Correct Estrogen test

[professorJohn]

A number of you have mentioned that the only correct way to measure estrogen levels is to have a "ultrasensitive estradiol" test, for example, through Quest.

When I go to Quest's website I can only find these tests:

Estradiol, Amniotic Fluid
Estradiol, Bioavailable
Estradiol, Free
Estradiol, Rapid
Estradiol, Serum
Estradiol, Urine

Nothing about ultrasensitive. Called my local Quest location and they never heard of ultrasensitive. Can anyone help?

 

[JanSz]

A number of you have mentioned that the only correct way to measure estrogen levels is to have a "ultrasensitive estradiol" test, for example, through Quest.

When I go to Quest's website I can only find these tests:

Estradiol, Amniotic Fluid
Estradiol, Bioavailable
Estradiol, Free
Estradiol, Rapid
Estradiol, Serum
Estradiol, Urine

Nothing about ultrasensitive. Called my local Quest location and they never heard of ultrasensitive. Can anyone help?

This is most likely the lattest, as it comes from Nichols Institute.
You have more details under each name.
Nichols Institute - Endocrinology

Estradiol, Free, LC/MS/MS 36169X
Estradiol, Rapid 15577X
Estradiol, Serum 4021X
Estradiol, Ultrasensitive, LC/MS/MS 30289X
Estriol, Serum 34883X
Estrogen, Total, Serum 439X
Estrogens, Fractionated, LC/MS/MS 36742X
Estrone Sulfate 37104X
Estrone, LC/MS/MS 23244X
============================================

There is also
http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual_3rdEd_2004.pdf

go to alphabetical Tests section

there is estrogen 10 items (estrogen, estrodial, estrone)
there are more details on idividual pages.

The 2004 seems like old now, progress have been made since.

If I am not mistaken, newer technology in tests designated LC/MS/MS

At one time Dr John was planning to write about his discussion with Big Cheese at Nichols Institute.
=========================================
I have a suspicion that soon we will be concerned with

Estradiol, Free, LC/MS/MS 36169X
Includes: total estradiol(most likely high quality test)

CPT Code(s): 82670 (x2)
Clinical Significance:
Much of Estradiol is bound to proteins. The unbound portion and Estradiol bound to proteins with low affinity reflect the Free concentration. The Free Estradiol may better correlate with medical conditions than the Total Estradiol concentrations.

SHBG will raise to prominence again.

 

[professorJohn]

Thank you.

This is most likely the lattest, as it comes from Nichols Institute.
You have more details under each name.
Nichols Institute - Endocrinology

Estradiol, Free, LC/MS/MS 36169X
Estradiol, Rapid 15577X
Estradiol, Serum 4021X
Estradiol, Ultrasensitive, LC/MS/MS 30289X
Estriol, Serum 34883X
Estrogen, Total, Serum 439X
Estrogens, Fractionated, LC/MS/MS 36742X
Estrone Sulfate 37104X
Estrone, LC/MS/MS 23244X
============================================

There is also
http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual_3rdEd_2004.pdf

go to alphabetical Tests section

there is estrogen 10 items (estrogen, estrodial, estrone)
there are more details on idividual pages.

The 2004 seems like old now, progress have been made since.

If I am not mistaken, newer technology in tests designated LC/MS/MS

At one time Dr John was planning to write about his discussion with Big Cheese at Nichols Institute.
=========================================
I have a suspicion that soon we will be concerned with

Estradiol, Free, LC/MS/MS 36169X
Includes: total estradiol(most likely high quality test)

CPT Code(s): 82670 (x2)
Clinical Significance:
Much of Estradiol is bound to proteins. The unbound portion and Estradiol bound to proteins with low affinity reflect the Free concentration. The Free Estradiol may better correlate with medical conditions than the Total Estradiol concentrations.

SHBG will raise to prominence again.

 

[professorJohn]

This is most likely the lattest, as it comes from Nichols Institute.
You have more details under each name.
Nichols Institute - Endocrinology

Estradiol, Free, LC/MS/MS 36169X
Estradiol, Rapid 15577X
Estradiol, Serum 4021X
Estradiol, Ultrasensitive, LC/MS/MS 30289X
Estriol, Serum 34883X
Estrogen, Total, Serum 439X
Estrogens, Fractionated, LC/MS/MS 36742X
Estrone Sulfate 37104X
Estrone, LC/MS/MS 23244X
============================================

There is also
http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual_3rdEd_2004.pdf

go to alphabetical Tests section

there is estrogen 10 items (estrogen, estrodial, estrone)
there are more details on idividual pages.

The 2004 seems like old now, progress have been made since.

If I am not mistaken, newer technology in tests designated LC/MS/MS

At one time Dr John was planning to write about his discussion with Big Cheese at Nichols Institute.
=========================================
I have a suspicion that soon we will be concerned with

Estradiol, Free, LC/MS/MS 36169X
Includes: total estradiol(most likely high quality test)

CPT Code(s): 82670 (x2)
Clinical Significance:
Much of Estradiol is bound to proteins. The unbound portion and Estradiol bound to proteins with low affinity reflect the Free concentration. The Free Estradiol may better correlate with medical conditions than the Total Estradiol concentrations.

SHBG will raise to prominence again.

Sorry if I'm a little slow on the uptake, however, am I then correct in saying that technically Quest does not have an actual test called ultra sensative in reference to estrogen, but rather, this is simply a generic term some folks use?

 

[KSman]

Quest 30289X Estrodiol, Serum is stated to have:

"high sensitivity"

I still object to these posts stating that everyone needs to do multiple tests for E2 and that if it is not "ultra sensitive" that it is the wrong test.

These multiple tests are expensive and totally unnecessary for most guys.

With most TRT guys, there will be a "normal" ratio of the different estrogens and their metabolites. If they use an AI, they still have a "normal" ratio of the different estrogens and metabolites. They simply respond normally.

If E2, serum is high[er] and there are symptoms associated with higher levels of E2, then when an AI is used and E2 is lowered and the problems go away, what more do we want to know. For those guys, how is all of that other data actionable and what improvement in QOL follows?

I am not trying to offend the "ultra-sensitive" E2 advocates, but I do find that the cookie cutter statements that all need to do this and that are definitely lacking a sense of pragmatic principles.

I think that one should start with 'E2, serum' and treat E2 symptoms with AI [or OTC products perhaps] to lower 'E2, serum' levels. If there are still adverse symptoms after 'E2, serum' levels are in a range where these symptoms should not occur, then one can then look at the deeper E2 tests.

If you do all of those [other] E tests then lower E levels [of any measure] with AI and the patient then feels great, what interventions are you then going to make based on those other tests?

Another problem is that we see guys with E2 symptoms here and on other sites who have Doctors who will not treat high-normal E2, serum levels. Some Doctors will not even test E2 levels as they feel that there is no point. Most Doctors who are doing TRT would have no idea what to do with the data from a suite of estrogen tests. These Doctors will simply have no use for these tools. And there is little published data of clinical use that can be found as to how to do anything to make changes and what to be concerned about. There is good info available and experience with 'E2, serum' levels, symptoms, interventions and outcomes. (I recently saw a post where a guy had an E2=60+ and his Doctor simply stated that that was "ok".)

 

[professorJohn]

Quest 30289X Estrodiol, Serum is stated to have:

"high sensitivity"

I still object to these posts stating that everyone needs to do multiple tests for E2 and that if it is not "ultra sensitive" that it is the wrong test.

These multiple tests are expensive and totally unnecessary for most guys.

With most TRT guys, there will be a "normal" ratio of the different estrogens and their metabolites. If they use an AI, they still have a "normal" ratio of the different estrogens and metabolites. They simply respond normally.

If E2, serum is high[er] and there are symptoms associated with higher levels of E2, then when an AI is used and E2 is lowered and the problems go away, what more do we want to know. For those guys, how is all of that other data actionable and what improvement in QOL follows?

I am not trying to offend the "ultra-sensitive" E2 advocates, but I do find that the cookie cutter statements that all need to do this and that are definitely lacking a sense of pragmatic principles.

I think that one should start with 'E2, serum' and treat E2 symptoms with AI [or OTC products perhaps] to lower 'E2, serum' levels. If there are still adverse symptoms after 'E2, serum' levels are in a range where these symptoms should not occur, then one can then look at the deeper E2 tests.

If you do all of those [other] E tests then lower E levels [of any measure] with AI and the patient then feels great, what interventions are you then going to make based on those other tests?

Another problem is that we see guys with E2 symptoms here and on other sites who have Doctors who will not treat high-normal E2, serum levels. Some Doctors will not even test E2 levels as they feel that there is no point. Most Doctors who are doing TRT would have no idea what to do with the data from a suite of estrogen tests. These Doctors will simply have no use for these tools. And there is little published data of clinical use that can be found as to how to do anything to make changes and what to be concerned about. There is good info available and experience with 'E2, serum' levels, symptoms, interventions and outcomes. (I recently saw a post where a guy had an E2=60+ and his Doctor simply stated that that was "ok".)

In your opinion, for a normal e2 serum test what is a good range for normal youthful level?

 

[JanSz]

Sorry if I'm a little slow on the uptake, however, am I then correct in saying that technically Quest does not have an actual test called ultra sensative in reference to estrogen, but rather, this is simply a generic term some folks use?

Nichols Institute - Endocrinology
click on------->
ENDOCRINOLOGY TEST LIST

Nichols Institute - Endocrinology

click on letter "E"

Electrolyte Panel 34392X
Endocrine Hypertension 15026X
Epinephrine, Plasma 37560X
Erythropoietin (EPO) 427X
Estradiol, Free, LC/MS/MS 36169X
Estradiol, Rapid 15577X
Estradiol, Serum 4021X
Estradiol, Ultrasensitive, LC/MS/MS 30289X
Estriol, Serum 34883X
Estrogen, Total, Serum 439X
Estrogens, Fractionated, LC/MS/MS 36742X
Estrone Sulfate 37104X
Estrone, LC/MS/MS 23244X

 

[KSman]

In your opinion, for a normal e2 serum test what is a good range for normal youthful level?

Many refer to a range of 17-20 as optimal for libido. Libido is a damm good proxy for feeling well in my opinion. My Labcorp 37 (<53) made me feel like hell. When 1mg/wk of anastrozole took me to 22 my problems went away. So the 17-20 range has merit for me. I am now taking 1.22mg/wk to target that 17-20 and will soon do another LabCorp E2 test to find out what the results are.

My Doctor was cool with trying to get to 17-20 to evaluate that. I had a natural E2=17 with LabCorp 3.5 years ago and may have always been a lean low E guy.

With the change from 1.0 to 1.22 mg/wk, I have a greater libido [was very good before] and better sexual performance. However my emotions are 'drier'. I am more analytical and less 'feeling-intuitive' than before. My wife probably would say more of my frustrating male nature is showing. I seem to be more energetic and wanting to get things done. Compounding these observations is the fact that I have started a small dose of Armour at the same time. I think that it took 6-8 weeks for the thyroid levels to adjust to the dosing as there should be some TSH suppression then recovery. I will soon be testing TSH, T4, FT4 and FT3 to see what has happened.

So that is my option and experience. I have PM'd with many who have started AI that have had huge changes in QOL. But where one feels best is hard to tell, everyone will have a different optimum range.

I never felt that I ever had gyno. But my "breast" area now feels different than before when there seemed before to be some granularity. Nothing ever was visible. So there never was a obvious problem but there certainly has been a [subtle] change. Now all that I can feel is some fat under the skin and muscle. When I pinch the skin there picking up all that I can against flexed muscle, the thickness of the pinch is the same as the top of my quads. I used to carry more fat on my torso. I feel that I have lost fat and leaned out my torso and belly quite a bit since going to 1.22mg/wk of AI. However, there may be some increases in thyroid levels that are helping that along. Now having recently started low dose lr3 IGF-1 40mcg EOD, it will be come impossible to attribute further reductions in BF to AI. I may be an experiment, as we all are, but certainly not a controlled experiment.