Why Sensitive Estradiol test?

[Janosch]

I read that for men, we should have the Estradiol LC/MS/MS test done because the standard Estradiol test is inadequate for men. I just had my labs done and the lab accidentally did the standard test. My doctor said that he checked with the lab and was told that a sensitive E2 was only needed if my previous values were very low. Could somebody explain why men need the sensitive test? Also, I am able to get only the Ultra sensitive Estradiol test. Whats the difference to the sensitive Estradiol test? Thank you for any input!

 

[Nelson Vergel]

Why Men Should Be Tested Using the Sensitive Estradiol Test | Discounted Labs

 

[Vince Carter]

Sensitive and ultra sensitive are interchangeable terms, it's the testing method, LC/MS/MS, that is key. Even Quest and I think Lbacorp, too, print right on the test results of the ECLIA method that it's the wrong test for men.

 

[Vince Carter]

Its supposed more accurately read the lower E levels that would be found in men.

 

[Janosch]

Why Men Should Be Tested Using the Sensitive Estradiol Test | Discounted Labs

Thanks, interesting results!

 

[DragonBits]

I have a question about this subject.

They say the regular estrogen test is for women. The reason is because women have higher levels of estrogen than men.

So if a man also has high levels of estrogen, wouldn't the regular test be just as good as the sensitive test?

AND if it's not, then maybe women should also be taking the estrogen sensitive test?

Which way is it, is the regular estrogen test not accurate no matter how high your estrogen is? Is so, why shouldn't women also take the sensitive test?

 

[madman]

I have a question about this subject.

They say the regular estrogen test is for women. The reason is because women have higher levels of estrogen than men.

So if a man also has high levels of estrogen, wouldn't the regular test be just as good as the sensitive test?

AND if it's not, then maybe women should also be taking the estrogen sensitive test?

Which way is it, is the regular estrogen test not accurate no matter how high your estrogen is? Is so, why shouldn't women also take the sensitive test?

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(direct) immunoassays:


-they display a significant loss of specificity and accuracy at low concentrations.

AND

-the direct immunoassays are prone to issues with sub-optimal accuracy and specificity due to cross reactivity with estradiol conjugates and metabolites




Estradiol assays--The path ahead.


Abstract
Estradiol quantitation is useful in the clinical assessment of diseases like hypogonadism, hirsutism, polycystic ovary syndrome (PCOS), amenorrhea, ovarian tumors and for monitoring response in women receiving aromatase inhibitor therapy. Physiologically relevant serum estradiol concentration in women can span across four orders of magnitude. For example, in women undergoing ovulation induction serum estradiol concentration can range between 250-2000 pg/mL whereas aromatase inhibitor therapy can decrease serum estradiol concentration to <5 pg/mL. While high-through-put automated un-extracted (direct) immunoassays accommodate the growing clinical need for estradiol quantitation, are amenable to implementation by most hospital clinical laboratories, they display a significant loss of specificity and accuracy at low concentrations. Most clinical scenarios (example: estradiol monitoring in fertility treatments) place a modest demand on accuracy and precision of the assay in use but accurate quantitation of estradiol in certain clinical scenarios (pediatric and male patients and for monitoring aromatase inhibitor therapy) can be challenging using currently available immunoassays since the direct immunoassays are prone to issues with sub-optimal accuracy and specificity due to cross reactivity with estradiol conjugates and metabolites. In this review we discuss the bases for the evolution of estradiol assays from extracted (indirect) radio-immunoassays to direct immunoassays to liquid-chromatography tandem mass spectrometry (LC-MS/MS) based assays, discuss technical factors relevant for development and optimization of a LC-MS/MS assay for estradiol and present the details and performance characteristics of an ultra-sensitive LC-MS/MS estradiol assay with a limit of quantitation of 0.2 pg/mL.









4. Conclusion
Several studies and the recent Endocrine Society Position Statement have addressed the deficiencies in current immunoassays used for the quantitation of estradiol [2,8,9,12,13]. Direct immunoassays lack appropriate sensitivity at low estradiol levels (<40 pg/ mL). Although a GC–MS estradiol assay is considered the gold standard, it is complex to use in a routine clinical laboratory and is not amenable to high test through put. LC–MS/MS estradiol assays offer the throughput, sensitivity and precision required for estradiol quantitation over a wide range of physiological concentrations. Patients receiving AI therapy are a subset for whom high sensitivity estradiol assays are particularly useful as treatment efficacy depends on the degree of estradiol suppression. Whereas, automated direct immunoassays will remain as the first line approach for the vast majority of clinical situations where the demand for assay sensitivity is modest (example: women undergoing ovulation induction), high sensitivity LC–MS/MS assays with LOQ between 0.1 and 0.2 pg/mL are needed for optimal clinical management of certain subset of patients like those receiving AI pharmacotherapy.

 

[DragonBits]

thanks madman, I am glad they specified what they meant by low estradiol levels. So often they only say low and I have no idea of how low low is. "immunoassays lack appropriate sensitivity at low estradiol levels (<40 pg/ mL).

And I didn't know women can be as high as 2000 pg/ml.

 

[fifty]

The real question is, why not sensitive E2? Because doctors get pinged by the insurance for racking up another $2 to $20 on the lab order bill?

 

[DragonBits]

The real question is, why not sensitive E2? Because doctors get pinged by the insurance for racking up another $2 to $20 on the lab order bill?

I agree that the sensitive test isn't that much more expensive so why not get it?

Though I private pay, an insurance company would likely not pay at all for what they thought was the wrong test. And what happens is that you get a HUGE bill if insurance doesn't pay. Then most patients tend to blame the doctor.

IE: My primary once coded a lipid test as routine, medicare doesn't pay for routine testing, the lab wanted to charge $149 for a lipid test I could self pay $20 for.

 

[BenM]

The lab here advised someone I know that 'the sensitive oestradiol assay is only worthwhile for levels less than 70pmol/L - otherwise the normal oestradiol assay is sensitive above these levels'.

I tested it out myself, I've always had the non-sensitive test done because that's all the main lab here offers, most recent test from them was 76 pmol/L. The next lot of tests I went to a different lab specifically to get the sensitive assay and it came back at 72 pmol/L so very little difference in my case.

 

[Nelson Vergel]

The overestimation of estradiol values provided by the regular ECLIA estradiol test is due to interference with inflammatory markers like CRP. If your CRP is low, chances are that the regular versus sensitive (LC/MS) E2 test results are similar.

 

[Dansk]

The overestimation of estradiol values provided by the regular ECLIA estradiol test is due to interference with inflammatory markers like CRP. If your CRP is low, chances are that the regular versus sensitive (LC/MS) E2 test results are similar.

Hmmm... this is interesting. Thought the sensitive test was needed in men period. As the non sensitive was designed around women’s values (or something like that) don’t quote men that.

 

[BenM]

The overestimation of estradiol values provided by the regular ECLIA estradiol test is due to interference with inflammatory markers like CRP. If your CRP is low, chances are that the regular versus sensitive (LC/MS) E2 test results are similar.

Thanks for pointing that out. I assumed in my head that inflammatory markers were high. Like my CK for example is always way high even though I don't train for 48 hours before having blood taken (I really need to take a break from the gym.....) but it turns out this last test was the only time I've had CRP done and it was 5 mg/L which is at the higher end but still within range. What would you call low?

 

[DragonBits]

Thanks for pointing that out. I assumed in my head that inflammatory markers were high. Like my CK for example is always way high even though I don't train for 48 hours before having blood taken (I really need to take a break from the gym.....) but it turns out this last test was the only time I've had CRP done and it was 5 mg/L which is at the higher end but still within range. What would you call low?

Most people should get the high sensitivity CRP test, or hs-crp.

The lower crp is the better. If you have something like rheumatoid arthritis your crp is likely to be above 10.

An hs-CRP level greater than 2.0 mg/L puts you at greater risk of a heart attack.

Levels between 3 mg/L and 10 mg/L are mildly elevated and usually result from chronic conditions such as diabetes, hypertension, or things like tobacco smoking and being sedentary.

High-calorie, high-fat meals cause a sudden spike in CRP, high triglycerides can cause a spike up.

Problem is that while hs-crp indicates some sort of inflammatory response, you can't exactly tell what is causing it.

A lot of supplements like aged garlic and turmeric can help to lower CRP, as can diet changes.

In Jan 2018 my crp was 3.39, the doctor wanted me to lower lipids or maybe I should take a stain which also works. I got my CRP down to 2.09 recently in April 2018 and will retest again this month. I am looking to get it below 1.0.