the sens E2 test. But that’s just my experience, and also that’s going through quest. Other lab companies might have less discrepancies with their sens E2 testing. But ime, getting the sens E2 test done is not nearly as important as people make it out to be. In theory, it does seem very important, but again ime, in reality it doesn’t make much difference. The only time it makes a difference is when the sens E2 test is not accurate. So for me it does sometimes make a difference, but not in a good way.

 

[Cataceous]

RE the non sensitive test being reliable: I only have non-sensitive E2 from prior to TRT. Can I measure my non-sensitive E2 now and use it as a point of comparison? Like is it “reliably inaccurate?”

The short answer is yes, the non-sensitive test is particularly good for relative measurements, even if you haven't figured out the systematic error. Ideally you'd get a few simultaneous results to quantify the error in the non-sensitive test. We just did something similar for @Gman86 here (actually using free estradiol as the standard) and found a very consistent 16% elevation in the non-sensitive test. Even without this correction the non-sensitive data produce better results for him. His data and mine have shown that the sensitive test is capable of randomly throwing out completely wrong numbers. This is in line with the temperamental nature of mass spectrometry equipment. It takes skilled operators doing everything right. Whereas the non-sensitive immunoassay tests are simple and pretty much idiot-proof—but have more cross-reactivity with other substances.

 

[Gman86]

The short answer is yes, the non-sensitive test is particularly good for relative measurements, even if you haven't figured out the systematic error. Ideally you'd get a few simultaneous results to quantify the error in the non-sensitive test. We just did something similar for @Gman86 here (actually using free estradiol as the standard) and found a very consistent 16% elevation in the non-sensitive test. Even without this correction the non-sensitive data produce better results for him. His data and mine have shown that the sensitive test is capable of randomly throwing out completely wrong numbers. This is in line with the temperamental nature of mass spectrometry equipment. It takes skilled operators doing everything right. Whereas the non-sensitive immunoassays tests are simple and pretty much idiot-proof—but have more cross-reactivity with other substances.

Love having people much smarter than me on here that can explain things so much better lol

 

[Raddad]

I’m definitely leaning towards lab error. I believe I’m a low aromatizer based on previous labs but there’s no way my E2 is <1 with a TT >1700. I’d really like to know what it is but it’s sucks to have to pay for labs again when it’s their error.

 

[Cataceous]

I’m definitely leaning towards lab error. I believe I’m a low aromatizer based on previous labs but there’s no way my E2 is <1 with a TT >1700. I’d really like to know what it is but it’s sucks to have to pay for labs again when it’s their error.

Sometimes if you have a good case for lab error and make enough noise you can get a retest at no cost—other than your time/transportation/blood.