T Nation

First Blood Work Since Dropping AI

My current protocol includes 100mg test cyp e3.5d and 250iu hcg e3.5d. I stopped taking adex around September at which time I was using.125mg e3.5d
Total T 1335 ng/dL 264-916
Free T 26.8 pg/mL 8.7-25.1
Total E 132 pg/mL 40-115 (test ordered was sensitive E2?)
Any thoughts? Should I be concerned about the high estrogen. I have had no high estrogen side effects. I know hcg could be driving my E higher but I feel so much better. My Dr. is unconcerned with the numbers.

Your numbers are awesome. With that free t and total t you can have a slight higher e2. In fact if you do end up getting high e2 sides you can adjust your dose.

Great!

Total Estrogens is the wrong testing, if you feel fine, then no need to do anything. If you did start to experience high E2 symptoms, you could always decrease the dosage, no AI needed.

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I actually feel better than I have in the 4 years I’ve been on trt. Should I order a sensitive estrogen test? Should I be concerned with my testosterone number being high. Free T is just barely out of range.

Do you want to make the number look better or do you want to feel better?

Higher testosterone is healthier than midrange levels or lower.

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I certainly don’t want to chase numbers. Just want opinions of well informed peers.

If it aint broke dude.

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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.

Some labs with both methods run concurrently:

IA%20LC%2021%2018 IA%20LC%2023-23 IA%20LC%2026-21 IA%20LC%2028-27%20clear IA%20LC%2028-27

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I don’t think it was an LC/MS/MS vs ECLIA situation. Looks like he got a total estrogen test. Not just E2 but all the estrogens.

Right, but I think he is asking about getting “a sensitive test” which I assume is the E2 sensitive or ultrasensitive test.

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Gotcha.

I believe my Dr simply used the wrong code or the lab made a mistake. The original req was for Estradiol Sensitive LCMS.

I contacted Lab Corp and they did indeed order the wrong estrogen test. It seems they keep your sample for 7 days so they ordered the correct E2 sensitive test at no charge.

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I’ll guess it’s in the 30s…

If it’s in the 30s that would be awesome.

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What’s the difference. I get what sensitive is/ but total? I saw many comments where they said there are different types of estrogen and you should test all if you feel there is a problem with e2.

This makes me very curious. Is there an estrogen that is known to have different benefits or negatives: for instance too high estrogen type A might be related to bone health or water gain if elevated or low.

Estradiol is the most powerful estrogen. Like testosterone is the most powerful androgen. Other estrogens are estrone (E1), and estriol (E3). There is also an E4 produced in females during pregnancy but not sure if its ever seen in men.

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Got it. Thanks

I got the results of the E2 sensitive test. 11.8 pg/mL ref. range 8pg/mL-35pg/mL
Anyone have any thoughts on this. Would that be a normal E2 with a total E of 140?

How weird. That’s low and you feel good.