Wildly Different E2 Numbers - LabCorp vs. Quest

[DragonBits]

Much of the result variation has to do with how long the specimen sits before being processed, in addition to the environment where its stored and the shipping process (ie time of year, exposure to temperatures, etc).
This variation probably applies to many biomarkers and all labs unless the specimen is processed on the spot.

That's true too, but I don't know to what degree E2 and T is subject to those problems.

I have seen other tests that if the collection tube is shaken too much, it causes a wildly different result.

 

[Nelson Vergel]

The liquid chromatography/ mass spectrometry estradiol (sensitive) test is the most time consuming of all hormone tests with several variables involved. I would not be surprised if two companies use different machines. See paper attached.

 

[Nelson Vergel]

Jkozlow3:

Why did you order the sensitive E2 from LabCorp but not the equivalent ultrasensitive E2 from Quest? The LCMS is the only thing worth comparing.

 

[jkozlow3]

Jkozlow3:

Why did you order the sensitive E2 from LabCorp but not the equivalent ultrasensitive E2 from Quest? The LCMS is the only thing worth comparing.

Combination of cost, not necessarily believing that LC-MS/MS is always “better” in all circumstances (i.e. unless at the very bottom of the reference range), and kind of losing faith in the reliability of the Quest Ultrasensitive right off the bat when I got the “54” result a couple of months into TRT when everyone says ultra/sensitive is typically equal or lower than the non-sensitive. I’ve also read several stories here and on other TRT forums where people have had ultra/sensitive tests that made no sense compared to previous E2 labs and upon retesting the values were more in line with what they expected and/or previous results. It seems like the LC-MS/MS is better in theory but highly prone to lab technician errors.

My 2 LabCorp E2 labs (sensitive and non-sensitive) were pretty darn close (13 vs. 12), so perhaps non-sensitive is accurate enough with LabCorp for some people. My sensitive and non-sensitive labs were drawn in 2 separate vials and sent to 2 different labs for testing (sensitive is only evaluated in North Carolina for LabCorp where as my non-sensitive was done locally in CA).

I didn’t want to make my original post longer than it was or clutter it with unnecessary details, but I’ve actually tested with Quest about a half-dozen other times that I didn’t list. I was trying different T dosages and protocols (EOD, daily, etc.) over the past several months and testing total T and E2 (non-sensitive) every couple/few weeks on average to make sure I was on the right track. The non-sensitive Quest E2 results were consistent and in-line with what I expected each time (i.e. they peaked and fell as expected, varied depending on the dose of T as expected, etc.). While the Quest numbers were always consistent, they may be inaccurate and erroneously high if the LabCorp numbers are to be believed.

I kind of think LabCorp might be correct. I just dug through some old lab work (pre-TRT) and found some lab results from over a year ago where a different doctor I was seeing awhile back ordered the sensitive E2 from LabCorp. I didn’t realize that he had ordered the sensitive until now. Anyway, my sensitive E2 was an 8.0. This was pre-TRT and my total T was in the 200-250 range pre-TRT before I began treating it earlier this year (had it tested a couple of times before moving across the country, deciding to treat it, etc.). An 8.0 E2 kind of makes sense considering you need T to make E2 and my total T numbers were very low.

Now my LabCorp sensitive E2 was around 13 on a micro-dose of Arimidex dissolved in vodka (~0.25mg/week give or take). Had I not been on the Arimidex, I likely would have had an E2 in the 20s. The increase from 8.0 to 20-something makes sense with normal T values...at least in my mind! Although this makes me wonder...why wouldn’t most men with low T start out with low E2 which normalizes with T treatment?

 

[DragonBits]

Combination of cost and kind of losing faith in the reliability of the Quest Ultrasensitive right off the bat when I got the “54” result a couple of months into TRT when everyone says ultra/sensitive is typically equal or lower than the non-sensitive. I’ve also read several stories here and on other TRT forums where people have had ultra/sensitive tests that made no sense compared to previous E2 labs and upon retesting the values were more in line with what they expected and/or previous results. It seems like the LC-MS/MS is better in theory but highly prone to lab technician errors.

My 2 LabCorp E2 labs (sensitive and non-sensitive) were pretty darn close, so perhaps non-sensitive is accurate enough with LabCorp for some people. My sensitive and non-sensitive labs were drawn in 2 separate vials and sent to 2 different labs for testing (sensitive is only evaluated in North Carolina for LabCorp where as my non-sensitive was done locally in CA).

I didn’t want to make my original post longer than it was or clutter it with unnecessary details, but I’ve actually tested with Quest about a half-dozen other times that I didn’t list. I was trying different T dosages and protocols (EOD, daily, etc.) over the past several months and testing total T and E2 (non-sensitive) every couple/few weeks on average to make sure I was on the right track. The non-sensitive Quest E2 results were consistent and in-line with what I expected each time. It’s just that they may be inaccurate and erroneously high if the LabCorp numbers are to be believed.

I kind of think LabCorp might be correct. I just dug through some old lab work (pre-TRT) and found some lab results from over a year ago where a different doctor ordered the sensitive E2 from LabCorp. I didn’t realize that he had ordered the sensitive until now. Anyway, my sensitive E2 was an 8.0. This was pre-TRT and my total T was in the 200-250 range pre-TRT before I began treating it earlier this year (had it tested a couple of times before moving across the country, deciding to treat it, etc.). An 8.0 E2 kind of makes sense considering you need T to make E2 and my total T numbers were very low.

Now my LabCorp sensitive E2 was around 13 on a micro-dose of Arimidex dissolved in vodka (~0.25mg/week give or take). Had I not been on the Arimidex, I likely would have had an E2 in the 20s. The increase from 8.0 to 20-something makes sense with normal T values...at least in my mind! Although this makes me wonder...why wouldn’t most men with low T start out with low E2 which normalizes with T treatment?

IMO the situation of T converting to E2 is way more complicated than we talk about.

If I were you, I would calculate the % of E2 you produce with various TT levels to see what the trend / % is on all the tests. You maybe able to develop an idea of what to expect.

When I say it's complicated, it seems like TT and the conversion to E2 along with your FT levels are also dependent on your vitamin levels, like Vit D, boron, probably a couple of others.

I typically expect about 2.9-4% of TT to be expressed as E2. But when I was lacking in boron, it seemed this was lower. Supplementing with Boron raised my FT and E2 when my TT was 348. Before supplementing my E2 was below <5, my FT was 5.5, after supplementing E2 went to 11 and FT went up to 7.5, I didn't change anyone else. Still low, but more what one would expect with a TT level of 348. I was also at one time low on Vit D, and raised that from 26 to 56 (30-100), so I don't know how that affects results.

Now that I am a lot closer to optimum vitamin levels, my conversion of TT to E2 stays pretty consistent.

It does seem if my TT goes a lot higher, say 1300, then I start to convert a greater % to E2, like 4% instead of 3%. But I have only measured TT that high one time, so it isn't much of a sample size to go on.

A lot can change to cause higher or lower e2 levels, the what lab you use and what test is only one of the confounding factors.