finally e2 ultrasenitive essay the truth..

[hardasnails1973]

First of all these "invalid " results are a bunch of horse crap. They stand as normal. Today I became really good freinds with the director the quest nichols institute in california. He was so intriqued by our convesations (over 2 hour long) that he may be intersted in coming to this forum.
The ultrasentive essay test uses mass spectrometer which isolates the estridial from a seas of surrogate estrogens (estriol, estrone, andriosteindione, ect) By running the less then 2 means its >1.6 but lower <2.4 so it is rounded to the nearest whole numbers. The (RAA )traditional essay of sensitive essay meant that other factor could be running shbg, and the sea of surrogate estrogens and androsteidiones could also have a greater impact on the results with a 20-30% devitaiton. With the new ultrasenitive the deviation is <5%. When dealing with breast cancer the whole idea is to get e2 lowest as possible this is reason they quest designed and bought the machines for a half million.

The <29 means that any where from 2 to < 29 is where males are symptom free from e2 side effects. I presented the question to him about guys on adex and are showing up <2 that if they are experiencing symptoms that they should back off a bit to see if there symptoms are alleviate. He totally concured. I presented the the idea a good range to shoot for would be the mid range to play safe 10-15 area? The lab director agreed that is an very conservative range. With the ultrasentive essay the impacy of shbg, thyroid, tesosterone has already been in the result you get from ultrasentive.
Also dr's that are dealing with thyroid, adrenal, liver issues should not run bio T, free,total , shbg together because the results will be have a huge deviation because the molecules are so similar that it may interfer with the specific hormone you are looking to target. People with thyroid, adrenal, liver issues run the free and total testosterons to get the most valid results.
If people are in the range of <29 and having issues then they are either psychosomatic or from other hormones being out of balance.

BTW like my self he is a very clincal person and mentioned that when guys approach the 500-600 midrange (NOT TROUGHT) is when the conversion of Testosterone to dht and estrogen start to increase significantly in relationship to testoserone. He has seen results of people at 10,000 ng/dl on blood test, He laughed when I mentioned that after going about 500-600 you are entering dark waters. He replied "thats a great way to put it mate" So seeing it from a person that sees thousands of labs on a monthly basis I hope this makes a person re-evaluate just what dosages are really doing. He said the average healthy 25-30 year old testosterone is between 400-500 not 600-700 like we all have been mis lead. Trust me we had a very intersting conversation and I learned a hell of alot from it as well.

[chilln]

First of all these "invalid " results are a bunch of horse crap. They stand as normal.


To you.



They stand as normal. Today I became really good freinds with the director the quest nichols institute in california. He was so intriqued by our convesations (over 2 hour long) that he may be interested in coming to this forum.


He's never going to be impartial. He's going to be a cheerleader. He has invested millions.

If you invested millions of your shareholders dollars, you would not be impartial.

We are not blinded by this absolutely critical fact.

We all work for our employers, we know what it takes to be the leaders in our respective organizations, and towing the line is absolutely mandatory, no deviations are tolerated.

That's why we rely on 3rd party researchers to write the reports which we read and discuss on this forum. And we first check (at least I do) to determine who funded the report, so that we know in which direction the results have been skewed - and then we know which "side" of the story we have been told.

The way that we get a comprehensive discussion, is to avoid "cheerleaders", and target input from several different pragmatic researchers, all with different perspectives on the same problem. Because we know we cannot get a full spectrum approach from any individual.



The ultrasentive essay test uses mass spectrometer which isolates the estridial from a seas of surrogate estrogens (estriol, estrone, andriosteindione, ect) By running the less then 2 means its >1.6 but lower <2.4 so it is rounded to the nearest whole numbers. The (RAA )traditional essay of sensitive essay meant that other factor could be running shbg, and the sea of surrogate estrogens and androsteidiones could also have a greater impact on the results with a 20-30% devitaiton. With the new ultrasenitive the deviation is <5%. When dealing with breast cancer the whole idea is to get e2 lowest as possible this is reason they quest designed and bought the machines for a half million.


He's not going to let you know the error percentage due to poor lab technique, or poor delivery technique, or poor collection technique. Or poor "other" (I'm not a lab dude, so I'm leaving this open).

That would require him to be impartial.

He's never going to be impartial. He's going to be a cheerleader. He has invested millions. As I stated earlier.




The <29 means that any where from 2 to < 29 is where males are symptom free from e2 side effects. I presented the question to him about guys on adex and are showing up <2 that if they are experiencing symptoms that they should back off a bit to see if there symptoms are alleviate. He totally concured.


When the <2 result is indeed correct, then this is indeed a self-evident solution to all of us.

The issue at hand is "how often is the result in error ?" And he's never going to tell us that. For the reasons I stated earlier.




I presented the the idea a good range to shoot for would be the mid range to play safe 10-15 area? The lab director agreed that is an very conservative range.


We're not trying to beat cancer. And higher levels of estradiol actually suppress osteoclasts from losing bone minerals. So I do not concur with 10-15 being safe.

I also do not believe this director is necessarily going to deliver to us optmum hormone management therapy.

I believe he is best suited to be the director of a pathology organization, not necessarily a hormone management therapy designer.

They are different skills - although they are related by the hormones and their levels.



With the ultrasentive essay the impacy of shbg, thyroid, tesosterone has already been in the result you get from ultrasentive.
Also dr's that are dealing with thyroid, adrenal, liver issues should not run bio T, free,total , shbg together because the results will be have a huge deviation because the molecules are so similar that it may interfer with the specific hormone you are looking to target. People with thyroid, adrenal, liver issues run the free and total testosterons to get the most valid results.


OK, when the E2 results are not in error.



If people are in the range of <29 and having issues then they are either psychosomatic or from other hormones being out of balance.


OK, when the E2 results are not in error, but not correct when the E2 results are in error.

[rick055]

We're not trying to beat cancer. And higher levels of estradiol actually suppress osteoclasts from losing bone minerals. So I do not concur with 10-15 being safe.


What is the generally accepted optimum range on the (correctly run) Ultrasensitive E2?

I agree with everything you state in reply. He has to champion the method and machine.

What I don't get is the statement about T/bioavail/SHBG not being accurate if they are run together. Does that mean all my past results are inaccurate??

[brandO]

He said the average healthy 25-30 year old testosterone is between 400-500 not 600-700 like we all have been mis lead.

its still sort of misleading.. only males who have low testosterone symptoms get testosterone tested..

why on earth would a healthy male having loads of sex get his T levels tested? i certainly would not..

but a young male who suffers from problems like myself get there testosterone levels tested..


even if a healthy male has 400-500, there BAT/FREE are probably near top range,

[hardasnails1973]

Because in a normal healthy male there are no other factors such as thyroid and adrenal imbalanacing effecting the lab results making appear low. Even the biggest natural bodybuilders testosterone is only at 550-600, but with not thyroid, estrogen, adrenal issue would result in higherfree T and bio T. When you have other factos involved then it make an impact. People with hashimotos should never run bio T, total t, free T, shbg together because the antibodies can offset the readings. He even mentioned that it is possible to even have testosterone antibodies and also androgen receptor resistance

The gold standard for people with liver, thyroid, adrenal issues is the free T and total testoserone with out the shbg, bio T

remember when you get a test script it just has those all together ..It does not stipulate which ones should be ran seperate. The free T and total T should be run on mass spectrumeter vs the RA due to the fact that the antibodies could interfer with the readings when ran on RA method. I have the lab test here that he gave me.

In stead of slamming me be thankful that I am in the positon to be able to get shed some light on the issue. Be glad that I took the freaken time and intiaitive to get the answers even though they may not be the ones you wanted to hear.

Even mariano revamped his theory on testosterone by lowering it from 650 down to 500. Because there's point of benefit to ratio once you start to pass these numbers. That is the point I am getting at. I am coming to conclusion that alot of men are over medicated on TRT because other factors are not addressed along with it like they it should be. higher numbers cause other hormones to get out of balance and basically what he was saying once you got into the 700 to 800 is where you start to see these imbalances occuring in a clincal setting.

Mayoclinic even had to revamp their methods because they where getting false reading on cancer paitients which were 3 times the high end of normal, but there machines had to be recalibrate due to the new technology that quest has.

Trust me just for shits and giggles I am sure he be glad to come on here and explain things to clear up specific questions you may have.

[hardasnails1973]

What is the generally accepted optimum range on the (correctly run) Ultrasensitive E2?

I agree with everything you state in reply. He has to champion the method and machine.

What I don't get is the statement about T/bioavail/SHBG not being accurate if they are run together. Does that mean all my past results are inaccurate??

if your thyroid and adrenals, liver are healthy then it is not an issue.

[MarkLA]

HAN,

Thanks for the legwork and getting this posted. While there may be differences of opinion, I believe each bit of information helps move us forward.

Mark

[researchin]

he was saying once you got into the 700 to 800 is where you start to see these imbalances occuring in a clincal setting.
.

Now, can this just be fought with aromatase inhibitors ?

Or the person's going to need growth hormone as well, to match the super high Testosterone?

[hardasnails1973]

if need be armidex is added but goal of TRT is to feel good on the less possible meds. Trust me you may be disagreeing with me now, but many people have really considered what I have said and came down in dosage (consulted their dr and I am sure he had no problem with it) feel better, and have reduced other medicines or stoped meds that were offsetting benefit to ratio. Do remember there are alot of variables to take into consideration so it is by individual case.. Prgmmer is starting to realize this with thyroid. Males should be in the mid range give or take a few provided that they do not have any other factors affecting the thyroid function. Keeping it in mid range also does not stress adrenals making adrenal fatigue easier recovery. ITs all about balance. For example one person may for some reason have a genetic low testosterone, but is super muscular, prefer like a wildman in bed, have erections that are just insane. In this case they most likely have androgen receptors hypersensity. This is where bioindividuality comes into play and why people can walk around on 300 T and be a stud. People that androgen receptros insensitive need more testoserone because other things are binding it up or have some kind of receptor resistance. Trust me when you think you got one thing figured our there are other avenues starting to open up.
One possibilty for these hypometabolizer could be testosterone antibodies or receptor insensitity which are rare, but can occur. Just in the past week I have learned more then I have learned in past 6 months.

[chilln]

What is the generally accepted optimum range on the (correctly run) Ultrasensitive E2?


It's the value around E2=30 which doesn't result in too frequent ED (erectile dysfunction)

You want E2 to be relatively as high as you can tolerate so that your joints and bones remain as strong as possible.

The lower the E2, then more your bones and joints will lose minerals and lose strength.



What I don't get is the statement about T/bioavail/SHBG not being accurate if they are run together. Does that mean all my past results are inaccurate?


The statement is that you should not run T total and T free and SHBG together with T bioavailable.

You should run T total and SHBG and T bioavailable together, without T free. We run SHBG to help us understand how our serum E2 and T (total) values differ from our urinary T and E2 (free) values.

We don't place any more faith in measuring serum T free because we now understand that T bioavailable is the metric which more closely matches our theoretical understanding of biological health.

In the past we though the T free metric most closely matched our understanding of health, but there were too many discrepancies due to the variations in our SHBG-to-albumin ratio.

[chilln]

I put your comments into an order consistent with their common topics.



Even Marianco revamped his theory on testosterone by lowering it from 650 down to 500. Because there's point of benefit to ratio once you start to pass these numbers. That is the point I am getting at. I am coming to conclusion that alot of men are over medicated on TRT because other factors are not addressed along with it like they it should be. higher numbers cause other hormones to get out of balance and basically what he was saying once you got into the 700 to 800 is where you start to see these imbalances occuring in a clincal setting.


I corrected your spelling of Marianco's name.

...and...



Even the biggest natural bodybuilders testosterone is only at 550-600, but with not thyroid, estrogen, adrenal issue would result in higherfree T and bio T.


OK. But Marianco's recommendation is based on someone with naturally high levels of GH (growth hormone) - and I bet these so called "natural" body builders also have very high levels of growth hormones.

And that's the ultimate kicker for all of us aging males, or subclinical-hypopituitary males.

Our GH has tanked. Bummer, but you can't overlook it. You must confront this nasty reality head on.

We only have two hormones which initiate repairs. GH and T. If someone doesn't have very high GH, then that person will have to either:

a) boost their GH and boost their total T to around 500, and boost their bioavailable T as a result
or
b) max our their T to compensate for their lack of GH.

And that's the fundamental reason why males who are not boosting their GH, really only feel good on very high levels of total T and bioavailable T.

Most of us males who are not boosting GH, start out targeting some or other value of total T (whether it's 300 or 900 ng/dL who cares) but in the end we stabilize on the value which "heals" us (whether that's 300ng/dL or 1100 ng/dL, or anything in-between).

So there's no point recommending some sort of target numerical value, other than to ask someone to keep it under 1100 ng/dL.

The final value we arrive at is the one which is the sum of all of the compromises we have had to make along the way - such as not boosting GH, and boosting T to compensate.

That's life, and we need to respect that.




remember when you get a test script it just has those all together ..It does not stipulate which ones should be ran seperate.

The free T and total T should be run on mass spectrumeter vs the RA due to the fact that the antibodies could interfer with the readings when ran on RA method. I have the lab test here that he gave me.


I recommend we never bother with free T. For the reasons I mentioned in my response to rick055 above.




In stead of slamming me be thankful that I am in the positon to be able to get shed some light on the issue. Be glad that I took the freaken time and intiaitive to get the answers even though they may not be the ones you wanted to hear.


I doubt anyone could slam you HAN, and if they did they wouldn't live to tell the tale.



Mayoclinic even had to revamp their methods because they where getting false reading on cancer paitients which were 3 times the high end of normal, but there machines had to be recalibrate due to the new technology that quest has.


I can't speak for cancer patients, but I know that many of our members know how to corroborate their serum E2 values to:
a) no aromatase inhibitor
and/or
b) previous ultrasensitive E2 measurements all showed much higher E2
and/or
c) urinary E2 shows medium or high E2

...and when these members get a serum E2 = "<2", when all the indicators suggest high E2, then I most frequently go with the circumstantial evidence, and the serum result of E2 = "<2" is in error.




Trust me just for shits and giggles I am sure he be glad to come on here and explain things to clear up specific questions you may have.


So long as we never discuss accuracy, I agree that a discussion with this person would be beneficial.

We already know in advance that this person will never discuss the inaccuracies of the ultrasensitive E2 test honestly on this public forum.

Only Dr Crisler would have the opportunity to participate in an honest discussion re any inaccuracies with the Quest director.

And I also believe that any such discussions re accuracy would be entirely off-the-record.

###

One of the critical issues we must uncover on our own, is how frequently those E2 "<2" results appear, and then we should determine whether those E2 results go against the correlated evidence, and then we can decide whether to vote with our feet.

We are too "street-wise" to trust any discussion re the accuracy of Quest testing coming from the mouth of a director of Quest, and issued on any public forum.

We've already got enough members who know in their heart that their E2 = "<2" was in error.

Ie: I'm referring to those of our members who experienced their E2 = "<2" result, and then correlated that result against the following:
a) no aromatase inhibitor
and/or
b) previous ultrasensitive E2 measurements all showed much higher E2
and/or
c) urinary E2 shows medium or high E2

[crazycrew]

HAN,

Thanks for the legwork and getting this posted. While there may be differences of opinion, I believe each bit of information helps move us forward.

Mark
Dido---- This could turn into an informative thread indead if the Quest man isn't too intimidated by the knowledgeble people here.

If the normal "is between 400-500 not 600-700 like we all have been mis lead." Why do their tests have such a high end range for normal? If 700 is not normal then the medical community should say so.

[pmgamer18]

As to the range one should have for there TY levels some men do good at 600. I for one did not using Androgen G's my levels were 600. My joints and muscles hurt so bad I was house bound for yrs.

Going to shots and getting my labs up into the 800's my pain was gone. I am not the only one that had this problem there are a lot of men at the H2 forum with this same problem.

Some men don't support there joints and muscles with lower numbers. Before all of this with labs yrs. ago we did good by going on how we feel. Don't waste your health trying to reach numbers from labs they are just a tool go by how you feel.

[researchin]

As to the range one should have for there TY levels some men do good at 600. I for one did not using Androgen G's my levels were 600. My joints and muscles hurt so bad I was house bound for yrs.

Going to shots and getting my labs up into the 800's my pain was gone. I am not the only one that had this problem there are a lot of men at the H2 forum with this same problem.

Some men don't support there joints and muscles with lower numbers. Before all of this with labs yrs. ago we did good by going on how we feel. Don't waste your health trying to reach numbers from labs they are just a tool go by how you feel.

then my question is how high was your growth hormone during this ?

Is it possible it's the healing factor, you raised your T to make up for lack of GH?

[hardasnails1973]

Take home message
1. Dr explained the difference of ultrasensitive vs sensitive essay -
ultrasensitive is not affected by other variables (shhg, thyroid antibodies, androstendiones, estrones, ect) The sensitive essay could have picked up trace amounts of these effecting the results by a great margin

2. The orginality of the ultrasentive test was not for male in the first place, but breat cancer patients on suppression therapy.

3. <2 is not an error, but an indication that there is estrodial there but it is not defieinct. A large proportion of males not on TRT are testing <2 and are perfectly fine. For guys on TRT and on adex recieving <2 readings and are experiencing low e2 symptoms then with Dr's permission they may reduce armidex and come up to a higher number 3, or 4

4. In clincal studies it was shown that males with in the <2-<29 range did not expereince any gynocomastia, or other estrodial related symptoms. These may not relate to people on TRT when other variables are taken in consideratoin

5. To get an accuarte reading on people with thyroid issue (graves, hashimotios, liver dysfunction, adrenal insufficency) then the free and total need to be ran together not combined with shbg, bio T as these factors could give increase degree of inaccuracy. If you are a normal male no hormone issue then ran all together would be acceptable. The point that he is making is when ran through the max spectrometer vs the normal RA there would be less then a <5% deviation because the machine could total isolate just testoserone with out other things affecting it.

6. Symptoms should be taken in consideration not lab results, but the most accurate forms of testing can be used as a diagnostic tool. The experience of your practioner will be the biggest contributing factor.

7. Clincal evidence has shown that once peoples males testosterone get above the 600-700 ratio the increase of estrodial and DHT in relationship to testosterone is significantly increased. Above 800-900 in then there is some suppementation that they are using to manipulate their levels. Above 1100 then it would be need to ruled out a testosterone secreting tumor.

[tommytuna]

5. To get an accuarte reading on people with thyroid issue (graves, hashimotios, liver dysfunction, adrenal insufficency) then the free and total need to be ran together not combined with shbg, bio T as these factors could give increase degree of inaccuracy. If you are a normal male no hormone issue then ran all together would be acceptable. The point that he is making is when ran through the max spectrometer vs the normal RA there would be less then a <5 deviation because the machine could total isolate just testoserone with out other things affecting it.



OK .. . this sounds like a bunch of wishy washy excuses to account for lab errors. If this is truly the case, wouldn't the lab publish this information so Dr.'s would be aware the tests need to be run seperately? Wouldn't this result in more money in the lab's pockets since more frequent testing would need to be performed? I guess I am just skeptical.

[hardasnails1973]

First question I asked
They do publish it and only endos are trained in it. Also how many endos do complete thyroid and adrenal evaluations? NONE that I know of even check for antibodies unless they are asked. Let take this a step further as technology increases so does the degree of accuracy. This technology has only been around a very short time and we have to understand the main reason this machine was designed was for cancer not male hormone issues. Am I not making excuses for them. I am just presenting the facts. Also if you look at labcorp testing results they are now coming back with 2 different readings. One with total and free test the other with bio T and total T with out shbg. So obviously there is a direct correlation to what he has been saying.

In the world of lab specialist's clincal evidencee will over rule anedoctal information, but its the experience of the DR that will make the appropriate choice of treatment. Believe me when I heard some of these "Top Dr's" treatment protocols I just started laughing.

One of the best ones was a dr from an extremley well known university had a person on clomid and since his total estrogens where elevated started them on adex at 1 mg a day for 6 months and never retest them over the whole time.

Best way to best an appointment really quick with a specialist tell them you went to a foreign country trust me their will be no waiting peroid to get in.

[rick055]

It's the value around E2=30 which doesn't result in too frequent ED (erectile dysfunction)


But the top range of the scale is 29. Or am I missing something?

[JanSz]

First of all these "invalid " results are a bunch of horse crap. They stand as normal. Today I became really good freinds with the director the quest nichols institute in california. He was so intriqued by our convesations (over 2 hour long) that he may be intersted in coming to this forum.


Doing good job HAN, thank you.

I will put aside all claims that you have made so far on the E2 topic, and am hoping that this director from Nichols Institute will write a position paper or technical guidelines or useage guideliness for E2 and other of his tests and make it available to us.

It would be nice if he could join us on this board.
It would be even better if in his first post he could give us some run down on where his tests are applicable and where they should not be used.

Btw, I think that close to 100% of people have some thyroid problems when they start looking closely at it. We would need detailed guidelines on tests applicability.
----------------------------------------------------------------------

Speaking of estradiol I think that the situation is a mirror image of testosterone.
TotalTestosterone -----> E2
FreeTestosterone-------> FreeEstradiol
BioAvailableTestosterone----->BioAvailableEstrodial

Problem that we have is availablility of reliable tests.

Quest Diagnostics made attempt at this and they have available test:
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

I had conversation with Dr John in the past, about this test.
At the time Dr John was against all other estradiol tests axcept for:
Estradiol, Ultrasensitive, LC/MS/MS (30289X) - (30289N)

Possibly it is a time to revisit this subject.

Urine E2 test is a good indicator of FreeE2

Rhein test, when testing E2 shows range starting at zero.
I am not comfortable with that, even after I got some explanation from Dr John why it is so. Therefore I am not comforatble with the rest of this.

When similar urine test is done by
Meridian Valley Laboratory (Jonathan V. Wright M.D)
they have a range for E2 with upper and low number for a range.
At least off hand it makes me feel better.

http://musclechatroom.com/forum/showthread.php?t=3199
Estradiol: (0.8-4.6)

http://www.meridianvalleylab.com/steroid_hormone-interpretation.html#dhea
================================================== ========

Many of our E2 problems surfaced because of weekly schedule for testosterone injections.
7 days is a terribly long time and testsoterone, e2 and other hormones vary widely within that time span.

OTOH this may be only measuremet problem, not a health problem.

As a analogy, AC (alternating current) goes thru zero 60x over each second but we still have 110V in the wall socket.



-------------------------------
.
.

[rick055]

@HAN

Nobody's slamming you buddy and good job for taking the initiative to call the lab director.

But, as is my right, I remain skeptical that all of the <2 results are valid.

As Reagan said, "Trust, but verify." As a matter of course, I am going to discount the opinion of someone with a vested interest.

This doesn't mean the conversation isn't useful or you didn't provide relevant information.

[hardasnails1973]

It has been roughly estimated that 20% or more of the clincal test are showing up <2 in general population.

e=30 is with the RA method is not the same as the Mass spectrometer (<29) reading

<29 = >28.6 and <29.4
Some people feel fine above <29 it really person dependent.

[chilln]

But the top range of the scale is 29. Or am I missing something?


The top of the range is much higher than 29.

Quest's recommendation for males is that E2 be less than 29.

[rick055]

The top of the range is much higher than 29.

Quest's recommendation for males is that E2 be less than 29.

ahhh...so, in this case Quest is, in a sense, defining the optimal range with anything less than 29 being acceptable.

[chilln]

It has been roughly estimated that 20% or more of the clincal test are showing up <2 in general population.


These would be mostly HRT patients taking an aromatase inhibitor, or bodybuilders taking an aromatase inhibitor, or women taking an aromatase inhibitor - or they would be erroneous results. Ie: they are not the "general population".




e=30 is with the RA method is not the same as the Mass spectrometer (<29) reading


I suspect you're referring to my statement "try to get E2 as close to 30" - or responses to that same statement.

My recommandation for E="as close to 30 as you can get without experiencing too much ED and gyno symptoms" is based on the Quest ultra sensitive test, not the older female-only RIA test.

My recommendation is not a target number. My recommendation is a dual concept:

a) get E2 as close to 30 as you can, on the Quest Ultrasensitive E2 test

...and

b) determine how close you get to 30, by monitoring your ED and gyno tendencies, and then back off your E2 when those symptoms become a problem.





Some people feel fine above <29 it really person dependent.


And that's critical that we always advertise this, rather than only occasionally.

[pmgamer18]

At the time we did not know I am Secondary and were not checking GH. I can tell you when something is off your GH takes a hit first trying to fix whats wrong. Today my IGF-1 is good.

then my question is how high was your growth hormone during this ?

Is it possible it's the healing factor, you raised your T to make up for lack of GH?

[chilln]

Take home messages

1. Dr explained the difference of ultrasensitive vs sensitive essay -
ultrasensitive is not affected by other variables (shhg, thyroid antibodies, androstendiones, estrones, ect) The sensitive essay could have picked up trace amounts of these effecting the results by a great margin

2. The orginality of the ultrasentive test was not for male in the first place, but breat cancer patients on suppression therapy.


OK



3. <2 is not an error, but an indication that there is estrodial there but it is not defieinct. A large proportion of males not on TRT are testing <2 and are perfectly fine. For guys on TRT and on adex recieving <2 readings and are experiencing low e2 symptoms then with Dr's permission they may reduce armidex and come up to a higher number 3, or 4


I believe there's a high percentage of errors in there, and Quest haven't yet woken up.

I can't say "how" high - only that it's "too high" for our members.

Perhaps there's too much cheerleading going on at Quest, or perhaps its like their Vitamin D lab measurement inaccuracies - where they had to do a "recall" and invite patients to have their Vit D levels retested.

But we'll never learn about this in a public forum discussion, with a Quest Director.




4. In clincal studies it was shown that males with in the <2-<29 range did not expereince any gynocomastia, or other estrodial related symptoms. These may not relate to people on TRT when other variables are taken in consideratoin


OK.




5. To get an accuarte reading on people with thyroid issue (graves, hashimotios, liver dysfunction, adrenal insufficency) then the free and total need to be ran together not combined with shbg, bio T as these factors could give increase degree of inaccuracy. If you are a normal male no hormone issue then ran all together would be acceptable. The point that he is making is when ran through the max spectrometer vs the normal RA there would be less then a <5% deviation because the machine could total isolate just testoserone with out other things affecting it.


My understanding is that for each and every single lab test, a small portion of the vacutainer sample is used.

And the small portion of the vacutainer which is tested for "total T" is not re-used in any other test (such as SHBG).

Therefore the tests are run from separate samples (ie: separate components of the same vacutainer) and not re-used in any other tests on the same lab requesition.




6. Symptoms should be taken in consideration not lab results, but the most accurate forms of testing can be used as a diagnostic tool. The experience of your practioner will be the biggest contributing factor.

7. Clincal evidence has shown that once peoples males testosterone get above the 600-700 ratio the increase of estrodial and DHT in relationship to testosterone is significantly increased. Above 800-900 in then there is some suppementation that they are using to manipulate their levels. Above 1100 then it would be need to ruled out a testosterone secreting tumor.

OK

########

These are critical discussion points, and thanks for airing them here.

########

But you missed the most critical point re accuracy - which is actually where you started, in your first post

1) Since Quest refuse to accept that E2=<2 could be an error, therefore we will never get our money back when E2=<2 and when corroborative evidence from other aspects confirms that E2 should be higher than "<2".

2) It's very difficult to convince many medical professional advisers who are new to male HRT, to switch from the old female-only E2 test to the new Ultrasensitive E2 test.

3) Even when some of us do manage to finally convince a medical professional adviser to go with the new Ultrasensitive E2 test, there seem to be too many incidences where E2=<2, and the medical professional adviser's intuition and training suggest that E2 should be higher than "<2".

4) In this nasty circumstance (not too rare) we as patients lose credibility with our medical professional advisers.

5) HOWEVER if we were armed with the stats as to how often to expect an erroneous result - or if we were armed with the knowledge that only Quest's "EZ" lab issues erroneous results - then we would pass this on to our medical professional adviser - and that would most likely tip the scales to the point where we would be prepared to recommend the Quest ultra sensitive test to our medical professional advisers who are not yet using this test for E2.

[dano79]

He said the average healthy 25-30 year old testosterone is between 400-500 not 600-700 like we all have been mis lead. Trust me we had a very intersting conversation and I learned a hell of alot from it as well.

This statement is really thrown me off. I agree that not everyone needs super high levels of testosterone, but EVERYWHERE I have seen or talked to have said that 650 is the average testosterone level for this age group. I would assume that this number comes from credited research mapping out averages on a standard deviation bell curve.

If we take it that 400-500 as the normal average. That means someone in the 600 ranges is one standard deviation from what is considered normal and a score like 650 would be considered high for the average individual. If someone has a level in the 800 range (per the current testing range) that would be considered super-physiologic. (theoretically)

How does that make sense if the average testosterone level is 450 (instead of 650) a drop of 150 points would bottom you out, but 150 more you are still in the normal range on quest, even 300 points more is still considered normal. The statistical bell curve can't be accurate here.

[chilln]

At the time we did not know I am Secondary and were not checking GH. I can tell you when something is off your GH takes a hit first trying to fix whats wrong. Today my IGF-1 is good.

But have you confirmed this with a urinary GH ?

My IGF-1 is at 75% of the maximum range, but my urinary GH is below the minimum of the range.

That's most likely because my IGF-1 is bound to too much IGFBP-1, and / or IGFBP-2, and / or IGFBP-3, making my free IGF-1 actually below the bottom of the reference range - just like my urinary GH.

But neither I nor my medical professional adviser could be bothered measuring my IGFBP-1, IGFBP-2, and IGFBP-3, only to prove what's self-evident.

###

If you have not yet validated that your IGF-1 measurements are consistent to your urinary GH, then I recommend you do so, before you commit to believing that your GH is fine.

[chilln]

This statement is really thrown me off. I agree that not everyone needs super high levels of testosterone, but EVERYWHERE I have seen or talked to have said that 650 is the average testosterone level for this age group. I would assume that this number comes from credited research mapping out averages on a standard deviation bell curve.

If we take it that 400-500 as the normal average. That means someone in the 600 ranges is one standard deviation from what is considered normal and a score like 650 would be considered high for the average individual. If someone has a level in the 800 range (per the current testing range) that would be considered super-physiologic. (theoretically)

How does that make sense if the average testosterone level is 450 (instead of 650) a drop of 150 points would bottom you out, but 150 more you are still in the normal range on quest, even 300 points more is still considered normal. The statistical bell curve can't be accurate here.


I recommend taking a more broader perspective than targeting a number.

If your GH (growth hormone) is high, as measured via urinary GH, not IGF-1, then OK fine, target lower levels of T (testosterone).

But if your GH is not high, then you will need more T to heal yourself 100% (or as close as possible) overnight.

But this has diverted off the E2 measurement topic.

If you want to know what level of T you should take, then please start a new thread.

[dano79]

I recommend taking a more broader perspective than targeting a number.

If your GH (growth hormone) is high, as measured via urinary GH, not IGF-1, then OK fine, target lower levels of T (testosterone).

But if your GH is not high, then you will need more T to heal yourself 100% (or as close as possible) overnight.

But this has diverted off the E2 measurement topic.

If you want to know what level of T you should take, then please start a new thread.

Sorry Chillin,
I thought this was related to HAN's comments that the Quest director made. This is not about my testosterone levels, this is about the statement of what the Quest director considered normal

[chilln]

Sorry Chillin,
I thought this was related to HAN's comments that the Quest director made. This is not about my testosterone levels, this is about the statement of what the Quest director considered normal


No stress.

I don't mind your short diversion into T level targeting, but the Quest director is not here to explain himself, so if you want to address the Quest Director's view, then you should ask HAN, in this thread, to setup a discussion with the Quest Director to discuss that view (which should be done in another thread - clean slate so to sleak)

But we must be careful to avoid discussion re his opinion re errors in the Quest Ultrasensitive E2 testing - we know he'll cover up any issues there.

###

There's even a more broader argument as to why we can technically discuss all hormones in any post, in any thread.

ie: since all hormones are related to each other by direct and indirect feedback mechanisms, therefore whenever anyone discusses the effects of one hormone on another hormone, the entire field of hormones is open to discussion.

But I see the main crux of this thread as relating to E2 measurement technology.

So I'll try to bring discussions back to this point as best as possible.

[hardasnails1973]

I know of several natural proBB that are drug free no prohormones ever used and tested in the 500-600 range, but have optimal levels of other hormones igf-1, thyroid, adrenals, ect. So if all other system are in check then 450-550 is well respectable number. As mentioned before androgen receptor sensitivity is also a factor that needs to be examed. People that are in 300 serum ranges and are extremely lean muscular, have incredible sex, can put on muscle with ease probably have incredible androgen receptor sensitivity. I believe that ever one has a genetic thermastat where they have a sweet spot. Once they go out of this sweet spot other hormones will get knocked out of balance.

[JanSz]

I know of several natural proBB that are drug free no prohormones ever used and tested in the 500-600 range, but have optimal levels of other hormones igf-1, thyroid, adrenals, ect. So if all other system are in check then 450-550 is well respectable number. As mentioned before androgen receptor sensitivity is also a factor that needs to be examed. People that are in 300 serum ranges and are extremely lean muscular, have incredible sex, can put on muscle with ease probably have incredible androgen receptor sensitivity. I believe that ever one has a genetic thermastat where they have a sweet spot. Once they go out of this sweet spot other hormones will get knocked out of balance.


I you say that some person have TT(500-600) or (450-500) and is happy and succesfull, I would guess that hi have low SHBG, but I would not advice his TT level to everybody.

.
.

[dano79]

This also further proves the point one should not judge there health solely by a number on a stinking lab report.

[hardasnails1973]

Please refer to point number 6

6. Symptoms should be taken in consideration not lab results, but the most accurate forms of testing can be used as a diagnostic tool. The experience of your practioner will be the biggest contributing factor.

[hardasnails1973]

I you say that some person have TT(500-600) or (450-500) and is happy and succesfull, I would guess that hi have low SHBG, but I would not advice his TT level to everybody.

.
.

Ok riddler answer me this
Explained why highly trained professional boxers, foot ball players testosterone are in low 300's taken first thing in the morning. They function fine and are extremely lean and muscular.

[chilln]

I know of several natural proBB that are drug free no prohormones ever used and tested in the 500-600 range, but have optimal levels of other hormones igf-1, thyroid, adrenals, ect. So if all other system are in check then 450-550 is well respectable number. As mentioned before androgen receptor sensitivity is also a factor that needs to be examed. People that are in 300 serum ranges and are extremely lean muscular, have incredible sex, can put on muscle with ease probably have incredible androgen receptor sensitivity. I believe that ever one has a genetic thermastat where they have a sweet spot. Once they go out of this sweet spot other hormones will get knocked out of balance.


I see you've given up pursuing the issue of erroneous E2=<2 results, and you prefer to discuss T number targets.

I take from this that you either:

a) prefer to believe the Quest Director's view, that all E2<2 results are 100% accurate, but you are not able to make a strong case for his position, here on this forum

or

b) you recognize that the Quest Director's view, that all E2<2 results are 100% accurate, is factually incorrect, but you're not prepared to state this publicly for fear of jeopardizing your relationship with this Quest Director.

Either way, I assume this discussion is closed from your perspective, and since this is your thread, therefore I will stop pursuing you any further on this issue.

####

Re the T targets, look to GH, not so much T receptors, to improve overall health.

The GH hormone is a much more powerful trigger of repairs than T will ever be.

Children with huge GH levels and low T levels are practically indestructible.

In other words, GH levels will far outweigh T receptor sensitivity, as the driving force behind human body repairs.

###

However, when it comes to libido issues, T and E2 are more powerful drivers than GH ever will be.

ie: children with massive GH levels have nowhere near the libido of testosterone loaded teenagers and adult males.

[hardasnails1973]

Sorry but I do not kiss any ones ass.

The lab director took the time to explain the difference between the 2 tests.

There could always be an error no machine or test is 100% perfect.

Could <2 be an accurate reading YES
Could <2 be a potential lab error yes

Depends on the person individual case and what factors could be influencing it.

[JanSz]

Ok riddler answer me this
Explained why highly trained professional boxers, foot ball players testosterone are in low 300's taken first thing in the morning. They function fine and are extremely lean and muscular.

Many of them probably have low SHBG, they are able to process available testosterone very quickly.
I would expect that they have a lot of testosterone and testosterone by-products in their urine.

By looking only at urine it may be difficult to distinguish them from (sick) hypermetabolizers.

Check around, let me know.

.
.

[JanSz]

Sorry but I do not kiss any ones ass.

The lab director took the time to explain the difference between the 2 tests.

There could always be an error no machine or test is 100% perfect.

Could <2 be an accurate reading YES
Could <2 be a potential lab error yes

Depends on the person individual case and what factors could be influencing it.

Just to be clear,
we are back to square #1 on E2<2 issue.

But HAN, thank you for trying
==================================================

I think:

E<2 in those that feel bad and are loosing bones is correct value

E<2 in those that feel real good is

either
good value, but they are on weekly schedule and their E2 vary from day to day and blood draw happened on a low day

or
E<2 is wrong, study similar to the kind 00slotiv did would help to find out if particular E2 test is good or bad.

.
.

[pmgamer18]

No nothing down with urinary GH but the Heart Dr. feels my problem with my heart was due to low GH when I see him next month I will ask him to test this. Can't get my Dr. to do urine tests he feels they are only good for a few things. Even when we have a dam good Dr. you still only can get them to do so much.

But have you confirmed this with a urinary GH ?

My IGF-1 is at 75% of the maximum range, but my urinary GH is below the minimum of the range.

That's most likely because my IGF-1 is bound to too much IGFBP-1, and / or IGFBP-2, and / or IGFBP-3, making my free IGF-1 actually below the bottom of the reference range - just like my urinary GH.

But neither I nor my medical professional adviser could be bothered measuring my IGFBP-1, IGFBP-2, and IGFBP-3, only to prove what's self-evident.

###

If you have not yet validated that your IGF-1 measurements are consistent to your urinary GH, then I recommend you do so, before you commit to believing that your GH is fine.

[rick055]

Ok riddler answer me this
Explained why highly trained professional boxers, foot ball players testosterone are in low 300's taken first thing in the morning. They function fine and are extremely lean and muscular.

First, the kind of stress they're under could easily lower T levels.

Second, were these professional drug tests? IE, something they had to "pass"?

Third, wouldn't it make intuitive sense that this specific subset of athletes may have had some endocrine disruption?

[Wise Guy]

First, the kind of stress they're under could easily lower T levels.

Second, were these professional drug tests? IE, something they had to "pass"?

Third, wouldn't it make intuitive sense that this specific subset of athletes may have had some endocrine disruption?

Athletes always seem to measure low in T levels.

Doesn't mean their actual T levels are low, quite the opposite actually. Due to the frequent traiing they do, interesting things begin to happen.

"Kraemer noted that the athletes' blood levels of Testosterone plummeted after a workout. While that initially sounds like a bad thing, it's not. Instead, it shows that something good happened.

Since the "roads" (blood vessels) had less Testosterone flowing through them, it meant that Testosterone had pulled off the road and "parked" in the new Testosterone receptors found on the user's muscle.

Since there were more parking spots for Testosterone to park, it leads to more protein synthesis, which literally means more muscle.

Furthermore, the temporarily low level of free Testosterone in the blood stream tells the brain (the pituitary-gonadal axis), through negative feedback, that it needs to start producing even more Testosterone."

. Kraemer, William J. et al. Androgenic Responses to Resistance Exercise: Effects of Feeding and L-Carnitine. Med Sci Sports Exerc. Vol. 38, No. 7, pp. 1288-96.

[rick055]

Athletes always seem to measure low in T levels.

Doesn't mean their actual T levels are low, quite the opposite actually. Due to the frequent traiing they do, interesting things begin to happen.

"Kraemer noted that the athletes' blood levels of Testosterone plummeted after a workout. While that initially sounds like a bad thing, it's not. Instead, it shows that something good happened.

Since the "roads" (blood vessels) had less Testosterone flowing through them, it meant that Testosterone had pulled off the road and "parked" in the new Testosterone receptors found on the user's muscle.

Since there were more parking spots for Testosterone to park, it leads to more protein synthesis, which literally means more muscle.

Furthermore, the temporarily low level of free Testosterone in the blood stream tells the brain (the pituitary-gonadal axis), through negative feedback, that it needs to start producing even more Testosterone."

. Kraemer, William J. et al. Androgenic Responses to Resistance Exercise: Effects of Feeding and L-Carnitine. Med Sci Sports Exerc. Vol. 38, No. 7, pp. 1288-96.

Makes sense.

SERUM T lower, intramuscular T higher.

[JanSz]

Athletes always seem to measure low in T levels.

Doesn't mean their actual T levels are low, quite the opposite actually. Due to the frequent traiing they do, interesting things begin to happen.

"Kraemer noted that the athletes' blood levels of Testosterone plummeted after a workout. While that initially sounds like a bad thing, it's not. Instead, it shows that something good happened.

Since the "roads" (blood vessels) had less Testosterone flowing through them, it meant that Testosterone had pulled off the road and "parked" in the new Testosterone receptors found on the user's muscle.

Since there were more parking spots for Testosterone to park, it leads to more protein synthesis, which literally means more muscle.

Furthermore, the temporarily low level of free Testosterone in the blood stream tells the brain (the pituitary-gonadal axis), through negative feedback, that it needs to start producing even more Testosterone."

. Kraemer, William J. et al. Androgenic Responses to Resistance Exercise: Effects of Feeding and L-Carnitine. Med Sci Sports Exerc. Vol. 38, No. 7, pp. 1288-96.

Yes,
----------------------------------------
is there a way to measure how much total test (daily) was produced by testis?

Answering (partly) my own question,
we probably should sum testosterone and some of the metabolites present 24hr urine sample.
I just do not know which ones.

This sum is most likely an important indicator that we have not discussed as of yet.

It may be a good guage for those of us who use supplemental testosterone.

.
.