T Nation

Need Help Deciphering Lab Results. Sky High E2

31 y/o Male
230lb 14% BF
Muscular and never had a problem with strength.
Low grade depression and anxiety.
Balding with sparse beard.
Varicocele left side (atrophied significantly)
Sore Joints.
Moody as hell
No morning wood.
Decreased sex drive.
Training for 12 years and haven’t made significant gains in 5.
Testicle ache- sometimes
Currently not on TRT.
Drugs/Alcohol - Moderate

Labs Levels Range
Estrogen, total, Serum. 177 pg/ml (60-190) converts to 650 pmol
Test, Total, MS. 822 ng/dl (250-1100)
Test, Bioavailable 263.2 ng/dl (110-575)
SHBG 32 nmol/l (10-50)
Albumin, Serum 4.6 g/dl (3.6-5.1)
LH 17 Iu/L (1.24- 7.8)

Ferritin 109 ng/ml (20-345)
Iron, Total 134 mcg/dl (50-180)
DHEA 333 mcg/dl (106-464)
Cortisol, total 15.9 mcg/dl (4- 22)

TSH W/reflex to FT4 1.31 (.4- 4.5)
AM Temp average 97F

I’m trying to gain some perspective on whether or not my issues could be hormonal. Estrogen levels are the most concerning, considering my pg level would convert to 650pmol. Did I do the right test or is the “estrogen, total” not a good gauge of where I’m at? Should i explore thyroid testing further? Also LH is damn high, which is not surprising given my atrophied left testicle. Any input would be greatly appreciated, thank you in advance!!

If one of your testicles is having trouble related to the varicocele, your pituitary would deal with that by increasing LH to compensate, suggest perhaps one testicle is having trouble which is related to the varicocele. It’s very strange to me that Free T is where it is given high normal total testosterone and midrange SHBG.

It’s not normal to have LH so high like it is, you definitely have hormonal issues going on.

I don’t think your estrogen testing is the correct test as the ranges are wrong, total estrogens isn’t the same thing as standard estrogen testing. Men require the Liquid Chromatography–Mass Spectrometry or LC/MS/MS method, not the Roche ECLIA methodology.

Total estrogens is useless and provides zero diagnostic value.

As for thyroid testing, Free T3 levels indicates what’s going on the cellular levels and is more closely related to symptoms than Free T4 or TSH as Free T3 is the only active thyroid hormone. It soaks into your cells and increases metabolism.

AM and late night temperatures are lower than they are during the day, otherwise you would never fall asleep, you would be wired all of the time.

That is not accurate.

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, as 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.

On the other side of the coin, the 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.

For comparison, below are examples of samples tested with both methods.







Ok thanks for the clarification. I will tell my doc to order the right test and hopefully that will clear things up. I was concerned that I was off the charts for a minute. I appreciate the response.