ESTRADIOL , Sensitive (LC/MS/MS)

ESTRADIOL , Ultra Sensitive (LC/MS/MS)

Estradiol sounds like something out of a medical textbook but it’s a hormone found in both men and women [1]. In simple terms think of estradiol as a form of estrogen, a hormone associated with women but just as important in men. It’s produced when testosterone, the male hormone, is converted especially in fat tissue, liver, testicles and adrenal glands [2]. This hormone is important for bone health, cognitive function, sex drive and overall body composition in both genders [3].

The body produces estrogen by aromatizing testosterone in the testicles, liver, fat tissue and adrenal glands. Estradiol is involved in bone health, cognitive function, sex drive and body composition in both men and women. Depending on lifestyle factors, liver issues, medications, body fat mass and genetics some people may have higher estradiol conversions from testosterone [4].

The commonly used estradiol test may overestimate estradiol [5]. That test uses immunoassay technology that can’t differentiate C-reactive protein (involved in inflammation) from estradiol so it reads the combination of the two as estradiol. This overestimation can lead to overuse of aromatase inhibitors which can result to low estradiol which can cause many health issues. This ultrasensitive estradiol test is based on liquid chromatography/mass spectrometry (LC/MS) an assay technology that doesn’t have that limitation [6].

What is Estradiol and Its Role in Hormone Therapy?

Estradiol is a natural estrogen steroid hormone that regulates the female menstrual cycle and develops and maintains female secondary sex characteristics. Beyond its natural functions estradiol is a cornerstone in hormone therapy. It’s used to alleviate menopausal symptoms like hot flashes and night sweats, combat osteoporosis by maintaining bone density and treat vaginal atrophy. It’s also a key component in transgender hormone therapy to feminize. Available in various forms oral tablets, patches, gels and vaginal rings estradiol has many options for those undergoing hormone therapy.

Factors that Affects Estradiol and Sex Hormone Binding Globulin in Men

Several factors can affect how much estradiol is produced from testosterone. For postmenopausal women estradiol is a key component in hormone therapy to alleviate menopausal symptoms. These are lifestyle habits, liver health, certain medications, body fat mass and genetics. For example someone with more body fat may produce more estradiol because fat tissue is one of the sites where this conversion happens.

How is an Estradiol Test done?

An estradiol test is a simple blood test that measures the level of estradiol in your blood. A healthcare professional will draw a blood sample from a vein in your arm or hand. The sample is then sent to a lab for analysis. The estradiol test is used to check reproductive health in women, monitor ovarian function and evaluate fertility issues. It’s also used to track hormone levels during menopausal transition and guide decisions on hormone replacement therapy.

Bone Health and Estradiol

Estradiol is very important for bone health [7]. This is seen in men who have very low estrogen levels due to genetic conditions that either prevents them from producing estradiol or makes them insensitive to estrogen. These individuals have bone development issues and grow taller and have higher risk of bone fractures.

Flaws in Traditional Estradiol Testing

Testing estradiol in men is tricky. The commonly used immunoassay tests have a major flaw: they can’t differentiate C-Reactive Protein (CRP) which is involved in inflammation from estradiol. So they read the combination of the two as estradiol. This overestimation can lead to over treatment like using aromatase inhibitors which will reduce estrogen production and can cause many health issues if estradiol levels become too low.

What Estradiol Test Results Mean

Estradiol test results are reported in picograms per milliliter (pg/mL). Normal estradiol levels varies by age and sex. For women estradiol levels peak during reproductive years and decline after menopause. Abnormal estradiol levels can mean many things. Low estradiol levels may mean delayed puberty, infertility or other health issues. High levels may mean early puberty or fertility problems. Understanding these levels is important because it affects bone health, mood and overall well being.

Why LC/MS is Better for Estradiol Testing

The best way to measure estradiol in men is through a method called liquid chromatography/mass spectrometry (LC/MS) [8]. Unlike immunoassay tests, LC/MS can measure estradiol in men’s blood accurately without interference from other substances. This is important because although estradiol levels in men are lower than women, it plays a big role in many bodily functions including sperm production and quality.

Gynecomastia: When Estradiol and Testosterone are Out of Balance

An imbalance of hormones, high estradiol compared to testosterone is what causes gynecomastia, a condition where men’s breast tissue enlarges [9]. This can happen for many reasons including obesity (which increases estradiol production), liver dysfunction, external estrogen ingestion or tumors that produce estrogen. Men can also develop gynecomastia if their testosterone levels are low and their estrogen-to-androgen ratio becomes relative high.

Risk Factors

Many risk factors can cause abnormal estradiol levels including lifestyle habits, liver problems, certain medications, body fat mass and genetics. To keep estradiol levels healthy you need to have a balanced lifestyle. This means a healthy diet, regular exercise and healthy weight. Be aware of medications and substances that can affect estradiol levels like birth control pills and aromatase inhibitors. Regular check ups and open communication with your doctor is also important in managing and preventing abnormal estradiol levels.

Male Feminization

Gynecomastia is just one of the many aspects of what is called ‘male feminization’ which can be caused by absolute increase of estradiol [9]. Tumors in the testes for example can secrete excess estradiol. On the other hand, conditions or medications that lower testosterone levels can also cause feminization symptoms because of the altered estrogen-to-androgen ratio.

Treatment and Management

Managing abnormal estradiol levels involves addressing the root cause. For low estradiol levels, hormone therapy including estradiol replacement may be prescribed. For high estradiol levels, aromatase inhibitors may be used. For PCOS, ovulation stimulating medications may be effective. For delayed puberty, hormone therapy may be needed to induce puberty. For reproductive function issues, testosterone replacement therapy may be beneficial. Consult with a doctor to determine the best treatment and management plan for you.

Conclusion: Why Ultrasensitive Estradiol Test in Men is Important

Measuring estradiol in men is more than just a scientific interest; it’s men’s health. With its effects on bone health, cognitive function and reproductive function, estradiol needs precise measurement and management. This is where LC/MS comes in, a more accurate and reliable way to measure this important hormone and guide treatment.

• Estradiol: A Hormone for Men as Well as Women - EndocrineWeb
• Estradiol and Testosterone Conversion - Healthline
• The Role of Estradiol in Male Reproductive Function - Asian Journal of Andrology (2016)
• Body Fat and Estradiol Metabolism - The Journal of Clinical Endocrinology & Metabolism (2002)
• Comparison of Clinical Significance Between Different Estradiol Testing Methods - Clinical Biochemistry (2017)
• LC/MS for Estrogen Measurement - Clinical Chemistry (2015)
• Estradiol and Bone Health in Men - The Journal of Clinical Endocrinology & Metabolism (2015)
• Gynecomastia: Clinical Evaluation and Management - Indian Journal of Endocrinology and Metabolism (2014)
• Estradiol and Male Feminization - Journal of Urology (2019)

Note: Sample is sent to Quest Diagnostics Nichols Institute San Juan Capistrano, CA. Overnight and Sunday and Friday testing. Reports in 5-7 days.