e2 vs e2 ultra sensitive

I am trying to better understand the change in theory now that everyone is saying using ultra sensitive is better. For years all studies and hrt have used 20-30 as the range where guys feel best. Life extensions research also shows all their studies all used the standard estradiol test . So if all the research and trt over the years has used the regular estradiol test and found 20-30 to be the best range how is the ultra sensitive test better when it is normally way different results then then regular test. If we were say 25 on the ultra e2 test that would put us at probably around 50 on a regular estradiol test which is way over what is considered healthy based on all studies that have been done. Hopefully someone can help me understand this better because I find estradiol to be by far the most controversial and confusing part of trt.

This is an excerpt from Dr. John Crisler's new book; Testosterone; A Receipt for Success re the Sensitive E2 assay.

Good idea to buy the book and learn!

This is VERY important: unless you specify a “sensitive” (or “ultrasensitive”, or “enhanced”) assay for your male patients, the lab will default to the standard estradiol test, which is designed for women. The standard laboratory methodology is invalid for adult males. In fact, if you do that by what is called immunoassay technique with Quest Diagnostics, a paragraph will appear below the results, directing you to run the correct test next time.


The reason for this discrepancy is the bottom of “normal range” for a woman is the top of “normal range” for a man. Without getting too technical, laboratory science is based on what is called the bell curve, which uses statistical analysis of a given patient population to figure out what “normal” is. Specifically, it is meant to cover 95% of the population. Aside from the issues with the concept of “normal” range (explored more fully elsewhere in this paper) the bell curve, for this test, sits well within the “normal” range for females.

Therefore the hormonal concentration range appropriate to adult males falls on a very flat slope out on the edge of the bell curve. You want your result to land on a steep slope--positive or negative--of the bell curve. Laboratory testing is best when small changes in concentrations result in large changes in the reported result.

How much difference between the "sensitive" array and the "ultra-sensitive"? I don't think that has been answered? If I'm scoring in the low 20's in the sensitive - how would that correlate to the "ultra-sensitive"? Are the threshold/ranges at all comparable?

They are pretty much the same. Sensitive is cheaper. DiscountedLabs.com sells the sensitive test now.

Hmmmm
So are we saying that the results from the ULTR and difference between that and the SENSITVE do not warrant the additional cost associated with the ULTRA test???

Or saying it a different way "The SENSITVE test is accurate enough so the extra cost for the ULTRA test is not supported." ???

Orrin Israel said:

Hmmmm
So are we saying that the results from the ULTR and difference between that and the SENSITVE do not warrant the additional cost associated with the ULTRA test???

Or saying it a different way "The SENSITVE test is accurate enough so the extra cost for the ULTRA test is not supported." ???

Click to expand...

The former is correct

Ok the confusion is all the studies and research on estradiol in men has said 20-30 on the standard test. It says higher then 30 is bad for prostate etc. So why are we now saying that's too low?

Sensitive and ultrasensitive estradiol test both use LC/MS/MS technology. For $20 more, the ultrasensitive test can go to single digits accurately. But as we know, once your E2 is under 20 pg/mL we know you have low E2. Both tests accurately measure values over 20 pg/mL, which is what we need in TRT management. This assay technology does not get interference from C-reactive protein (some men may have high CRP due to inflammation).

Nelson -

My understanding is that there are two C-reactive protein tests - the cCRP (cardiac), and the more general CRP?

So if one's cCRP score is low - can you assume the CRP is likely to be low - or should both tests be conducted?
And if your cCRP is low, you can assume that the sensitive test is sufficient?

Labcorp also says other hormones can affect the value:

https://www.labcorp.com/wps/portal/...408440&criterion=Estradiol,+Sensitive+(LC/MS)


Adult Men. The use of a sensitive, LC/MS assay for serum E2 measurement in males is preferred over direct immunoassays because of its greater sensitivity and lesser interference by other steroids.[SUP]28[/SUP] In males, estradiol is present at low concentrations in blood, but it is extraordinarily high in semen.[SUP]4[/SUP] Estradiol plays an important role in epididymal function and sperm maturation and is essential for normal spermatogenesis and sperm motility.[SUP]4
[/SUP]
Gynecomastia refers to a syndrome of abnormal feminization with swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone.[SUP]29 [/SUP]Gynecomastia is common during puberty in boys and can be seen in older males due to increased estrogen level-related obesity (increase aromatase activity), decreased hepatic clearance, estrogen ingestion, and estrogen producing tumors. Asymptomatic gynecomastia is common in older men, but individuals who present with gynecomastia of recent onset associated with pain and tenderness may require clinical workup.[SUP]29[/SUP] Gynecomastia and other signs of male feminization may be caused by an absolute increase in E2 and/or E1. The testes may directly secrete too much estradiol due to a Leydig-cell or Sertoli-cell tumor. They may also secrete estradiol indirectly through the stimulatory effects of a human chorionic gonadotropin-secreting tumor of gonadal or extragonadal germ-cell origin.[SUP]29
[/SUP]
Alternatively, men with normal estrogen levels can develop gynecomastia, if testosterone levels are low due to primary/secondary testicular failure, resulting in an abnormally elevated estrogen-to-androgen ratio. Feminization may also occur in men treated with antiandrogen therapy or drugs with antiandrogenic effects (eg, spironolactone, digitalis). Conversely, individuals with elevated androgen levels will often exhibit gynecomastia caused by aromatase catalyzed estrogen production.

Estrogens (and androgens) play an important role in the normal physiology of the skeleton in both sexes.[SUP]4[/SUP] Males with diminished estrogen levels due to congenital aromatase deficiency or insensitivity to estrogens due to estrogen receptor deficiency have a characteristic phenotype with regard to bone development.[SUP]4,25,30[/SUP] These males exhibit significant increased overall height due to lack of estrogen-induced epiphyseal closure.[SUP]25[/SUP] The importance of estradiol in bone health is further supported by the fact that estradiol levels correlate better with bone mineral density than do testosterone levels in aging men.[SUP]25[/SUP] The Endocrine Society has recently reported that low estradiollevels are associated with increased fracture risk and accelerated bone loss in older men.[SUP]31[/SUP]

Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men


"In conclusion, our findings suggest interference in the standard immunoassay-based E2 analyses, possibly by CRP or a CRP-associated factor. Although this interference does not seem to affect association studies between immunoassay E2 levels and skeletal parameters, we propose a reevaluation of previous association studies between immunoassay-based E2 levels and inflammation-related outcomes. In addition, MS-based assays are to be preferred for the quantification of E2 levels in men."