Estradiol bloodwork results and how to interpret ranges sensitive vs. "regular"

[HoustonTX]

Estradiol
Estradiol 35.4 7.6-42.6 pg/mL 01
Roche ECLIA methodology
Estradiol, Sensitive
Estradiol, Sensitive 33.7 8.0-35.0 pg/mL 02
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared by the Food and
Drug Administration.
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

This is a copy of the first sensitive estradiol test I got. I have had one since that was in the high 50's. I am not sure how to read the difference between the 2 as I just recently read the reason why to get the sensitive.

Looking at the this first test that cam back with the regular and sensitive along with a testonsterone reading of 1134, I said well look they are almost the same 35 and 33.7...so much for paying extra to have the sensitive test. But, when looking at the ranges, the sensitive test shows my estradiol was at the top end of the rand or high. The regular says it's in the low 30's with a test reading of 1134, this is good.

How should this be interpreted?

 

[Vince]

Looks very good to me, are you feeling good? A full panel would be nice.

 

[ERO]

You have to remember that the "range" shown the tests assumes (and is calculated with) a much lower Total T than you currently have, so when you take that into consideration, your E2 is not at all high. Unless you are feeling overt high E2 symptoms, I would leave it where you are.

 

[CoastWatcher]

Pay no attention to anything but the sensitive assay. The "regular" test, designed to measure estradiol in women, is of no value to men. Just as importantly, how are you feeling?

 

[Vince Carter]

Curious as I don't usually see the two tests so close to together the Sens can typically read 10 points lower but it's hard to compare the two, the ROCHE ECLIA is just plain wrong and shouldn't be used for anything.

 

[HoustonTX]

Looks very good to me, are you feeling good? A full panel would be nice.

I can post the full panel, but this is an older panel that I was using as an example to answer my discussion. To answer your question, though, I felt good at the time this panel was done. However, it's not all about feeling good. It's mostly about feeling good. We always say that the proof is in the lab work though. If I said I felt good and my E2 was 60, wouldn't that raise some eye brows. My question was that I know that an e2 reading on a normal lab of 20-35 for me is good and generally where I feel good. The ranges for the sensitive are very different though.

How should we read them differently? Suppose I feel off and I am at t he high end of the range, is my E2 high at 32, or only if it is higher than 40 or so just like the normal test.

 

[HoustonTX]

Curious as I don't usually see the two tests so close to together the Sens can typically read 10 points lower but it's hard to compare the two, the ROCHE ECLIA is just plain wrong and shouldn't be used for anything.

Is it really that wrong? It's the one the vast majority of people have used for many years, and it's one that has always confirmed how I felt.

I was surprised by the 2 being on the same report as well. I ordered the female hormone panel from private MD and the sensitive through discount and they came in on the one single Labcorp report. I had the blood drawn for both at the same time.

 

[HoustonTX]

You have to remember that the "range" shown the tests assumes (and is calculated with) a much lower Total T than you currently have, so when you take that into consideration, your E2 is not at all high. Unless you are feeling overt high E2 symptoms, I would leave it where you are.

I know that you. Can have higher E2 with higher test, but at the same time there has to be a point at which the ratio theory doesn't hold true. If you. Have E2 of 60 but your test level is 1500, that's still high right? Also, for example, if you were on higher than a TRT dose taking 400-600 mugs of test and your reading was 3000 or higher (if they can test that), and your E2 was 100, that can't be good....right? Just taking this to an extreme to get to my question,

 

[HoustonTX]

Sorry for the gramatical errors. I have been wanting to respond for some time and haven't had a chance

 

[HoustonTX]

I know that the sensitive test is much greater more accurate and the way to go, but it's hard for me to reason that it's worthless. I could be wrong. I've read Nelson's information about the difference and will reread

 

[ERO]

The ratio holds for any level. I used to know a guy that used AAS and he once had a sensitive E2 of 172 and felt awesome, huge libido, no water retention, was killing it in the gym, etc. for the simple reason that his T was so high that an E2 of this level was likely in the sweet spot of between 14 and 20.

Now we all know that such a hugely elevated T level is not healthy long-term for a great many reasons, and I am not recommending that, but it illustrates that what is important in how you feel is the ratio of T to E, not any fixed number.

 

[Jon H]

I don't agree with the statement that it holds true for any level for everyone. I'm a low-SHBG guy, and almost all of the rules that apply to most folks simply don't work for me. I can say without a doubt that whether my total test is 840 or 1600 the following holds true.

If my estradiol is lower than 20 my skin dries out (even on my penis), my joints get uncomfortable, my mood becomes clinical and a good erection is a crapshoot even with Cialis. It doesn't need to be much under 20 for this to happen.

If my estradiol is higher than 30 on the sensitive test (and I've never tested over 40) I feel like I'm getting hot flashes, I have a very short temper, erections are crap, I retain water, and I've gotten a small amount of noticeable gyno that I'm still dealing with. It doesn't need to be much over 30 for this to happen. Even in the high 20's I can start to feel the symptoms creeping up. I'm also pretty sensitive to Anastrozole, and the amount I need varies each week, between .5mg and 1mg.

I think when giving advice to folks it's important to caveat replies with the disclaimer that some advice falls under the category of general guidance (which applies to most guys) vs. fact for everyone. I'd hate for someone to not deal with estradiol problems simply because they are plugging their numbers into the ratio calculator. Anastrozole isn't always evil. If you need it, you need it. I think the general guidance of "not chasing a ratio" is just as valid as "not chasing a number".

 

[CoastWatcher]

I think the general guidance of "not chasing a ratio" is just as valid as "not chasing a number".

I agree with this. We all are tempted to look for a single, quantitative score that will allow for easy E2 management. It's not that easy. That said, the ratio is a valuable way of interpreting a complex set of variables.

 

[ERO]

I don't agree with the statement that it holds true for any level for everyone. I'm a low-SHBG guy, and almost all of the rules that apply to most folks simply don't work for me. I can say without a doubt that whether my total test is 840 or 1600 the following holds true.

If my estradiol is lower than 20 my skin dries out (even on my penis), my joints get uncomfortable, my mood becomes clinical and a good erection is a crapshoot even with Cialis. It doesn't need to be much under 20 for this to happen.



If my estradiol is higher than 30 on the sensitive test (and I've never tested over 40) I feel like I'm getting hot flashes, I have a very short temper, erections are crap, I retain water, and I've gotten a small amount of noticeable gyno that I'm still dealing with. It doesn't need to be much over 30 for this to happen. Even in the high 20's I can start to feel the symptoms creeping up. I'm also pretty sensitive to Anastrozole, and the amount I need varies each week, between .5mg and 1mg.

I think when giving advice to folks it's important to caveat replies with the disclaimer that some advice falls under the category of general guidance (which applies to most guys) vs. fact for everyone. I'd hate for someone to not deal with estradiol problems simply because they are plugging their numbers into the ratio calculator. Anastrozole isn't always evil. If you need it, you need it. I think the general guidance of "not chasing a ratio" is just as valid as "not chasing a number".

I too agree that it doesn't apply to everyone - I was referring about the majority of folks that fall under the bell curve. I also have low SHBG and it makes TRT very much of a challenge, and at least in my case, somewhat of a let-down in term of overall benefit.

 

[Vettester Chris]

Curious as I don't usually see the two tests so close to together the Sens can typically read 10 points lower but it's hard to compare the two, the ROCHE ECLIA is just plain wrong and shouldn't be used for anything.

Definitely agree with this!

 

[HoustonTX]

I don't agree with the statement that it holds true for any level for everyone. I'm a low-SHBG guy, and almost all of the rules that apply to most folks simply don't work for me. I can say without a doubt that whether my total test is 840 or 1600 the following holds true.

If my estradiol is lower than 20 my skin dries out (even on my penis), my joints get uncomfortable, my mood becomes clinical and a good erection is a crapshoot even with Cialis. It doesn't need to be much under 20 for this to happen.

If my estradiol is higher than 30 on the sensitive test (and I've never tested over 40) I feel like I'm getting hot flashes, I have a very short temper, erections are crap, I retain water, and I've gotten a small amount of noticeable gyno that I'm still dealing with. It doesn't need to be much over 30 for this to happen. Even in the high 20's I can start to feel the symptoms creeping up. I'm also pretty sensitive to Anastrozole, and the amount I need varies each week, between .5mg and 1mg.

I think when giving advice to folks it's important to caveat replies with the disclaimer that some advice falls under the category of general guidance (which applies to most guys) vs. fact for everyone. I'd hate for someone to not deal with estradiol problems simply because they are plugging their numbers into the ratio calculator. Anastrozole isn't always evil. If you need it, you need it. I think the general guidance of "not chasing a ratio" is just as valid as "not chasing a number".

I also have a range that I know I feel good in and above and below which I don't feel good. Whenever I test below 20, I feel miserable, can get erections (morning wood is off and on), but I lose sensitivity, so erections aren't really enjoyable. When I am higher than 35, I am moody, erection quality is poor, and I get fatigued. Any where in between, I feel great. And, it doesn't matter of my test level is 1000 or 1500. If I am at an E2 of 40 or higher, I feel the high E2.

All of this has been based on the regular E2 test that I got as part of the female hormone panel from Private MD for $50-60 which made it inexpensive to test everything, but everyone on this board says I could use as TP. I am trying to dial in my E2 with a new protocol and using lower test cyp but no Arimidex. I've had great success so far, but how do I correlate those numbers now with the sensitive test? I agree that anastrozole isn't evil and if you need it you need it. However, most docs like mine start people out at 200mgs of test. Of all the guys on this forum and others that are on 200mgs, I don't know any that don't have to take anastrozole. There are a lot of guys, Nelson included, that are taking 100mgs -140mgs that doesn't have to take adex. If I cannot keep my test value at a decent number with the lower test dosage, then I will go back on adex and try and hit that ever moving good E2 target again. But, my goal is to hit a good E2 feel which will correlate to a range for me in blood work and hopefully have a test range of 800 plus. 1000 would be even better LOL

 

[Dr Justin Saya MD]

We use the LC/MS/MS, but the Roche ECLIA is better than nothing (better than not testing at all, in other words). The sensitive test is more expensive. We at Defy and Nelson with Discounted Labs have negotiated a MUCH lower price than is available to other providers on the sensitive E2 test. The biggest deficiency of the RIA (standard test) is that it can cross-react with C-reactive protein. For folks that have an elevated CRP (or simply a CRP that is NOT low), the RIA may indeed overestimate E2 levels quite a bit. If cost is a factor, I would suggest ordering your own labs through Discounted Labs for a reduced price on the sensitive E2. Compare that cost to the cost you currently pay for the standard E2 PLUS a C-reactive protein test (which you should test concurrently with the standard E2 to "calibrate" your results and make sure you are not elevated on CRP). If the cost of the standard E2 + CRP is still significantly less than the price for the sensitive E2 test...then you have a decision to make. I suspect the sensitive E2 test will have a more attractive price point when viewed in that light. Either way, correlating your levels with symptoms is the key. Good luck.

 

[Vitamin_C]

My doc is not using the sensitive test, whatever he is using I tend to run low in estrogen. One test the reference range was 8-43 and I came back <5 (not on TRT at that time, not on AI, TT was 305)

The last test he ran I was doing 10% t-gel which barely raised my Testosterone, TT was at 541, the reference range for this estrogen test was 26-61, I came back 21pg/mL. Does this mean that I am even lower in estrogen if I did the sensitive test? We increased my dosage to 20% Test cream and I am going to up my HCG dose to 500 IU twice per week instead of 250 IU twice per week. Any help would be appreciated.

 

[Vince Carter]

It's all moot and frankly, not worthy of discussing, it's the wrong test and it's useless to base your care on it.

ask him for the Quest 140244 test, this is one that is widely accepted as the right test to use.

 

[CoastWatcher]

My doc is not using the sensitive test, whatever he is using I tend to run low in estrogen. One test the reference range was 8-43 and I came back <5 (not on TRT at that time, not on AI, TT was 305)

The last test he ran I was doing 10% t-gel which barely raised my Testosterone, TT was at 541, the reference range for this estrogen test was 26-61, I came back 21pg/mL. Does this mean that I am even lower in estrogen if I did the sensitive test? We increased my dosage to 20% Test cream and I am going to up my HCG dose to 500 IU twice per week instead of 250 IU twice per week. Any help would be appreciated.

The fact that your doctor doesn't monitor your estradiol via the sensitive assay raises the question of whether he/she understands contemporary TRT protocol management. That, in turn, leads one to ask if you are receiving the care you deserve.