Estradiol bloodwork timing question

[jp]

Hey guys, I've got a quick question about Estradiol. My urologist pulled bloodwork for my testosterone totals along with Estradiol at trough about 5 weeks after starting TRT(50mgs 2x/wk). I asked him to run the sensitive test for Estradiol and he said he didn't know what that was. After all my research on this forum I know I need to start looking for a new doctor.


8/16/17
TT - 711.8 249-836 ng/dL
FT - 119.9 46-224 pg/mL
Est - 19.4 25.8-60.7 pg/mL


I happened to have some follow up blood work with my primary and asked her to run the sensitive Estradiol test.


8/25
Est Sensitive(LC/MS/MS) - 52 <=29 pg/mL


This was not run at trough. Do Estradiol levels have peaks and valleys like the Tcyp does? It seems odd that the normal test which tends to overestimate levels is low and then 9 days later the sensitive test is so much higher. My urologist gave me an rx for anastrozole stating that Estradiol levels won't have a trough since we aren't currently treating it. I don't really want to start this until I have a more clear picture to what's going on and plan on ordering another sensitive test. I just wanted to know if that needs to be run at trough also which might account for the strange values. Thanks.

 

[Vince Carter]

They should be run together, I forget the saying but its something like "E follows T" so there's definitely an up and down and "there's no trough because we're not treating it"...wow that is unbelievable.

As far as the sens and standard, I can pull a higher sensitive test, Ive done it several times with the same blood draw at the same time.

I would retest with T and E, the right test, and then make a decision. It should be said that absent negative symptoms that an E of 52 is not really a problem that should be treated though you've probably read that here at EM, too.

 

[CoastWatcher]

Yes, "E follows T," as Vince Carter noted. You pull a trough reading of testosterone you are - in theory - pulling something like a peak estradiol. But, as he also wrote, if you haven't a complaint, I would let things ride.

 

[jp]

Yes, "E follows T," as Vince Carter noted. You pull a trough reading of testosterone you are - in theory - pulling something like a peak estradiol. But, as he also wrote, if you haven't a complaint, I would let things ride.

Just to clarify, when you guys say "E follows T", I take that to mean that as T goes up, so does E. So if I'm pulling a trough reading which would be when T is at it's lowest in my 3.5 day protocol, E should be at it lowest also correct?

 

[CoastWatcher]

Just to clarify, when you guys say "E follows T", I take that to mean that as T goes up, so does E. So if I'm pulling a trough reading which would be when T is at it's lowest in my 3.5 day protocol, E should be at it lowest also correct?

No...estradiol FOLLOWS testosterone. Testosterone is injected/applied, estradiol starts to climb...in its wake. Aromatization has to occur; there is a temporal lag. As testosterone is bottoming out, e2 is still higher on its overall trajectory.

 

[jp]

No...estradiol FOLLOWS testosterone. Testosterone is injected/applied, estradiol starts to climb...in its wake. Aromatization has to occur; there is a temporal lag. As testosterone is bottoming out, e2 is still higher on its overall trajectory.

Got it. Thanks for the clarification.

 

[CoastWatcher]

What your doctor may have meant is that estradiol won't have as decided a trough as testosterone...or perhaps she doesn't understand it.