Advice on whether or not to start TRT or look for other causes

[madman]

An E2 at 32 pg/mL is perfectly normal as those ranges for estrogen are poorly established. LabCorp has E2 ranges all the way up to 46 pg/mL.

His estradiol was tested using what would be considered the most accurate assay LC/MS-MS.

If we are speaking in terms of specific assays LC/MS-MS then the top-end reference range for Labcorp is 35 pg/mL whereas Quest is ≤ 29 pg/mL.

140244: Estradiol, Sensitive, LC/MS

Labcorp test details for Estradiol, Sensitive, LC/MS

www.labcorp.com

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

Labcorps Electrochemiluminescence immunoassay (ECLIA) is 42.6 pg/mL whereas Quest is ≤ 39 pg/mL.

004515: Estradiol

Labcorp test details for Estradiol

www.labcorp.com

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

 

[madman]

My estradiol level came back overnight, it is higher as expected, which it was quite low before starting. Any thoughts?
View attachment 41636
View attachment 41637

Driving up your FT is going to drive up your estradiol.

Nothing to fret over as it is expected.

You almost doubled your FT (6.6--->12.5 ng/dL) and more importantly, this is trough.

Your peak FT and estradiol will be even higher!

You are missing your results for CBC which includes critical blood markers (RBCs, hemoglobin, and hematocrit).

Hematocrit will increase within the 1st month of starting TTh.

Should have been tested 6 weeks in to get a snapshot of where it sits.

Even then where it sits 6 weeks in is not where it will end in the long run as it can take anywhere from 6-9 months and in some cases up to a year to reach peak levels.

Keep in mind that every time you tweak your protocol (increase dose of T) such blood markers will be driven up further and it will take many months at said dose of T to see where it truly ends up.