The correct e2 assay

[moonman]

Is ESTRADIOL ULTRASENS (method RIA) the same as the extraction or sensitive method??

The lab for GP uses (PA LABS) has this
http://www.palab.com/testcat/SrchRes.asp

The Estradiol Serum uses method: Electrochemiluminescence

Whereas...

The Estradiol Ultrasens uses method: RIA

Either of these good for men????????

[moonman]

anyone?.....

[JanSz]

anyone?.....

Nobody really knows, it would be a total guess,

best if you could go to Quest Diagnostics.

[phatkid77]

yeah, since i finally calculated that canadas <220pmol= 0-59ng one...

is this fine? you hear so much about the 0-29 test..

[Dr. John Crisler]

Is ESTRADIOL ULTRASENS (method RIA) the same as the extraction or sensitive method??

The lab for GP uses (PA LABS) has this
http://www.palab.com/testcat/SrchRes.asp

The Estradiol Serum uses method: Electrochemiluminescence

Whereas...

The Estradiol Ultrasens uses method: RIA

Either of these good for men????????

Interesting question. I have come to look for LC/MS/MS, not RIA, for the ultrasensitive assays. Maybe we can find a good Lab Director to come on and explain this. I know Dr. Nordt is out of town right now.

[JanSz]

Is ESTRADIOL ULTRASENS (method RIA) the same as the extraction or sensitive method??

The lab for GP uses (PA LABS) has this
http://www.palab.com/testcat/SrchRes.asp

The Estradiol Serum uses method: Electrochemiluminescence

Whereas...

The Estradiol Ultrasens uses method: RIA

Either of these good for men????????

You may want to read this link, (and weep).
http://www.labtestsonline.org/understanding/features/ref_ranges-7.html

To me it means, that if anything, thruot the time, tests should always be done at one laboratory.

The results come with units,
but any units conversion to compare results for one to other laboratory is at least questionable.

Use of good testing methods and high quality control is always a plus.
================================================== ==

I usually think that in USA we have a two choices
Quest Diagnostics
and
LabCorp

the link you have provided

shows that PALabs is a subsidiary of LabCorp.
Hopefully under their QA program.
Well no such a thing is mentioned here:
http://www.palab.com/about/qa.htm


The test ESTRADIOL ULTRASENS
sounds good

If you have no other choice,
you have no other choice but use it.
At least make sure that you stick with this lab.
Often lots is missing between doc's office and a lab.
Make sure that the blood is drawn at the lab, not at the doctor's office.
-------------------------------------

[moonman]

I'll give PA Labs a call and see if I can find out...

[Dr. John Crisler]

What a coincidence! We just ran RIA and LC/MS/MS on same sample. Came back with LC/MS/MS half of RIA result. This happened totally by accident (lab mistake), and results came in today.

Clinical response matches LC/MS/MS. Remember, both "ultrasensitive".

A common failing of RIA is they tend to stick to more than they should, thus falsely elevating results.

[phatkid77]

not gunna lie.....confused up here in canada...lol

so all those letters.. one is 0-29 range and the other to 59? by chance...:confused:

[hardasnails1973]

So to clarify things

For example if you run both test on tjhe same blood draw the ranges 13-54 and <29 should be in synch with each other unless there would be a lab error correct?

[moonman]

What a coincidence! We just ran RIA and LC/MS/MS on same sample. Came back with LC/MS/MS half of RIA result. This happened totally by accident (lab mistake), and results came in today.

Clinical response matches LC/MS/MS. Remember, both "ultrasensitive".

A common failing of RIA is they tend to stick to more than they should, thus falsely elevating results.

So Im taking it that RIA method for E2 in men is no good??

What about the Electrochemiluminescence method?

Sorry Im dont understand all the abreviations....

[JanSz]

What a coincidence! We just ran RIA and LC/MS/MS on same sample. Came back with LC/MS/MS half of RIA result. This happened totally by accident (lab mistake), and results came in today.

Clinical response matches LC/MS/MS. Remember, both "ultrasensitive".

A common failing of RIA is they tend to stick to more than they should, thus falsely elevating results.

You may want to add this two ultrasensitive tests from same blood draw,
to your cllecton of head scratchers.
It is not easy being green.
Blood drawn 8/30/07 reported 9/10/07


60 Estradiol, Free, LC/MS/MS (36169X)
61 /------------------------------------Estradiol, Free 0.75 (< or = 0.45) pg/mL
xx /------------------------------------Estradiol, Free &#37; 2.59 (1.25-1.85) %
62 /------------------------------------Estradiol 29 (< or =29) pg/mL
63 Estrogens, Fractionated, LC/MS/MS (36742X)
64 /------------------------------------Estrone, serum 24 (< or =68) pg/mL
65 /------------------------------------Estradiol, serum 61 (<or=29) pg/mL
66 /------------------------------------Estriol <0.10 (0.2 or less) ng/mL

[Dr. John Crisler]

So to clarify things

For example if you run both test on tjhe same blood draw the ranges 13-54 and <29 should be in synch with each other unless there would be a lab error correct?

No. You are still comparing an invalid assay to one which is valid. Logic violation.

The assay of use is the ULTRASENSITIVE LC/MS/MS.

An invlaid assay is just that. It may be right, it may be wrong. No way to tell. That is what "invalid" means. This is different from lab error, which can happen at any time.

I'm glad we got that one figured out. Actually, it explains some issues I have had with patients in the past.

[rick055]

So if one had to use LabCorp, what tests would one order?

[Dr. John Crisler]

You may want to add this two ultrasensitive tests from same blood draw,
to your cllecton of head scratchers.
It is not easy being green.
Blood drawn 8/30/07 reported 9/10/07


60 Estradiol, Free, LC/MS/MS (36169X)
61 /------------------------------------Estradiol, Free 0.75 (< or = 0.45) pg/mL
xx /------------------------------------Estradiol, Free % 2.59 (1.25-1.85) %
62 /------------------------------------Estradiol 29 (< or =29) pg/mL
63 Estrogens, Fractionated, LC/MS/MS (36742X)
64 /------------------------------------Estrone, serum 24 (< or =68) pg/mL
65 /------------------------------------Estradiol, serum 61 (<or=29) pg/mL
66 /------------------------------------Estriol <0.10 (0.2 or less) ng/mL

See why this area of medicine can be so challenging?

[hardasnails1973]

So do the ultra senitive e2 with <29 range is this correct. For the last time and finally time :D

[pmgamer18]

I don't think so read back and see what he said. I get this ultra senitive test and my labs don't have this range they did send it once and my Dr. told them not to. I think Quest is trying to push this on people.

So do the ultra senitive e2 with <29 range is this correct. For the last time and finally time :D

[hardasnails1973]

So from now on the proper range for gold standard for ultrasenstive e2 is <29 and not 13-54 range

[pmgamer18]

I am sorry wrong thread in a different post Dr. John said Jan should stop telling people to use this test for E2 < or = 29 and Jan still thinks it's a good test. I guess Dr. John needs to give us the range because the order number is the same and if our don't tell them they will send you this crap < or = 29 I can't find the thread it does not have a title about E2.

So from now on the proper range for gold standard for ultrasenstive e2 is <29 and not 13-54 range

[hardasnails1973]

I'm confused in my previous thread it said about comparing it to an invalid essay which is <29 or 13-54 ?

[pmgamer18]

Ilooked for the thread and can't find it I even thanked Dr. John for saying this E2 test Jan pushs is not the right one. There was a lot of hits in the thread Jan was even trying to tell me I was reading Dr. John's reply wrong. It's not in this post.

I'm confused in my previous thread it said about comparing it to an invalid essay which is <29 or 13-54 ?

[hardasnails1973]

No. You are still comparing an invalid assay to one which is valid. Logic violation.

The assay of use is the ULTRASENSITIVE LC/MS/MS.

An invlaid assay is just that. It may be right, it may be wrong. No way to tell. That is what "invalid" means. This is different from lab error, which can happen at any time.

I'm glad we got that one figured out. Actually, it explains some issues I have had with patients in the past.


DO WE? LOL
Is the <29 range valid ? in the quest lab test guide it says that its used to diagnose gynocemastia in males ..Jansz if you can please site this from the quest test manual..

[pmgamer18]

Sure if your over 29 and this goes against doing a Sensitive test in the first place. If the dam test will not go lower then 29 what good is it.

DO WE? LOL
Is the <29 range valid ? in the quest lab test guide it says that its used to diagnose gynocemastia in males ..Jansz if you can please site this from the quest test manual..

[JanSz]

Is ESTRADIOL ULTRASENS (method RIA) the same as the extraction or sensitive method??

The lab for GP uses (PA LABS) has this
http://www.palab.com/testcat/SrchRes.asp

The Estradiol Serum uses method: Electrochemiluminescence

Whereas...

The Estradiol Ultrasens uses method: RIA

Either of these good for men????????

I just found description of kits used to do Estradiol analysis using RIA method.

http://www.hkinfo.com/cp-adaltis/Data/ContentPageManagement/ContentPage/20001125104047/File/Estradiol&#37;20Maia%20(12264%2012268).pdf

Looks like the kit can be used for range 15 to 5000 pg/ml
more like for women.

It is also intersting to see the exceptions when attempting to compare results.

I am not saying that your lab would use this particular kit to do your Estradiol analysis by RIA method.
It is just a sample of so many problems when attempting to to quality testing.

[JanSz]

I am sorry wrong thread in a different post Dr. John said Jan should stop telling people to use this test for E2 < or = 29 and Jan still thinks it's a good test. I guess Dr. John needs to give us the range because the order number is the same and if our don't tell them they will send you this crap < or = 29 I can't find the thread it does not have a title about E2.

Phil;
one more time,
after Dr John said that (about my tests), he latter posted his list of tests, same (< or = 29 pg/mL)
-----------------------------------------------
Post where Dr John criticises my stuff, saying (Treating based upon them can lead to disaster.)
http://74.54.133.233/forum/showpost.php?p=655&postcount=5

I am using Estradiol, Free, LC/MS/MS (36169X)
Estradiol (Males (Adult): < or = 29 pg/mL)
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=41772N&SITE=4&SearchString=ESTR&tmradio=title
-----------------------------------------------
Dr John is using:
Estradiol (“ultrasensitive” assay only) #30289X
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=30289N&SITE=4&SearchString=ESTR&tmradio=title
Males: < or = 29 pg/mL
and
Estrogens, Fractionated, LC/MS/MS #36742X
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=5314N&SITE=4&SearchString=ESTR&tmradio=title
Part of it is
Estradiol, Ultrasensitive, LC/MS/MS
I am also using fractionated, Estradiol part is (or it should be) identical everywhere.
---------------------------------------------------------------------

Obviously, the range is (< or =29), the one I am using and the one hi is using.

[hardasnails1973]

Sure if your over 29 and this goes against doing a Sensitive test in the first place. If the dam test will not go lower then 29 what good is it.

ACtually the test is just saying <29 meaning 28.99999 I have had results of <2 meaning like 1.955555 it could be. It just means that its a lot more accurate i guess.

[pmgamer18]

Can you tell me how this test is of anygood to a guy like me I try to keep my E2 at 15 pg/ml this test does not tell you your this low it comes back saying < or = 29 what is so dam good about this. I am not using Quest anymore going back to my old lab so I am not worried about this mess.

Phil;
one more time,
after Dr John said that (about my tests), he latter posted his list of tests, same (< or = 29 pg/mL)
-----------------------------------------------
Post where Dr John criticises my stuff, saying (Treating based upon them can lead to disaster.)
http://74.54.133.233/forum/showpost.php?p=655&postcount=5

I am using Estradiol, Free, LC/MS/MS (36169X)
Estradiol (Males (Adult): < or = 29 pg/mL)
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=41772N&SITE=4&SearchString=ESTR&tmradio=title
-----------------------------------------------
Dr John is using:
Estradiol (“ultrasensitive” assay only) #30289X
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=30289N&SITE=4&SearchString=ESTR&tmradio=title
Males: < or = 29 pg/mL
and
Estrogens, Fractionated, LC/MS/MS #36742X
http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=5314N&SITE=4&SearchString=ESTR&tmradio=title
Part of it is
Estradiol, Ultrasensitive, LC/MS/MS
I am also using fractionated, Estradiol part is identical everywhere.
---------------------------------------------------------------------

Obviously, the range is (< or =29), the one I am using and the one hi is using.

[pmgamer18]

Here is what Dr. John said about your test.
=====================================
The bolded assays are not ultrasensitive, and so are not valid for adult males. Treating based upon them can lead to disaster.
=====================================
Now you saying and Dr. John never showed the range the his number is the same test as yours with a range of <or =29 Dr. John never said this range and was talking about it in the above. You are the one saying the range is the same where did you get this. Quest.

[JanSz]

Here is what Dr. John said about your test.
=====================================
The bolded assays are not ultrasensitive, and so are not valid for adult males. Treating based upon them can lead to disaster.
=====================================
Now you saying and Dr. John never showed the range the his number is the same test as yours with a range of <or =29 Dr. John never said this range and was talking about it in the above. You are the one saying the range is the same where did you get this. Quest.

Go to the links I have given, read, find ranges within text, find the test number.

I have given you link to Dr John's post where he says what tests he uses.
Find the same test number at Quest, will see what happens.

[pmgamer18]

They are down I am going to watch a move Ghost Rider talk to ya tomorrow.

Go to the links I have given, read, find ranges within text, find the test number.

I have given you link to Dr John's post where he says what tests he uses.
Find the same test number at Quest, will see what happens.

[moonman]

I called PA LABS, talked to some lady.

I asked her if they have an estradiol (e2) testt that is specifically for males.

She said she would have to go confirm it with someone "higher up".

Got back on and said yes our e2 test is for both males and females....

So I asked if it was the serum one, and she said yes.

Take it for what its worth lol

[JanSz]

They are down I am going to watch a move Ghost Rider talk to ya tomorrow.

Phil;
it is four day latter,

lets settle this simple mater.

Others are hesitating and are not sure what E2 tests to use.

[pmgamer18]

I opened them and put them side by side your say Free and Dr. John's says Ultrasensitive. Still the bottom line here is when quest sent me my results back 3 labs ago they sent me <or=29. My Estradiol was lower the 29 they did not say how low. My Dr. had them redo it and told them not to send this usless results again. When the test came back my E2 was 7 now I will ask again how is this test anygood to us if that only tell you your less the 29 but not how low.

When I first started getting my E2 checked my labs came back saying <20 to 50 pg/ml Dr. John said this is the wrong test it does not go lower then 20. This new test does not go lower the 29. What more can I say one on Arimidex needs to know if they are to low. I try to keep my E2 at 15 how does this test help me. When my Dr. talked the Quest and asked what is my true level they told him that ran the wrong test.

[hardasnails1973]

Different areas of the country send it off to different labs. When A guy in jersey asked for the test it can back 13-54 range whenI did it came back <29 but it had a number saying less then <2 which was representive of l.9599 is what it is really saying..and the urine test back this up as well too..

[JanSz]

I opened them and put them side by side your say Free and Dr. John's says Ultrasensitive. Still the bottom line here is when quest sent me my results back 3 labs ago they sent me <or=29. My Estradiol was lower the 29 they did not say how low. My Dr. had them redo it and told them not to send this usless results again. When the test came back my E2 was 7 now I will ask again how is this test anygood to us if that only tell you your less the 29 but not how low.

When I first started getting my E2 checked my labs came back saying <20 to 50 pg/ml Dr. John said this is the wrong test it does not go lower then 20. This new test does not go lower the 29. What more can I say one on Arimidex needs to know if they are to low. I try to keep my E2 at 15 how does this test help me. When my Dr. talked the Quest and asked what is my true level they told him that ran the wrong test.

I sympatize with your misgivings.
I have exactly the same misgivings, that is why I want to keep this topic discussed.
That is why I use

Estradiol, Free, LC/MS/MS (36169X)

http://cas2.questdiagnostics.com/scripts/webdos.wls?MGWLPN=QDCIAP20&wlapp=DOS&OrderCode=41772N&SITE=4&SearchString=ESTR&tmradio=title


This test contains what dr John is doing
but
it gives you more information so you know where you are.

Very similar situation one that:

someone would insist on
disregarding

SHBG
FreeT
BAT

and used only TotalT to figure out his T dosing.
I rather disregard TT (or not get overly excited about its level)
and put emphasis on

BAT
.
================================================== =============
Within the link above, I would like you to read this:

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.

[JanSz]

Different areas of the country send it off to different labs. When A guy in jersey asked for the test it can back 13-54 range whenI did it came back <29 but it had a number saying less then <2 which was representive of l.9599 is what it is really saying..and the urine test back this up as well too..

That is why I give a warning to have the tests specified exacly as I wrote them.
On a script, long hand by doctor or e-mail to doc and have it printed on his stationary and sign it.
Definitely not by using Quest's forms.

Then the test go to Nichols Institute (not a local lab) and (hopefully) is done right.
Also waiting time increases.

[pmgamer18]

If they have a range of 13 to 54 pg/ml and this is what I have been getting and if our lower then 13 they show the lower number.

If they would say <or=29 and if your number is lower then 29 and they give this number then that is Ok but this is not what they did and I am not the only one that had them do this.

Jan I don't dose my T meds by labs I go by how I feel been doing this for over 25 yrs. If I do a lab and it comes back over the top of the range for TT and FT we don't lower my dose because 6 weeks later the test comes back in range. If one is having a lot of stress or feeling sick from a cold you will use up your T levels and test lower. And the oppset is true.

I have talked to guys that read Shippens book and try to dose by a ratio for E2 to T and don't have any sex drive or morning and night time wood. All these lab numbers don't make you feel better. I would tell them forget the ratio go by how you feel. When I first read Shippens book I tried this and when the ratio was good I felt like crap on the test I felt good the ratio was way off.

Same thing for people that say if your E2 is very high lower your T dose sure this will lower your E2 in most cases but how are you going to feel. It's a small price to pay to have to take something to keep E2 down and have higher levels and feel good.