Hormone and Blood Count Analysis
Primary Assessment
These laboratory results show elevated estradiol (33.08 pg/mL) in what appears to be a male patient based on the testosterone levels (732 ng/dL total, 74.7 pg/mL free), with otherwise normal thyroid function, complete blood count, and gonadotropin levels—the elevated estradiol requires verification for analytical interference before any clinical intervention.
Hormone Profile Interpretation
Testosterone and Gonadotropin Status
- Total testosterone of 732 ng/dL and free testosterone of 74.7 pg/mL are within normal male ranges 1
- FSH (3.6 IU/L) and LH (4.37 IU/L) are appropriately normal, indicating intact hypothalamic-pituitary-gonadal axis function 1
- Sex hormone-binding globulin (SHBG) of 60.15 nmol/L is at the upper end of normal, which can affect free hormone availability 2
Estradiol Elevation Concerns
The estradiol level of 33.08 pg/mL appears mildly elevated for a male patient (normal male range typically 10-82 pg/mL) 3. However, this requires critical evaluation for:
- Analytical interference from heterophile antibodies, which can falsely elevate hormone measurements 4, 5
- Biotin interference if the patient is taking supplements, as biotin can affect multiple hormone immunoassays 4
- Cross-reactivity in steroid hormone immunoassays that may produce spurious results 4
Prolactin Assessment
- Prolactin of 7.4 ng/mL (assuming units are ng/mL) is normal for males 1
- This excludes hyperprolactinemia as a cause of reproductive dysfunction 1
Complete Blood Count Analysis
All hematologic parameters are within normal limits 1:
- Hemoglobin 15.1 g/dL (normal for adult males: >12 g/dL)
- Hematocrit 44.1% (normal for adult males: >37%)
- White blood cell count, red blood cell indices, and platelet count are all normal
Thyroid Function
TSH of 1.011 mIU/L is normal, indicating euthyroid status 2. This is important because:
- Thyroid dysfunction can affect sex hormone-binding globulin levels 2
- Estrogen administration increases thyroid-binding globulin, but this patient is not on estrogen therapy 2
Recommended Course of Action
Immediate Steps
Repeat estradiol measurement using a different immunoassay platform to exclude analytical interference 4, 5
- Use a competitive chemiluminescent immunoassay from a different manufacturer
- This is the most efficient method to identify heterophile antibody interference 5
Obtain detailed medication and supplement history 4:
- Specifically ask about biotin supplementation (often in hair/nail vitamins)
- Document any over-the-counter supplements
- Review prescription medications that might affect hormone assays
Assess clinical context 1:
- Evaluate for signs of gynecomastia or breast tenderness
- Document fertility concerns or erectile dysfunction
- Assess for testicular size, consistency, and descent
If Estradiol Remains Elevated on Repeat Testing
Investigate potential causes of true hyperestrogenemia in males:
- Consider testicular ultrasound to exclude estrogen-secreting tumors (rare) 1
- Evaluate for obesity, as adipose tissue aromatizes testosterone to estradiol 3
- Assess liver function, as impaired hepatic metabolism can elevate estradiol 2
Clinical Pitfalls to Avoid
- Do not initiate treatment based on a single elevated estradiol value without confirming the result 4, 5
- Do not assume laboratory interference is rare—it occurs more commonly than recognized and can lead to unnecessary interventions 5
- Do not overlook the discordance between normal gonadotropins/testosterone and isolated estradiol elevation, which strongly suggests analytical error 5
Monitoring Recommendations
If all hormone levels are confirmed as accurate and the patient is asymptomatic: