Estradiol missing from baseline blood tests

[Observer]

Let's say someone gets a pre-TRT baseline with practically every blood test you could ever want, but they accidentally ended up with a standard estradiol rather than an ultrasensitive estradiol. Would it potentially come back to bite them if they don't follow up with another test to get an accurate baseline reading of estradiol? Of all the various blood markers, is that one okay to skip?

 

[madman]

Let's say someone gets a pre-TRT baseline with practically every blood test you could ever want, but they accidentally ended up with a standard estradiol rather than an ultrasensitive estradiol. Would it potentially come back to bite them if they don't follow up with another test to get an accurate baseline reading of estradiol? Of all the various blood markers, is that one okay to skip?

If you have elevated CRP or you were one of those poor bastards who crushed their estradiol from overusing an aromatase inhibitor (AI) then you’d want the most accurate assay available LC-MS/MS, or better yet a CDC-standardized LC-MS/MS assay.

Otherwise the standard immunoassay is usually sufficient.




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

*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

Thread 'CDC STANDARDIZED TOTAL T and ESTRADIOL ASSAYS and soon to be FREE TESTOSTERONE!'

Jan 5, 2019

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 improvements for both total testosterone (TT) and estradiol (E2). Specifically, the among-laboratory bias has decreased from 16.5% in 2007 to 2.8% in 2017 for TT and from 54.8% in 2012 to 13.9% in 2017 for E2. Not only has bias improved, but data...

• madman
• Replies: 92
• Forum: Blood Test Discussion

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Thread 'Very low E2 levels during menopause complicate assay use, measurement'

Dec 23, 2020

Very low estrogen levels during menopause complicate assay use, measurement

Endocrine Today | Clinicians using mass spectrometry to measure hormone levels should exercise caution when assessing data from postmenopausal women, when very low estradiol levels are difficult to measure accurately.Accurate measurement of very low levels of circulating estradiol in...

www.healio.com

Clinicians using mass spectrometry to measure hormone levels should exercise caution when assessing data from postmenopausal women when very low estradiol levels are difficult to measure accurately.

Accurate measurement of very low levels of circulating estradiol in postmenopausal women is important to investigate sex steroid action in target tissues. However, immunoassays are inaccurate, and conventional mass spectrometry-based measurement is...

• madman
• complicate assay use/measurement very low e2 levels during menopause
• Replies: 4
• Forum: Testosterone and Men's Health Articles

• 

 

[Observer]

I should clarify that the standard estradiol results that I received were so poor, they showed as "<30" with the range listed as "< OR = 39 pg/mL". So almost no usable specificity at all.

 

[madman]

I should clarify that the standard estradiol results that I received were so poor, they showed as "<30" with the range listed as "< OR = 39 pg/mL". So almost no usable specificity at all.

Yes you tested through Quest as the reference range for males < OR = 39 pg/mL.

Labcorps standard IA would have been the better option as the reference range is 7.6–42.6 pg/mL.

Also keep in mind standard immunoassays are less accurate at lower estradiol concentrations.

 

[Observer]

But considering a useless result was given on the last blood test, would it be a mistake to just forgo the ultrasensitive estradiol test as a pre-TRT baseline? Is natural estradiol a measurement that factors into future decisions once TRT has begun, or is it not really relevant?

 

[madman]

But considering a useless result was given on the last blood test, would it be a mistake to just forgo the ultrasensitive estradiol test as a pre-TRT baseline? Is natural estradiol a measurement that factors into future decisions once TRT has begun, or is it not really relevant?

Always good to know where your baseline sits but it’s unlikely to make or break the outcome here.

Would not get too caught up on elevated estradiol unless you are experiencing symptoms as T's metabolites estradiol and DHT are important physiological mediators of its effects.

Maintaining them in a healthy physiological range contributes to multiple tissue specific processes (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system function, lipids, and body composition).

 

[Observer]

Always good to know where your baseline sits but it’s unlikely to make or break the outcome here.

Would not get too caught up on elevated estradiol unless you are experiencing symptoms as T's metabolites estradiol and DHT are important physiological mediators of its effects.

Maintaining them in a healthy physiological range contributes to multiple tissue specific processes (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system function, lipids, and body composition).

Makes sense, solid advice, thank you.

 

[Partapradip]

Yeah, using a standard estradiol assay instead of the ultrasensitive version for a pre-TRT baseline can come back to bite someone, but not for the reasons most guys think. And no, E2 is not okay to skip....but a “wrong” baseline may be worse than no baseline if it leads to incorrect decisions later.

 

[WhiteMale]

I dont think that as a baseline, that it matters for anything. Note when you get your lab orders if it's correct, or not, the lab didn't likely choose to run the wrong test, they ran the test that was ordered/prescribed. Be aware too that there are a number of clinics out there that may not use the LC/MS/MS test and in fact (still) use the standard test.