My cars TPMS reads about 2 lbs lower than my tire guage.
The kind of variation I am seeing is not due to a mis-match between a tire pressure gauge and what the TPMS sensors read.
I have six tire pressure gauges and they all pretty much agree with each other.
The TPMS sensors on the Model 3 are consistently under reporting tire pressure levels by an amount that directly matches with the TPMS sensors thinking they are at sea level when they are in fact at 6,000 feet.
Now if I ran the tires at Tesla's recommended 45-49 PSI for maximum range that wouldn't be an issue. Instead I run the tires at Elon Musk's recommended 39 PSI (I actually have to run at 41 even when "warm" to avoid alarms) for maximum comfort since the roads where I am suck.
Tesla needs to fix this.