Life Extension Foundation on TRT & estrogen management

[paco]

In this recent article, Life Extension Foundation gives their views on proper estrogen management while on testosterone replacement therapy. I look forward to hearing others' thoughts.

http://www.lef.org/magazine/mag2014/jun2014_Misguided-Medicine_01.htm

 

[jger242]

Excellent article.

 

[paco]

One unfortunate aspect of this article is that they do not differentiate between the sensitive estradiol assay and the standard estradiol assay. This makes judgment of their recommended range of approximately 20-30 pg/ml rather difficult.

Life Extension offers a sensitive assay by Lab Corp, but they are still promoting the standard assay for most men. Maybe someone here has the connections to educate them on this issue.

 

[Nelson Vergel]

I agree with Paco.

Good review. However, when they mentioned the Mass General Hospital study, they did not understand that the study design was done on purpose and with patient consent. The study needed to wipe out testosterone and estradiol to see the effects. Yes, it may seem misguided but this kind of "sacrifice" is needed in medical research.

These studies have been reviewed on here.

I am glad that the Life Extension Foundation has now changed their stand about estradiol and the dangers of low E2 levels.

 

[Gene Devine]

One unfortunate aspect of this article is that they do not differentiate between the sensitive estradiol assay and the standard estradiol assay. This makes judgment of their recommended range of approximately 20-30 pg/ml rather difficult.

Life Extension offers a sensitive assay by Lab Corp, but they are still promoting the standard assay for most men. Maybe someone here has the connections to educate them on this issue.

Dr. Crisler has brought this to their attention many times. In fact, I was there in person when he showed Bill Faloon (CEO of LEF) actual BW reflecting how the default E2 lab over estimates a man's serum levels.

They now offer a Sensitive assay as a result of this but the article makes no mention of it.

I have asked Dr. Crisler to comment on this thread so let's see his thoughts on the matter.

 

[HarryCat]

The Mass. General study says: "The serum level of estradiol was measured with the use of liquid chromatography–tandem mass spectroscopy, with a threshold for detection of 1.25 pg per milliliter."

What method is used by Lab Corp?

 

[Nelson Vergel]

Look at this paper comparing the two estradiol tests used in men:

Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men



"In conclusion, our findings suggest interference in the standard immunoassay-based E2 analyses, possibly by CRP or a CRP-associated factor. Although this interference does not seem to affect association studies between immunoassay E2 levels and skeletal parameters, we propose a reevaluation of previous association studies between immunoassay-based E2 levels and inflammation-related outcomes. In addition, MS-based assays are to be preferred for the quantification of E2 levels in men."

 

[Dr. John Crisler]

Look at this paper comparing the two estradiol tests used in men:

Comparisons of Immunoassay and Mass Spectrometry Measurements of Serum Estradiol Levels and Their Influence on Clinical Association Studies in Men



"In conclusion, our findings suggest interference in the standard immunoassay-based E2 analyses, possibly by CRP or a CRP-associated factor. Although this interference does not seem to affect association studies between immunoassay E2 levels and skeletal parameters, we propose a reevaluation of previous association studies between immunoassay-based E2 levels and inflammation-related outcomes. In addition, MS-based assays are to be preferred for the quantification of E2 levels in men."

Right.

I discussed this very topic with my new friend Jon Nakamoto MD PhD, Director of Quest Diagnostic's Nichols Institute, while in Chicago a few months ago. Quest assembled half a dozen of us to form their new Health Aging Advisory Committee.

Dr. Nakamoto (who is also a very nice fellow) was very clear that immunoassay techniques are not sufficient for hormonal evaluation because they simply can not accurately measure such low concentrations as are found in the blood. The LC/MS laboratory therefore stands alone for proper hormonal evaluation, especially for estrogen in adult males.

I'll share the inside skinny on all this: it is a matter of the replacement of the equipment currently in use. THEN this basic fact will come into favor.

 

[Dr. John Crisler]

In this recent article, Life Extension Foundation gives their views on proper estrogen management while on testosterone replacement therapy. I look forward to hearing others' thoughts.

http://www.lef.org/magazine/mag2014/jun2014_Misguided-Medicine_01.htm

This remains a wonderful piece, that we can rely upon for references detailing the dangers of inappropriate estrogen levels.

 

[Dr. John Crisler]

The Mass. General study says: "The serum level of estradiol was measured with the use of liquid chromatography–tandem mass spectroscopy, with a threshold for detection of 1.25 pg per milliliter."

What method is used by Lab Corp?

LabCorp's "Sensitive Estradiol" #140244 employs the Radioimmunoassay (RIA) methodology. It is much better than their Standard Estradiol, but still falls short of cutting edge technology....and reliability.

If you are to use LabCorp, their new "5 Series" (just my name for it) uses LC/MS methodology. They are:
Estradiol #500108
Estrone #500634

Now that I have a reliable E1 test I am able to do much more for my patients. I'll be publishing on that topic in the future.

 

[Dr. John Crisler]

Employment of RIA laboratory methodology is one reason Nelson keeps pushing back against the inappropriate use of aromatase inhibitors. This invalid methodology tends to overestimate actual estrogen concentration, so doctors who treat merely by the numbers on the laboratory printout are giving AI's to men who are not actually too high. Then their levels tank--and ill health, and unhappiness, follow.

 

[Nelson Vergel]

Dr Crisler, thank you for expanding on this issue.

Who do you think at Quest or Labcorp is the guru about estradiol testing methology in men?

I would love to interview them to then send the interview to most of the low T clinics out there so that the indiscriminate use of anastrozole is stopped.

I know this sounds like I am over reacting, but I can see 10-20 years from now having old men on long term anastrozole use join a malpractice lawsuit against the clinics that prescribed it. Most will complain or early bone loss and fractures.

 

[Dr. John Crisler]

Dr Crisler, thank you for expanding on this issue.

Who do you think at Quest or Labcorp is the guru about estradiol testing methology in men?

I would love to interview them to then send the interview to most of the low T clinics out there so that the indiscriminate use of anastrazole is stopped.

I know this sounds like I am over reacting, but I can see 10-20 years from now having old men on long term anastrazole use join a malpractice lawsuit against the clinics that prescribed it. Most will complain or early bone loss and fractures.

I would be happy to introduce you to Dr. Nakamoto.

I think you make a great point about the inappropriate prescription of AI's.