Why All Men Should be Tested with the Sensitive Estradiol Test

[Cataceous]

So you saw a test or tests of yours that was inexplicably high or low? Because I've seen that in my own tests, part of why I run three tests, LC/MS/MS, ECLIA, and Free Estrogen, to try and have side-by-side comparisons.

Yes. The ECLIA tests have been very consistent for me, always about 10% over the LC/MS/MS tests when done right. But a third of the LC/MS/MS have been less than half of where they should have been, as confirmed by subsequent testing.

If you have the money then testing with multiple methods is the way to go.

 

[Vince Carter]

Possibly why I've been able to pull a higher Sensitive value multiple times from blood taken the same time as the ECLIA test.

 

[fifty]

Vince you convinced me to get free e2 test. I have not been feeling too great so I’m finally biting the bullet thanks to you. A bit confused right now since my shbg has dropped nearly 50% since starting trt.

 

[Vince Carter]

I think it's a good option if things get difficult, it's a great insight from another angle, if it's affordable.

 

[Cataceous]

Vince you convinced me to get free e2 test. I have not been feeling too great so I’m finally biting the bullet thanks to you. A bit confused right now since my shbg has dropped nearly 50% since starting trt.

If you'd rather not spend the money then check out this spreadsheet. What's interesting is that @Gman86 obtained good matches between tested and calculated free estradiol using the standard total estradiol test. The sensitive test was more erratic. The bottom line though is that if you can get a pretty accurate total estradiol then this spreadsheet should give a free estradiol result pretty close to what you would measure.

 

[Vince Carter]

I need to crunch your spreadsheet Im just always at work when it hits me and this crap network I have to tolerate won't open that page.

 

[MarcoFL]

my labs from April 1 Labcorp
Free Estradiol percent 2.7 normal
Free Estradiol serum 1.2 normal
Estradiol serum, MS 43 High
Sensitive estradiol 31.5 normal

 

[Cataceous]

my labs from April 1 Labcorp
Free Estradiol percent 2.7 normal
Free Estradiol serum 1.2 normal
Estradiol serum, MS 43 High
Sensitive estradiol 31.5 normal

It would be interesting to crunch your numbers. Do you have SHBG, total T, albumin? Do you know specifically which total estradiol tests those are?

 

[MarcoFL]

SHBG 38.9 had been 59
Albumin 4.6
TT 1122
FT direct 22.8

LC/MS/MS on the sensitive

 

[Cataceous]

SHBG 38.9 had been 59
Albumin 4.6
TT 1122
FT direct 22.8

LC/MS/MS on the sensitive

So the multi-ligand method yields a cfE2 of 1.04 pg/ml, about 13% below the measured result, which isn't too bad. This is using the "MS" result for total E2, giving the impression that the sensitive result is low. cfT is about 24 ng/dL, also for Vermeulen. With TruT that jumps to 37 ng/dL.

 

[MarcoFL]

So the multi-ligand method yields a cfE2 of 1.04 pg/ml, about 13% below the measured result, which isn't too bad. This is using the "MS" result for total E2, giving the impression that the sensitive result is low. cfT is about 24 ng/dL, also for Vermeulen. With TruT that jumps to 37 ng/dL.

so what you are saying is my actual FT is more like 37 instead of 22.8? so if that is the case i do not need to increase my T dose. Thank you for your time.

 

[Cataceous]

so what you are saying is my actual FT is more like 37 instead of 22.8? so if that is the case i do not need to increase my T dose. Thank you for your time.

It gets confusing because there are so many different ranges around. Keep in mind that the normal range for TruT is around 16-31 ng/dL, so your value is over-range, but not excessive.

 

[in_TRT]

I see everyone here reference only using the ultrasensitive test, but many others have said it is not a good test. I am just curious as to why the thought is different here. Below is a clip from Life Extension blood tests, which I assume is the same test referenced....

This test is generally NOT suggested over the regular estradiol test (LC004515).
The only difference between this test and the regular estradiol test (offered in Life Extension panels) is better detection at the lower limits of the range. For example, the lower end of the range for estradiol is 7.6 pg/mL while the lower limit for the sensitive estradiol is 3 pg/mL. This test does not provide a more accurate result at normal ranges, it is only more accurate at very low levels of estradiol.
Since Life Extension advocates higher levels of hormones, it would be very rare to use this test for its greater sensitivity at the low end of the range. Remember that men also need a certain level of estrogen (estradiol) and that studies are showing that if the estradiol level for a man is below the 18-20 pg/mL range there is increased risk for osteoporosis.


Nelson Vergel disputes this statement from the Life Extension Foundation below.

What about Free Estradiol in men?

 

[Vince Carter]

I think it should be THE test we run but it's quiet a bit more costly than LC/MS that I know of and that can make it cost prohibitive for a lot of guys.

 

[in_TRT]

Agreed.. Hopefully accurate calculators based on experimental data can be published.. Like the discussion initiated in the other board:
Calculate free testosterone with TruT by FPT

 

[madman]

Yes, and it's buttressed by the comments of others on the pitfalls of MS:

This comment was made at least four years ago, so you might think the situation would be improving. But one of my botched sensitive tests was just last December.

Did you have the the LC/MS-MS done at a lab certified with the CDC HoSt Program?

LabCorp and Mayo Clinic are a few common labs that are.....Quest is not!




PDF-1
CDC LABORATORY/MANUFACTURER HORMONE STANDARDIZATION (HOST) PROGRAM STANDARDIZATION OF SERUM TOTAL ESTRADIOL (E2) MEASUREMENTS (2014)








Estradiol in Serum
The following laboratories have successfully passed the performance criteria of ±12.5% mean bias (for samples >20 pg/mL) and ±2.5 pg/mL absolute bias (for samples ≤20 pg/mL) to the CDC Estradiol Reference Method in serum over the concentration range of 1.92-209 pg/mL. Laboratories are awarded certificates for successfully completing bias testing using specific methods, reagent lots, calibrator lots and instrumentation. During the year it is the responsibility of the participant to ensure that the results of their method remain consistent over time, throughout the year, between lots, and over the measurement range reported. It is not the intent of the CDC HoSt Program to certify each lot of reagents, or to issue certification beyond the measurement range of 1.92-209 pg/mL, at this time.











There are two tables. Table 1 is the list of assays that are currently certified with the CDC HoSt Program. Table 2 is the list of assays that have been certified previously but are not currently certified. Participants are listed in alphabetical order.


PDF-2
CDC Hormone Standardization Program (CDC HoSt) Certified Estradiol Procedures (UPDATED 03/2018)


PDF-3
CDC Hormone Standardization Program (CDC HoSt) Certified Estradiol Procedures (UPDATED 03/2019)

 

[madman]

Yes, and it's buttressed by the comments of others on the pitfalls of MS:

This comment was made at least four years ago, so you might think the situation would be improving. But one of my botched sensitive tests was just last December.

April 3, 2019
New Analytical Method for Measuring Serum Estradiol Is Sensitive, Calibrated to CDC Standard

New Analytical Method for Measuring Serum Estradiol Is Sensitive, Calibrated to CDC Standards - Oncology Nurse Advisor

 

[Cataceous]

Did you have the the LC/MS-MS done at a lab certified with the CDC HoSt Program?

LabCorp and Mayo Clinic are a few common labs that are.....Quest is not!
...

It was LabCorp—LC/MS/MS. The result was 15 pg/mL (8-35), which made no sense according to previous results. We redid it, and included the ECLIA method. These results were 31 pg/mL (8-35) and 35 (7.6-42.6).

 

[fifty]

These tests are like the magic 8 ball sometimes. Makes u wonder.

 

[Cataceous]

"AWesker" reported some pretty whacky estradiol test results. Good LabCorp/Quest comparison, and later he also compared MS to immunoassay. Quest keeps showing him as "high" on the sensitive test; quite different at LabCorp; immunoassay tests are consistent but possibly a little higher than actual:

I just got my results back and it makes no sense - At approximately 7:30 AM I got my blood drawn at Quest. My results:
Estradiol, Ultrasensitive, LC/MS - 32 H - Range: <=29

Then, I immediately drove to LabCorp and got another draw at 8:12 AM. My results:
Estradiol, Sensitive (LC/MS/MS) - 20.9 - Range: 8-35
...
...
5/4/19, 8:17 AM, Quest Labs:
Estradiol, immunoassay (<= 39) Result: 21
Estradiol, ultrasensitive, LC/MS ( <=29) Result: 30 HIGH

5/4/19, 9:28 AM, LabCorp:
Estradiol, Roche ECLIA immunoassay (7.6 - 42.6) Result: 23.4
Estradiol, Sensitive, LC/MS/MS (8.0 - 35.0) Result: 15.6