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ARUP Estrogen Tests Comparison

Estradiol testing can be performed using either tandem mass spectrometry or immunoassay. Tandem mass spectrometry is more specific and accurate across a wider range of concentrations and is preferable if low estradiol concentrations are expected. Testing by immunoassay is accurate at higher estradiol concentrations and may be more cost-effective when clinically appropriate. Depending on the clinical scenario, tests for free estradiol or other estrogens may be useful.

		Expected Estrogen Concentration		Method				Results Reported				Notes
Select to Compare		High (eg, as found in adult premenopausal cisgender females or individuals on estrogen hormone therapy)	Low (eg, as found in children, adult cisgender males, postmenopausal females, individuals on estrogen-suppressing hormone therapy, or individuals at the initiation of some gender-affirming hormone therapies)	IA	MS	ED	Calc	Total Estradiol	Estrone	Total Estrogens	Free Estradiol
	Estradiol (Adult Premenopausal Females or Individuals on Estrogen Hormone Therapy) 0070045	High		✔				✔				Use this immunoassay to measure estradiol in adult premenopausal cisgender females and individuals on estrogen hormone therapies. Not recommended when low estradiol concentrations, such as those found in children, cisgender males, and postmenopausal females, are expected, or for monitoring antiestrogen (eg, aromatase inhibitor) therapy. The preferred estradiol test in these cases is Estradiol (Adult Males, Children, Postmenopausal Females, or Individuals on Estrogen-Suppressing Hormone Therapy) (0093247). Not recommended in the evaluation of estradiol status for individuals with protein-binding abnormalities or individuals on hormonal contraception. The preferred estradiol test for these individuals is Estradiol, Free, by Dialysis and Mass Spectrometry (2006160).
	Estradiol (Adult Males, Children, Postmenopausal Females, or Individuals on Estrogen-Suppressing Hormone Therapy) 0093247		Low		✔			✔				Use this mass spectrometry test to measure a wide range of estradiol concentrations. Most useful when low estradiol concentrations are expected, regardless of the patient’s sex assigned at birth. Use to monitor estradiol in individuals on estrogen-suppressing hormone therapies (eg, aromatase inhibitors or testosterone).
	Estrogens, Fractionated, by Mass Spectrometry 0093248		Low		✔		✔	✔	✔	✔		Use to evaluate estrogen status in children, cisgender males, and postmenopausal cisgender females. Most useful when low estrogen concentrations are expected, regardless of the patient’s sex assigned at birth.
	Estradiol, Free, by Dialysis and Mass Spectrometry 2006160	High	Low		✔	✔					✔	Use to directly measure free estradiol. May be used to evaluate estradiol status for individuals with protein-binding abnormalities or individuals on hormonal contraception.
Calc, calculation; ED, equilibrium dialysis; IA, immunoassay; MS, mass spectrometry