Orgasm, babies, puppies and other huggy and bonding events involve a release of prolactin which could affect your prolactin lab work. Note that prolactin release at orgasm is one of the primary reasons that men have a period of time after orgasm where sexual activity cannot happen. There is some study data somewhere that shows that holding a baby increases a man’s prolactin.
The quest diagnostics sensitive (4021x) is not available, what test should I use Estradiol or Estradiol Ultra sensitive? My guess is they combined the sensitive with one and not sure how to tell which one.
sorry- moved to own thread.
Kingsix, you’ll need to start your own thread so we can track your case in one thread. I’m a newbie, too, and I noticed the guys here don’t like it when you post about your own situation in the stickies or start different threads about your own situation. Also, read up on the stickies.
if someone is on weekly injections yes i read the protocol :). when would you suggest lab work be taken? end of week?
I suggest 1/2 between injections as that number will be more representative of your overall T levels.
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I have been getting the Ultrasensitive test (range <29) 30289 for E2 and just saw that KSman stated “For TRT, use the basic LabCorp serum E2 test or Quest Sensitive 4021x. DO NOT USE Quest ULTRASENTIVE! There are some similar issues with other testing labs as well.”. When I look up 4021x http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=4021 it states that the range is <39.
I realize others have posted on this, but could not find a definitive answer if this new version is a solid test. I am meeting with my doctor in the morning. Does anyone know if this is a reliable E2 test from Quest? If not, which is the best test? I am with Kaiser and they send to San Juan Capistrano Quest, which doesn’t do 4021.
Any thoughts or suggestions are appreciated.
I just found this 2013 study, called “Evaluating the Accuracy of Direct Estradiol Immunoassays for Human Male Serum” Endocrine Press | Endocrine Society
I read through it and don’t have the experience to understand it. If anyone has education in this area, could you check it out and let me know if this sheds any light on what we should be looking for in an estradiol test?
Here is another interesting and exciting article A Call for Better Estradiol Measurement | AACC.org
I have not kept up-to-date on the different offerings from Quest. One problem is when the labs have a high cut off value and when they report <29, what do you do with that. And some cut off around 17, so you have no idea how low you are and then cannot calculate an AI dose adjustment.
Thank KSman.
I find when doing the E2 test with the range of <29, that I get a number response. My last test came back 8. The <29 is just the reference range. There is another test I have done that isn’t as sensitive that has a range of <50 and just comes back with <50 if my number is, in fact, less than 50. If it is above 50, I get the actual number.
OK, take this to your own thread 
Sorry KSman. Wasn’t trying to hi-jack. Thought this was on topic and appropriate for this thread.
First question was generic, best to keep your specific details in your own thread; where we also have context. Check out the protocol for injections sticky and you can see what went wrong there.
I have been researching the Quest estradiol and testosterone blood work issues.
It appears that the current recommendation on this forum and elsewhere is that the best lab test for estradiol is 4021 (ref range <= 39) and testosterone 14966, which includes total, free, and bioavailable. From what I can find on accuracy of hormone tests, it appears the CDC (and others) recommend the LC/MS/MS test for hormones. The testosterone test 14966 fits this, but the estradiol 4021 is immunoassay, not LC/MS/MS. The estradiol test that is LC/MS/MS is 30289, Ultrasensitive, the one that is referenced at the beginning of this thread as inaccurate and to stay away from it.
Can someone shed some light on this discrepancy for me or direct me to another place to sort this out?
Thanks!
[quote]KSman wrote:
With TRT using transdermals, the swings in FT are more extreme and lab timing greatly determines the lab values. [/quote]
[quote]KSman wrote:
I suggest 1/2 between injections as that number will be more representative of your overall T levels. [/quote]
This is a great thread, thank you KSman! My question is related to the above, although I’m on transdermal T gel (no injections right now). I apply in the morning. I also generally take blood tests in the morning (especially if fasting is required).
Should I hold off on applying the gel until AFTER the test? Much appreciated.
With transdermals there is no concern that FT peaks are never high enough, except for non-responders. TT is a better guide to your status than FT in terms of driving dosing. If you do labs before application you at least know that you have FT results that are self consistent. Some docs may have some better insight into the utility of FT labs and methods.
[quote]KSman wrote:
In HPTA intact males, LH is released in pulses and diurnal patterns. This leads to changing FT levels. FT has a short half life. When you test FT in these males, the absolute number is not very important as the result is partly a factor of when the lab work was done. With TRT using transdermals, the swings in FT are more extreme and lab timing greatly determines the lab values. With frequently injected T, TT, FT and E2 levels can be very steady and FT lab results thus are more valuable in that case.
[/quote]
From what I have read In HPTA intact males, Free and protein-bound testosterone are in equilibrium, so that when free hormone is subtracted from circulation because of entry into tissue, new testosterone dissociates from albumin and SHBG, a new equilibrium is promptly reached, and free-hormone concentration in serum remains constant. SHBG and albumin seems to buffer serum testosterone levels, which, besides the physiological circadian rhythm, show only minor circhoral variations despite highly pulsatile LH secretion. So i don’t know if the short half life of free T really maters when it comes to blood tests?
Interesting: The Free Hormone Hypothesis Revisited:
Ksman
To answer your question about Why Scrotal (Testicular) Ultrasound would be ordered. If the patient is having what appears to be primary low testosterone. The Ultrasound could be helpful to check 1. Testicular size (much more accurate then the palpation method) 2. Blood flow if there has been testicular torsion-testicle twists on itself and cuts off its blood flow) yes it really,really hurts. 3. Trauma -that time you forgot your jock and your jewels took some damage. 4 Undescended testicle/or congenital defect- The testicle may lose some function. 5. Varicoceole (varicose veins can happen down there and can affect testicular function-and fertility). 6. inflammation/infection (acute or prior) that could be damaging the testicle.
So if FSH and LH are high and trying to get the boys to respond, an ultrasound can be used to ascertain if there is some blood flow issue, damage or congenital reason for testicular failure.
The link to the LabCorp test for E2 is broken., but the testID is correct. Here’s what I learned today:
Estradiol [standard]: Test: 004515 CPT: 82670 TestID: 408010 RefRange 7.6-42.6 pg/mL ECLIA $ 49 online
Estradiol, Sensitive: Test: 140244 CPT: 82670 TestID: 408440 RefRange 3 - 70 pg/mL RIA $119 online
RIA is “Radioimmunoassay”, which sounds expensive.
Although LabCorp says of the sensitive: “The analytic range of the assay is appropriate for the assessment of the low levels of estradiol typically observed in men, prepubertal girls, and postmenopausal women”, it also warns: “Estradiol results obtained with different assay methods cannot be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor serial patient results.”
T+SHBG is not buffering T
T+SHBG is tightly bound and is only a route to the liver for metabolization. A lot of literature is confused because E+SHBG can deliver E to tissues, so many assume that the same would be true for T.
A Bioavailable-T lab test measures T plus T_albumin and other weakly bound versions of T; and excludes T+SHBG. That sort of states it all.
As FT levels are quite variable over time, TT is useful. With guys who inject T frequently, FT is quite steady, so the lab results are quite indicative on one’s T status. If one has hight SHBG, TT goes up. With older males, aromatase is more active, also in part from fat gain. This leads to higher SHBG, SHBG+T and TT. So TT really does not tell the whole picture. Docs can miss this. TRT is indicated when FT or TT is below normal. But many docs have TT tunnel vision and cannot see the broader view.