Applications of estradiol and testosterone assays in the management of the infertile female patient

A collaborative effort to improve steroid hormone measurements in patient care was convened by the Centers for Disease Control in March 2008 to discuss the need for enhanced performance and standardization of clinical estradiol and testosterone assays. This article discusses the current status of estradiol and testosterone assays in the treatment of infertile women to include the assessment of ovarian reserve, ovulation induction and follicle tracking, ovarian hyperstimulation syndrome, and the role of testosterone in fertility management.     

Limitations of direct estradiol and testosterone immunoassay kits

Estradiol (E2) and testosterone (T) are biologically active hormones that serve as important diagnostic markers in serum of premenopausal and postmenopausal women and in men. These hormones are measured frequently by immunoassay in clinical laboratories and the test results are used in the diagnosis and treatment of patients. For measuring the hormones by immunoassay, most laboratories utilize commercially available reagents that are packaged in the form of a kit and are used either in an automated instrument or manually. However, both the diagnostic kit manufacturer and testing laboratory seldom thoroughly validate the assay methods generated with these kits. This deficiency may lead to unreliable test results that could affect clinical evaluation and treatment of patients. The purpose of the present study was to assess the reliability of immunoassays that quantify serum E2 and T levels with commercial diagnostic kits. The data generally show wide differences in the apparent levels of each hormone in a given sample obtained with kits from different manufacturers. This was especially true when measuring postmenopausal E2 and T levels. However, a purification step, which included organic solvent extraction, prior to radioimmunoassay (RIA) of E2 gave values that compared well with those obtained by conventional RIA (with preceding extraction/chromatographic steps). Our results point out the importance of more thoroughly validating assays performed with commercial immunoassay kits, especially with respect to sensitivity and specificity, prior to their use for measuring hormone levels in patient samples.     

Women's estradiol predicts preference for facial cues of men's testosterone

A growing body of research has shown that women express stronger attraction to more masculine traits when they are tested near ovulation than when tested during other times in the menstrual cycle. Although these effects have been interpreted as increased preferences for markers of elevated testosterone during times in the cycle when conception is most likely, no previous studies have directly demonstrated that women express stronger attraction to higher testosterone men at different times in the cycle. In addition, little research has addressed which hormonal or other physiological mechanisms may regulate temporal shifts in women's attractiveness judgments. In this research, we demonstrate that women with higher estradiol concentrations exhibit stronger preferences for the faces of men with higher testosterone concentrations, and that women's testosterone preference and estradiol curves track one another across days of the cycle. The findings are the first direct demonstration in humans that hormone concentrations in one sex are associated with attraction to cues of hormonal status in the opposite sex. The results support a functional role for estradiol in calibrating women's mating psychology to indices of their current fertility, analogous to similar processes that have been documented in nonhuman species. A strong correlation between estradiol and testosterone preference specifically during the luteal phase further suggests that women's mate preferences may track their fertility between different cycles in addition to being calibrated to the timing of ovulation within individual cycles.     

Testosterone and estradiol assays: current and future trends

Sex steroid measurements for the investigation of endocrine disorders have been fraught with accuracy and imprecision problems since the advent of high throughput, direct assays almost 10 years ago on automated analyzers. Results from testosterone and estradiol measurements at the low end of detectability have suffered the most and there are few automated systems that can accurately measure these steroids in women, children and hypogonadal males on a routine basis. With the advent of mass spectrometry coupled to either gas chromatography or liquid chromatography, an improved approach to the measurement of these steroids has developed that shows promise for accurately and precisely measuring testosterone and estradiol in all patient populations including women and children. These mass spectrometry based methods for the sex steroids have been established as higher order reference method procedures that will resolve the issues of low end sensitivity measurements for these steroids, provide for appropriate standardization and reference materials and align most laboratories in hospital and reference laboratories to generate results that are inter-changeable between laboratories and methods.     

B cells express intracellular but not surface receptors for testosterone and estradiol

Increasing evidence indicates the existence of membrane receptors for testosterone (mAR) and estradiol (mER) on the surface of cells, besides the classic intracellular androgen receptor (iAR) and estrogen receptors (iER). Here, we investigate the occurrence of sex steroid receptors in B cells isolated from the spleen of C57BL/10 mice using magnetic cell sorting. RT-PCR reveals the presence of iAR, iERalpha, but not iERbeta. Using different anti-iAR and anti-iER antibodies flow cytometry and confocal laser scanning microscopy (CLSM) localize iAR and iERalpha in the cytoplasm, which are translocatable to the nucleus upon incubation with testosterone (T) and 17beta-estradiol (E(2)). The surface of B cells is devoid of iAR and iERalpha and does not bind any T and E(2) conjugated to BSA-FITC as revealed by flow cytometry and CLSM. In accordance, T and E(2) are not able to induce any rapid rise in in the intracellular free Ca2+ concentration of Fura-2 loaded B cells. Our data indicate that B cells express neither mAR nor mER on their surfaces, in contrast to other major cells of the immune system such as T cells and macrophages.     

Serum estradiol, testosterone and dihydrotestosterone in male monkeys treated with testosterone propionate.

Serum estradiol (E2), testosterone (T) and dihydrotestosterone (DHT) were measured in juvenile (pre-pubertal) male rhesus monkeys injected with either 8 mg or 80 mg of testosterone propionate (TP). After one week, the three steroids were elevated and remained essentially unchanged for the duration of the study. There was little difference in serum E2 or DHT when comparing the two groups of steroid-treated monkeys. In contrast, T levels were consistently greater in the animals given the high dosage of TP.     

Plasma estradiol concentrations and effect of HCG on plasma estradiol and testosterone in normal subjects and patients with endocrine disorders.

Plasma estradiol concentrations were determined by radioimmunoassay in various endocrine disorders using antiserum to estradiol-17beta succinyl bovine serum albumin. Clinical significance and diagnostic value of plasma estradiol were assessed in hypothalamic-pituitary, adrenal and gonadal disorders. In general, estradiol concentration was correlated well with the degree of sexual maturity and was of great diagnostic use. Plasma estradiol in females mainly originated from the ovary, while the testis is the principal source of estradiol in males. The adrenal gland seemed to play a minor role as a source of estradiol at least in normal males and females. The role of estradiol in gynecomastia and in liver disease was also investigated. More than a half of the cases with gynecomastia had elevated concentrations of plasma estradiol, which probably explains the pathogenesis of this manifestation. Cirrhotic patients showed frequently hyperestrogenemia probably due to delayed disappearance of estradiol. In the study of stimulation with human chorionic gonadotropin (HCG), 3,000 IU daily for three days in ten normal men, the peripheral concentrations of esradiol showed maximum and fourfold increases 24 hours after the 1st injection of HCG. The testosterone levels, on the other hand, increased stepwise and reached a maximum of about two times preinjection levels 24 hours after the 3rd injection. In gonadal disorders, HCG produced various patterns of plasma estradiol and testosterone in accordance with the gonadal conditions and dissociated response patterns of both sex hormones were frequently found. The determination of plasma estradiol was useful in the study of the function of not only the ovary, but also the testis and the simultaneous measurement of plasma estradiol and testosterone after HCG administration presented interesting informations about pathophysiology of gonadal disorders.     

Effect of estradiol on the metabolism of testosterone by rat prostate

Prostatic tissue from normal, estradiol-treated, and castrated rats was incubated with testosterone, and the metabolites formed were studied. Pretreatment with estradiol-17β did not affect the total amount of testosterone metabolized per unit weight of tissue. In contrast, the total amount of testosterone metabolized was significantly reduced following castration. The formation of dihydrotestosterone (17β-hydroxy-5α-androstan-3-one; DHT) was not affected by treatment with estradiol, but was significantly reduced by previous castration. Estradiol treatment enhanced the formation of 17-keto metabolites of testosterone by the prostate, giving lower 17-hydroxy to 17-keto ratios than incubations with prostates from control or castrated rats. These results are consistent with the theory that the mechanisms leading to the involution of prostate after estradiol treatment and after castration are different.     

Lack of activity of estradiol in rodent bone marrow micronucleus assays

Estradiol has been evaluated in five independent rodent bone marrow micronucleus assays and has been found to be inactive. The dose-range evaluated extended from three daily doses of 20 μg/kg to the rat, a regimen that elicited a potent uterotrophic response from the animals, to single doses of between 10–150 mg/kg to the mouse. The mouse assays simulated and extended the conditions of test employed by earlier investigators who had found estradiol, and three structurally-related synthetic estrogens, to be active in mouse micronucleus assays over the dose range 1–10 mg/kg. It is concluded that estradiol is not genotoxic to the bone marrow of rodents. The top dose-level used in the present micronucleus assays (150 mg/kg) represented 150 000 times the minimum estrogenic dose of this chemical to rodents, and that was considered to be above the dose at which useful genetic toxicity data would be generated for this potent estrogen. The maximum tolerated dose (MTD) of estradiol to rodents remains to be established.     

Diazepam binding inhibitor (DBI) reduces testosterone and estradiol levels in vivo

Diazepam binding inhibitor (DBI) is a putative endogenous ligand capable of binding to the central type benzodiazepine (BZD) receptor located on the GABAA receptor and the peripheral type BZD receptor on the mitochondrial outer membrane. We examined the effects of an intracerebroventricular injection of DBI on the serum levels of the gonadal hormones, testosterone and estradiol, respectively, in male and female mice. DBI (0.3-10 nmol/mouse, i.c.v.) significantly reduced the levels of both gonadal hormones in a dose-dependent manner. The decrease in the gonadal hormone levels became evident at 1 hr and lasted for at least 4 hrs after the DBI injection. The effects of DBI (3 nmol/mouse, i.c.v.) in male and female mice were completely attenuated by the coadministration of flumazenil (66 nmol/mouse), a selective antagonist for the central type BZD receptor. These results suggest that DBI acts as an endogenous modulator to regulate the levels of gonadal hormones in vivo, and that the DBI-induced decrease in gonadal hormone levels is mediated by down regulation of the GABAergic system, implicated in gonadotropin-releasing systems and/or the hypothalamic-pituitary-gonadal axis.     

Arachidonate-induced thrombosis in mice: effects of gender or testosterone and estradiol administration

Sodium arachidonate (i.v.) has previously been shown to induce pulmonary emboli formation and a dose dependent cyanosis and respiratory depression in mice. Subsequently, we found that male mice are significantly more sensitive to arachidonate than females. Aspirin given orally 2 hours prior to arachidonate administration inhibits the responses of both males and females. Pretreatment with depo-testosterone markedly increases the effect or arachidonate in both males and females and depo-estradiol pretreatment reduces the responses in all mice. This exacerbation by testosterone of the arachidonate response and the attenuating effects of estradiol is consistent with data reported using other thrombogenic techniques.