Differential Diagnosis for False Low Estrogen and Testosterone on Bloodwork

• Single Most Likely Diagnosis
  • Hemodilution: This occurs when the blood sample is diluted with IV fluids or other substances, resulting in falsely low hormone levels. This is a common issue in hospitalized patients or those receiving IV therapy.
• Other Likely Diagnoses
  • Binding protein abnormalities: Alterations in sex hormone-binding globulin (SHBG) or other binding proteins can affect the measurement of estrogen and testosterone, leading to false low results.
  • Lab error: Human error in the laboratory, such as mislabeling or contamination of samples, can result in inaccurate hormone levels.
  • Certain medications: Some medications, like oral contraceptives or hormone replacement therapy, can interfere with hormone assays and lead to false low results.
• Do Not Miss Diagnoses
  • Hypopituitarism: A rare condition characterized by decreased production of pituitary hormones, which can lead to low estrogen and testosterone levels. Missing this diagnosis can have significant consequences, including adrenal crisis or infertility.
  • Adrenal insufficiency: A life-threatening condition that can cause low hormone production, including estrogen and testosterone. Prompt recognition and treatment are crucial to prevent serious complications.
• Rare Diagnoses
  • Klinefelter syndrome: A genetic disorder that affects males, characterized by low testosterone levels and elevated estrogen levels. However, in some cases, estrogen levels may be falsely low due to laboratory error or other factors.
  • Androgen insensitivity syndrome: A rare genetic disorder that affects the production or function of androgens, leading to low testosterone levels and potentially altered estrogen levels.