Standard E2 test vs. Sensitive E2 test

[jobshopper]

I had both the standard E2 and the Sensitive E2 lab tests done on the same day to use for comparison.

My Sensitive E2 test was 4 points higher (58 pg/mL (range: < or = 29 pg/mL)) than the Standard E2 test (54 pg/mL (range: < or = 39 pg/mL)).

I had expected the Sensitive E2 results to be lower.

Any ideas or opinions on why this would be the case?

 

[Systemlord]

My Sensitive E2 test was 4 points higher (58 pg/mL (range: < or = 29 pg/mL)) than the Standard E2 test (54 pg/mL (range: < or = 39 pg/mL)).

The sensitive E2 test is reliant on technician skill, so a poorly done sensitive test will not be as accurate, while the standard E2 test is more consistent if you don’t have an elevated C-reactive protein marker.

I have seen Highpull (on T-Nation) post a similar experience, with the sensitive E2 test showing a higher value than the standard E2 test.

The number isn’t the single most important parameter, how you feel is more important than a lab value.

 

[RickB]

My same day results:

standard: 44.9 (7.6-42.6)
sensitive: 41.0 (8-35)

 

[jobshopper]

The sensitive E2 test is reliant on technician skill, so a poorly done sensitive test will not be as accurate, while the standard E2 test is more consistent if you don’t have an elevated C-reactive protein marker.

I have seen Highpull (on T-Nation) post a similar experience, with the sensitive E2 test showing a higher value than the standard E2 test.

The number isn’t the single most important parameter, how you feel is more important than a lab value.

After reading your post I am really confused now.

If the sensitive test result is prone to technician errors then how can it ever be trusted? If it can't be trusted then why bother with it? A guy could end up making adjustments based on a botched test result. That would really suck!

I've read on this forum as well as T-Nation that a person should trust their labs and not the way the feel; especially when it comes to trying to get E2 levels in range.

Boy oh boy... what to do? ... what to do?

 

[Systemlord]

I've read on this forum as well as T-Nation that a person should trust their labs and not the way the feel; especially when it comes to trying to get E2 levels in range.

The difference between 54->58 isn’t that big a difference. As far as trusting these labs to make decisions, it’s not as simple as it seems. Early on in my TRT journey, my E2 was very high (70) and whenever I treated it, tried to get it in range, things went from bad to worse.

Fast-forward years later, my issues was something else, not E2 related. In this instance trusting my labs didn’t work because I feel amazing with high estrogen, not all men will.

I care more about how I feel as long as other bio markers are healthy.

 

[RickB]

The difference between 58 and 54 isn’t that big a difference.

But the issue is the accuracy.

And if you're using the standard result to confirm the accuracy of the sensitive result, that confirms the uselessness of the sensitive test.

 

[jobshopper]

The difference between 54->58 isn’t that big a difference. As far as trusting these labs to make decisions, it’s not as simple as it seems. Early on in my TRT journey, my E2 was very high (70) and whenever I treated it, tried to get it in range, things went from bad to worse.

Fast-forward years later, my issues were something else, not E2 related. In this instance trusting my labs didn’t work because I feel amazing with high estrogen, not all men will.

You are correct that it isn't a big difference. Imagine my surprise when I expected it to be lower and not higher. Everything that I had read was that my Sensitive E2 should be lower than my Standard E2 because of the C-RP issue. That's why I did the Sensitive E2 test.

 

[jobshopper]

My same day results:

standard: 44.9 (7.6-42.6)
sensitive: 41.0 (8-35)

I don't understand the point you are trying to make?

 

[madman]

I had both the standard E2 and the Sensitive E2 lab tests done on the same day to use for comparison.

My Sensitive E2 test was 4 points higher (58 pg/mL (range: < or = 29 pg/mL)) than the Standard E2 test (54 pg/mL (range: < or = 39 pg/mL)).

I had expected the Sensitive E2 results to be lower.

Any ideas or opinions on why this would be the case?

You had your lab work done through Quest!

Bet your results would have been different if you chose a lab that has had its sensitive estradiol assay certified through CDC HoSt.

If you have no issues with elevated CRP or have not driven your estradiol into the ground from the overuse of an AI then the standard assay should suffice.

If you choose to rely on what would be considered the most accurate assay (LC/MS-MS) then you would need to use a specific lab such as Mayo, LabCorp, or ARUP as said assay has been .certified through the CDC Hormone Standardization Program.

* the participating assays are bench-marked to a higher-order reference method and calibrator

For reassurance ask upfront before your order the assay!

Choose Quest or Labcorp?

This last year I have had my labs done by Interpath, Quest, and Labcorp, basically I used whatever lab the doctor's office used. Going foward I am going to select and stick with the same lab so that comparing my historical results is more consistent. Discounted Labs doesn't cover my state...

www.excelmale.com

Very low E2 levels during menopause complicate assay use, measurement

https://www.healio.com/news/endocrinology/20201210/very-low-estrogen-levels-during-menopause-complicate-assay-use-measurement Clinicians using mass spectrometry to measure hormone levels should exercise caution when assessing data from postmenopausal women when very low estradiol levels are...

www.excelmale.com

 

[madman]

You are correct that it isn't a big difference. Imagine my surprise when I expected it to be lower and not higher. Everything that I had read was that my Sensitive E2 should be lower than my Standard E2 because of the C-RP issue. That's why I did the Sensitive E2 test.

That's why we need this!

CDC STANDARDIZED TOTAL T AND ESTRADIOL TESTS and soon to be FREE TESTOSTERONE!

How the CDC Clinical Standardization Programs Are Improving Hormone Tests - AACC.org WHAT PROGRESS HAS CDC MADE WITH STANDARDIZING TOTAL TESTOSTERONE AND ESTRADIOL TESTS? Since HoSt began in 2010, CDC has had more than 350 participants in 15 countries. Participants have shown measurable...

www.excelmale.com

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients

 

[jobshopper]

If you have no issues with elevated CRP or have not driven your estradiol into the ground from the overuse of an AI then the standard assay should suffice.

I don't know that I have any CRP issues. It is not something that my PCP checks. As for crashing my E2; I have not taken an AI yet.

I have been on mono TC for over 4 years and have not had any issues until lately.

My raging libido that I enjoyed during the 4 years went off a cliff 10 weeks ago. It took some of my sexual functions with it I am experiencing a loss of penile sensitivity, delayed orgasm and at times anorgasmia. I had ED issues initially but that has subsided. I also experience brain fog but that has been ongoing for a couple of years now.

 

[Systemlord]

I also experience brain fog but that has been ongoing for a couple of years now.

There are a percentage of men who start TRT due to symptoms of low-T and after a time symptoms return even though hormone levels are elevated. The reason for this is because the internal dysfunction that lead to the symptoms and low-T is still going on.

If I feel unwell on TRT, the cause if my type 2 diabetes because this is what lead to my dreadfully low testosterone (91 ng/dL). If I eat the wrong food days in a row, it doesn’t matter how well optimized my hormones levels are, I will feel like sh**!

Your trying to circumvented a disease process.

 

[Systemlord]

 

[jobshopper]

There are a percentage of men who start TRT due to symptoms of low-T and after a time symptoms return even though hormone levels are elevated. The reason for this is because the internal dysfunction that lead to the symptoms and low-T is still going on.

If I feel unwell on TRT, the cause if my type 2 diabetes because this is what lead to my dreadfully low testosterone (91 ng/dL). If I eat the wrong food days in a row, it doesn’t matter how well optimized my hormones levels are, I will feel like sh**!

Your trying to circumvented a disease process.

I am sorry to hear about your medical issues and wish you good health.

6 years ago, at 64 I was diagnosed with hypogonadism. I also have BPH.

Other than that I have no underlying medical issues. Aside from elevated TT, FT and E2, the rest of my labs are good. My PCP who I see every 3 months always comments on how he wishes his other patients would take care of themselves as well as I do.

I attribute my good health to diet, exercise and maintaining my hormone levels and youthful levels.

... of course good genetics helps too...

 

[RickB]

I don't understand the point you are trying to make?

The results of my standard and sensitive were close, just like yours. Four point difference just like yours, though with mine it's the sensitive that is lower.

My point is if the sensitive is the more accurate reading (and obviously there's some debate about that), it's certainly not worth the extra money I paid. Paying an extra $42 to get a reading that may be more accurate by 3.9 points is not worth it.

HOWEVER, the ranges are different as well, which clouds the issue. My standard reading had me at 5.4% over range, while the sensitive had me at 17% over range.

If they're using different ranges can we even compare the standard and sensitive results as equal units? Or are we better off comparing where each one is in relation to its own range?

Maybe @readalot can chime in on that one.

 

[jobshopper]

The results of my standard and sensitive were close, just like yours. Four point difference just like yours, though with mine it's the sensitive that is lower.

My point is if the sensitive is the more accurate reading (and obviously there's some debate about that), it's certainly not worth the extra money I paid. Paying an extra $42 to get a reading that may be more accurate by 3.9 points is not worth it.

HOWEVER, the ranges are different as well, which clouds the issue. My standard reading had me at 5.4% over range, while the sensitive had me at 17% over range.

If they're using different ranges can we even compare the standard and sensitive results as equal units? Or are we better off comparing where each one is in relation to its own range?

Maybe @readalot can chime in on that one.

I get what you're saying and I think you have some valid points.

If I understand @madman then Quest is prone to human error and sub-standard testing methods and can not be trusted for the Sensitive test. If that is indeed true then it makes me wonder if their other tests are flawed as well.

Anyone else here use Quest for their blood work?

 

[tareload]

Post in thread 'Much wider Free Testosterone reference range in recent research on FT levels in healthy young men' Much wider Free Testosterone reference range in recent research on FT levels in healthy young men

Quest my new favorite lab. More above for an example with Quest vs Labcorp for FT.

Never had much difference between sensitive and standard E2. That difference varies on the individual's particular health situation (interference). Use the standard unless you have known inflammatory issues or be diligent and run both. At the end of the day most people aren't running replicates at a particular lab so machine and operator precision is a black box.

 

[tareload]

ANOVA gauge R&R - Wikipedia

en.m.wikipedia.org

 

[jobshopper]

... so machine and operator precision is a black box.

Sorry for being dense but what does that mean?

 

[tareload]

Sorry for being dense but what does that mean?

See Wikipedia article I posted above for overview.