Did I have the right estradiol test?

Cameron58 · Jan 9, 2023

This is the result of my estradiol test done in April 2022. I saw a new provider in November, and he felt no need to repeat the test. I suggested I should have the ultra-sensitive version of this test. He said I had the correct estradiol test for men. So did I or not? Nothing in the test results says "ultra-sensitive." Is the ultra-sensitive test called anything other than ultra-sensitive? Should I be tested for estrogen or estradiol? How much does biotin affect the test result? I take 5000mcg per day.

Estradiol	22 pg/mL	11 - 43 pg/mL
Reference Ranges: Males: 11-43 pg/mL Females: Follicular Phase 12 - 233 pg/mL Ovulation Phase 41 - 398 pg/mL Luteal Phase 22 - 341 pg/mL Postmenopausal <5 - 138 pg/mL Pregnancy: 1st Trimester 154 – 3,243 pg/mL 2nd Trimester 1,561 – 21,280 pg/mL 3rd Trimester 8,525 – > 30,000 pg/mL Boys (1-10 yrs) <5 - 20 pg/mL Girls (1-10 yrs) 6 - 27 pg/mL Assay methodology changed to Roche Diagnostics Estradiol III assay on April 20, 2015. Adult reference ranges updated as part of change in methodology. Adult male reference range further updated on 3/14/2017. Results from this assay may be falsely increased in patients taking high-dose biotin (>5 mg) within 12 hours of specimen collection.

Systemlord · Jan 9, 2023

The Roche method is the right test if you don’t have an elevation in C-reactive protein (marker for inflammation) which can falsely elevated the estrogen value. The sensitive method doesn’t have these limitations.

Since your result is 22 pg/mL, I seriously doubt you have an elevation in C-reactive protein.

Cataceous · Jan 10, 2023

However, biotin can interfere with immunoassays. Therefore you should either stop taking it a few days before the test or else request an estradiol test based on liquid chromatography and mass spectrometry (LC/MS).

Unfortunately, susceptibility to biotin interference is variable in magnitude and can skew results to be either falsely high or falsely low depending on the assay design and conditions. The ramifications for patients and caregivers are potentially grave. In typical competitive immunoassays for small molecules such as free thyroxine (fT4), free triiodothyronine (fT3), testosterone, estradiol, and cortisol, biotin interference blocks assay signal. Because signal is inversely proportional to analyte concentration in competitive assays, biotin can cause falsely high results. In the 2-site “sandwich” immunoassay format [typical for larger protein analytes such as thyroid-stimulating hormone (TSH), thyroglobulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, and for autoantibodies], excess biotin competes with the biotinylated complex causing a reduction in signal and a falsely lower result. This combination of 2 types of biotin interference can create the perfect factitious biochemical evidence of Graves thyrotoxicosis with highly increased fT4 and fT3, positive TSH receptor antibodies and suppressed TSH. Similar scenarios of biotin interference can be imagined for extremely high steroid hormone concentrations with suppressed LH or FSH, which would be suggestive of tumors.

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Usually interference is observed with a biotin dose of 5 mg [5,000 mcg] or higher depending on individual assay but a serum biotin level >500 ng/mL is known to interfere with all biotin-based assays. However, such high biotin concentration is only observed in people taking 100–300 mg biotin/per day.

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tareload · Jan 10, 2023

Far different reference ranges

I've been off trt for over three months and had blood work done at my urologist. They're using Roche now instead of LabCorp. One question comes up right away, and that's how the two estradiol methods differ. Because even though both labs use pg/mL, the reference ranges are drastically different...

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