Experiences of using two methods to measure estradiol in men: E2 (CLIA) Vs E2 (Sensitive)

[Turkishjade1989]

I have never seen a debate on this. Everyone always says get the e2 sensitive.... I’m interested in how big a difference the two tests truly make. Like what’s the variance?

 

[GeauxBears]

Big difference. Regular E2 test tends to overstate due to cross-reactivity with inflammatory markers, specifically CRP. Lots of reading material here and other places (peaktestosterone.com) to peruse.

 

[Turkishjade1989]

So if I am reading you correctly a non sensitive e2 test will always be higher. Never lower? If so. What are we talking about; 20%?...I get that this is more or less a guessing game. Just interested in an educated guess.

 

[Vince]

So if I am reading you correctly a non sensitive e2 test will always be higher. Never lower? If so. What are we talking about; 20%?...I get that this is more or less a guessing game. Just interested in an educated guess.

No not always. The sensitive estrogen test is more accurate, the women estrogen test can at times be accurate for men.

 

[GeauxBears]

Here’s a good place to start: https://www.peaktestosterone.com/Which_Estradiol_Test_Best.aspx

 

[fifty]

Everyone spends money for lcms estradiol but not lcms testosterone.

Lcms is more expensive, more accurate with the caveat of higher chance of being totally botched.

 

[HealthMan]

It varies. In my case both are almost identical

 

[fifty]

E2 sensitive is a money pit in blood test packages.

On lifeextension you can get the following for $107.

Total T
Estradiol (not sensitive)
FreeT
Dhea-s
Psa
Shbg
Cbc / lipids

 

[Cataceous]

This will put you in the middle of a long thread on the subject of estradiol tests. It's a particularly good post I copied from PeakTestosterone.com.

 

[Turkishjade1989]

Great read. Thank you

 

[Vince Carter]

Even the two big labs, Quest and LabCorp print right on the lab results for standard E2 that it is unsuitable for men with a paragraph why it's the wrong test.

 

[Cataceous]

Even the two big labs, Quest and LabCorp print right on the lab results for standard E2 that it is unsuitable for men with a paragraph why it's the wrong test.

Here's the actual wording from LabCorp:

E2 levels in children, postmenopausal women, and men are much lower than in women of reproductive age. The increased sensitivity and specificity that are achieved by LC/MS-MS are the more appropriate choice for these clinical situations than the electrochemiluminescence immunoassay (ECLIA) method.1,2 See Estradiol, Sensitive, LC/MS [140244]. LC/MS-MS offers superior analytical sensitivity, specificity and a larger dynamic range than immunoassays.1 The clinical applications benefiting from highly sensitive E2 measurement include the assessment of congenital defects in sex steroid metabolism and disorders of puberty. This sensitive assay also has application in the evaluation of estrogen deficiency in men and menopausal women, fracture risk assessment in these populations, and increasingly, in therapeutic drug monitoring of low-dose female hormone replacement therapy or antiestrogen treatment.

 

[Gman86]

Here’s all the times I tested both in the same blood work.

8-15-17
E2 Sensitive - 8
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)

12-13-17
E2 Sensitive - 9
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)

7-9-18
E2 Sensitive - 46
E2 NOT Sensitive - 27
E2 Free - 0.58 (0.2-1.5)

8-24-18
E2 Sensitive - 57
E2 NOT Sensitive - 56
E2 Free - 1.35 (0.2-1.5)

10-23-18
E2 Sensitive - 58
E2 NOT Sensitive - 68
E2 Free - 1.48 (0.2-1.5)

12-6-18
E2 Sensitive - 10
E2 NOT Sensitive - 15
E2 Free - 0.33 (0.2-1.5)

1-25-19
E2 Sensitive - 29
E2 NOT Sensitive - 27
E2 Free - 0.67 (0.2-1.5)

2-20-19
E2 Sensitive - 28
E2 NOT Sensitive - 32
E2 Free - 0.76 (0.2-1.5)

4-30-19
E2 Sensitive - 72
E2 NOT Sensitive - 49
E2 Free - 1.02 (0.2-1.5)

 

[James]

That is interresting Gman. There's another guy here who will occasionally get higher numbers from the sensitive test. I too will often pay for both tests. Sensitive for me is best between 8 - 12 on the labcorp scale. You show a lot E2 fluctuation.

 

[Gman86]

That is interresting Gman. There's another guy here who will occasionally get higher numbers from the sensitive test. I too will often pay for both tests. Sensitive for me is best between 8 - 12 on the labcorp scale. You show a lot E2 fluctuation.

Ya there’s a lot of fluctuation due to messing with ai’s. My latest labs were while on no ai at all. I honestly don’t notice a difference now that I’m off of it. So I think I’m most likely a person that doesn’t need it. The only thing I’ve noticed since being off of the ai is that libido might be slightly better, and erections are easier to get. While on ai’s, there would be periods where manual stimulation would be needed to get an erection. Now, just thinking about sex will give me a full erection.

 

[tareload]

Look at these parity plots (as they are typically called). Each point is an individual. E2 immunoassay (non-sensitive) is typically (majority of folks) but not always higher than the LC-MS (sensitive) E2 test. Some of these guys are below the parity line on the plots below.

My experience is quite different than Gman86's data above (I admire your systematic data collection). Inflammatory proteins/antibodies in the blood will cause interference on the RIA assay and typically my LCMS E2 runs 50% of the RIA number (for example, 34 pg/mL on the sensitive test vs 69 pg/mL with non-sensitive RIA). Hence, I am typically in range on the LC-MS test and out of range on the RIA. Good luck getting your provider to run both tests head to head (especially in-network). They will most likely have no idea what you are talking about. My in-network provider labels the sensitive test "pediatric estradiol" .

Very easy to do head to head comparison with Defy or with your enlightened cash pay provider. Where do you fall on the plots below if you are in to systematically measuring that type of thing?

Performance of direct estradiol immunoassays with human male serum samples.

Comparison of serum testosterone and estradiol measurements in 3174 European men using platform immunoassay and mass spectrometry; relevance for the diagnostics in aging men.

 

[James]

readalot - I'll order both tests and that's about right for me too.

Gman86 - My libido may be up a little when my E2 is higher. Keep in mind that high E2 for me would be considered low E2 to most others. But it's darn near impossible for me to get an erection with high E2. When I get my E2 in the single digits - mid teens (LCMSMS), I get strong wood and when flaccid, it will hang much lower, fuller and heavier. When my E2 is high, for me this means high teens / low 20's, it becomes smaller and more tight to my body.

 

[jsmith21896]

readalot - I'll order both tests and that's about right for me too.

Gman86 - My libido may be up a little when my E2 is higher. Keep in mind that high E2 for me would be considered low E2 to most others. But it's darn near impossible for me to get an erection with high E2. When I get my E2 in the single digits - mid teens (LCMSMS), I get strong wood and when flaccid, it will hang much lower, fuller and heavier. When my E2 is high, for me this means high teens / low 20's, it becomes smaller and more tight to my body.

I have similar symptoms, along with a weak stream with higher e2.

 

[Vince Carter]

Gman86 - My libido may be up a little when my E2 is higher. Keep in mind that high E2 for me would be considered low E2 to most others. But it's darn near impossible for me to get an erection with high E2. When I get my E2 in the single digits - mid teens (LCMSMS), I get strong wood and when flaccid, it will hang much lower, fuller and heavier. When my E2 is high, for me this means high teens / low 20's, it becomes smaller and more tight to my body.

Id say that I'm almost the same, my best experience by far on TRT was lately Ive had my trough Sens E2 in the single digits or low teens. Had some real glimmers of sexual improvement, some sensitivity is better but orgasm has been remarkably improved.