Bloodwork: Low Test, Low Estrogen

If your C-reactive protein is elevated (marker for inflammation) E2 will be falsely elevated.

Just for reference this is my bloodwork on pharmacy testosterone Cypionate 120 mg per week




Is that the E2 level where your libido is/was through the roof?

Yes that is correct. That blood was drawn 5 days ago and my libido has been raging since I dropped the DIM I was taking.

2 Likes

Elevated levels of C-reactive protein (CRP) may elevate the IA result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

1 Like

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.

On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.

Here are a couple of example in which we see the LC/MS/MS method coming back higher than immunoassay:

IA%20LC%2055-79

These examples were taken on the identical protocol with the IA results being within 10%, while the LC/MS/MS is within 20%, so the argument could be made that the LC is less accurate. I know, n=1, however, this is consistent with what I was told by the lab expert.

1 Like

This is a tremendous explantation! Thank you for taking the time to write this all out @highpull.

Great info! Thank you very much! My next test I do for blood work, I will request both sensitive and IA tests to be done for a comparison. When I find out my numbers, I will post my results on here if thats ok :slight_smile:

Your more than welcome to post them here @mademanv

My Estradiol test that was done via IA test came out to 135 but I feel great! So im curious to see how the sensitive test will read it.

I would be very interested in seeing that as well

What is your protocol again??

My IA estradiol was 25.6 on 126mg a week, split into 36mg EOD sub-q.

I seriously wonder if I need to be a lot higher.

200mg of Test C 1x a week IM. I know some people say to do it more often but I don’t mind doing it like this. Feel pretty good! At day 7 I can tell I could use another injection but its nothing major. Get a bit tired and not as outgoing but still ok.

1 Like

Bro it’s as simple as splitting the dose and you won’t have to deal with an off day. That extra day is worth something :slight_smile:

I was thinking of trying it out this week. Do 100mg every 2 or 3 days. Feel really good around day 2 and 3 but after that I feel flat lined which again aint bad but sure would like to feel like day 2 every day lol!

You can do a shot one thursday and another Sunday. Or jsut do it every 3 days. I do it daily and it’s so much better then when I was once weekly. Weekly for me was a living hell after day 4.

I normally do my shot every friday or saturday. Maybe do it this saturday and next shot on Wednesday. See how it works worth a shot.

Everytime I read guys posting they can feel the T the next day or lost something on day 4
I think my nerves must be half dead.
I have injected once a week twice a week 3 times a week and EOD. I it feels exactly the same. No ups or down from shot frequency.
Right now I settled on M/T because I just get sick of sticking myself all the time.

Just did the same thing. I switched from EOD back to M/T. Just didn’t feel much difference between the two.

I actually don’t feel much from TRT in the first place. Sometimes I wonder if I need to jack up the dose a bit. Maybe I need to be high outside the ranges to actually feel this stuff.

I have read a bit about testosterone resistence, etc. and that some just need higher levels to feel results.

The low point at the end of the week in my experience will get bigger with time until you get less relief from injections.

You could just inject twice weekly and not have to feel this way at the end of the week.