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Test Code ESTRN / E1-M Estrone, Serum

Reporting Name

Estrone, S

Useful For

As part of the diagnosis and workup of precocious and delayed puberty in females and, to a lesser degree, males


As part of the diagnosis and workup of suspected disorders of sex steroid metabolism (eg, aromatase deficiency and 17 alpha-hydroxylase deficiency)


As an adjunct to clinical assessment, imaging studies and bone mineral density measurement in the fracture risk assessment of postmenopausal women, and, to a lesser degree, older men


Monitoring low-dose female hormone replacement therapy in postmenopausal women


Monitoring antiestrogen therapy (eg, aromatase inhibitor therapy)

Testing Algorithm

See Steroid Pathways in Special Instructions.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum Red

Specimen Required

Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1.2 mL

Collection Instructions:

1. Centrifuge and remove serum from red blood cells within 2 hours of draw.

2. Aliquot serum to submission container.

Additional Information: See Steroid Pathways in Special Instructions.

Specimen Minimum Volume

0.8 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Red Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Special Instructions

Reference Values


1-14 days: Estrone levels in newborns are very elevated at birth but will fall to prepubertal levels within a few days.


Tanner Stages#

Mean Age

Reference Range

Stage I (>14 days and prepubertal)

7.1 years

Undetectable-16 pg/mL

Stage II

11.5 years

Undetectable-22 pg/mL

Stage III

13.6 years

10-25 pg/mL

Stage IV

15.1 years

10-46 pg/mL

Stage V

18 years

10-60 pg/mL

#Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (± 2) years. For boys there is no proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18.



Tanner Stages#

Mean Age

Reference Range

Stage I (>14 days and prepubertal)

7.1 years

Undetectable-29 pg/mL

Stage II

10.5 years

10-33 pg/mL

Stage III

11.6 years

15-43 pg/mL

Stage IV

12.3 years

16-77 pg/mL

Stage V

14.5 years

17-200 pg/mL

#Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for girls at a median age of 10.5 (± 2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18.


*The reference ranges for children are based on the published literature(1,2), cross-correlation of our assay with assays used to generate the literature data and on our data for young adults.



Males: 10-60 pg/mL


Premenopausal: 17-200 pg/mL

Postmenopausal: 7-40 pg/mL

Conversion factor

E1: pg/mL x 3.704=pmol/L (molecular weight=270)


For SI unit Reference Values, see

Day(s) and Time(s) Performed

Monday through Saturday; 1 p.m.

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
E1 Estrone, S 2258-2


Result ID Test Result Name Result LOINC Value
81418 Estrone, S 2258-2

Clinical Information

Estrogens are involved in development and maintenance of the female phenotype, germ cell maturation, and pregnancy. They also are important for many other, nongender-specific processes, including growth, nervous system maturation, bone metabolism/remodeling, and endothelial responsiveness. The 2 major biologically active estrogens in nonpregnant humans are estrone (E1) and estradiol (E2). A third bioactive estrogen, estriol (E3), is the main pregnancy estrogen, but plays no significant role in nonpregnant women or men.


E2 is produced primarily in ovaries and testes by aromatization of testosterone. Small amounts are produced in the adrenal glands and some peripheral tissues, most notably fat. By contrast, most of the circulating E1 is derived from peripheral aromatization of androstenedione (mainly adrenal). E2 and E1 can be converted into each other, and both can be inactivated via hydroxylation and conjugation. E2 demonstrates 1.25-5 times the biological potency of E1. E2 circulates at 1.5-4 times the concentration of E1 in premenopausal, nonpregnant women. E2 levels in men and postmenopausal women are much lower than in nonpregnant women, while E1 levels differ less, resulting in a reversal of the premenopausal E2:E1 ratio. E2 levels in premenopausal women fluctuate during the menstrual cycle. They are lowest during the early follicular phase. E2 levels then rise gradually until 2 to 3 days before ovulation, at which stage they start to increase much more rapidly and peak just before the ovulation-inducing luteinizing hormone/follicle stimulating hormone surge at 5 to 10 times the early follicular levels. This is followed by a modest decline during the ovulatory phase. E2 levels then increase again gradually until the midpoint of the luteal phase and thereafter decline to trough, early follicular levels.


Measurement of serum E2 forms an integral part of the assessment of reproductive function in females, including assessment of infertility, oligo-amenorrhea and menopausal status. In addition, it is widely used for monitoring ovulation induction, as well as during preparation for in vitro fertilization. For these applications E2 measurements with modestly sensitive assays suffice. However, extra sensitive E2 assays or simultaneous measurement of E1, or both are needed in a number of other clinical situations. These include inborn errors of sex steroid metabolism, disorders of puberty, estrogen deficiency in men, fracture risk assessment in menopausal women, and increasingly, therapeutic drug monitoring, either in the context of low-dose female hormone replacement therapy or antiestrogen treatment.


See Steroid Pathways in Special Instructions.


No significant cautionary statements.

Analytic Time

2 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK
Other Serum gel or SST tube

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)