FAQ

Under CLIA (Clinical Laboratory Improvement Amendments) regulations, testing varies by state and requires a written or electronic request for patient testing (493.1241). The exception to this regulation is those states that allow Direct Access Testing (DAT), which allows consumers to test without a prescription. For questions regarding this matter, please contact ZRT Laboratory. Please note that most insurance companies will not cover the cost of the testing unless your medical professional has ordered and provided a written prescription for the testing. Some restrictions apply in California, Maryland and New York.

Note: Samples should be sent as soon as possible after collection but will remain stable under average shipping conditions, including over weekends and holidays.

Most test kits contain a UPS or US Postal Service return label for sample returns within the US. Testers may choose to purchase an alternate form of shipping at their own expense. ZRT does not typically cover the cost of samples being returned from outside of the US.

International testers will need to purchase return shipping at their own expense. These samples are not bio-hazardous so as long as they are packaged according to the Collection Instructions, there should not be any restrictions imposed by customs.

See the Patient Handout Flexible Spending Account FAQs.

ZRT Laboratory will courtesy bill the following insurance companies as an out-of-network provider:

• Original Medicare Part B
• Medicare Advantage Plans
• TRICARE
• Humana

It is your responsibility to verify out-of-network benefit coverage with your insurance carrier prior to testing. Insurance is billed at the full retail price as listed on the test & fee schedule. You are financially responsible for any charges not paid by your insurance company as ZRT does not dispute or appeal denied/unpaid claims.

You may wish to prepay for services to receive the discounted price and request an itemized receipt. You can submit this receipt to your insurance company for reimbursement (in accordance with your health plan benefit coverage).

You will need to send the following along with your sample:

• Legibly signed laboratory order with applicable diagnosis code(s)
• Date of birth
• Physician’s full printed name, address, and NPI number
• Legible front & back copy of primary insurance card
• Signed & dated ZRT Insurance Authorization Form (included in kit)

Please Note: Incomplete or invalid information does not stop your sample from processing and may result in you being billed at the full retail price.

ZRT will be unable to file a claim. Send prepayment with your sample, at the discounted price, and request an itemized receipt which you may submit to your insurance company for reimbursement (in accordance with your health plan benefit coverage).

In the event that you have Medicare Part B as your secondary insurance, send prepayment with your sample, at the discounted price and request an itemized receipt. You can submit this to your primary insurance company for reimbursement (in accordance with your health plan benefit coverage). Once the claim has been processed, forward a copy of your Explanation of Benefits (EOB) to us and we will bill Medicare on your behalf.

We accept VISA, Master Card, American Express, Discover Card, personal checks and US money orders. All internet orders must be paid by credit card.

Prepayment in United States dollars is required. We cannot accept foreign currency or bill insurance companies outside of the United States.

Please complete our Become a Provider form and we will contact you to complete your account setup. You can also call ZRT Laboratory toll free at (866)600-1636 or locally at (503)466-2445. Customer Service is available Monday through Friday, 6am-5pm Pacific Time.

ZRT allows relevant businesses to link to our website; however, we do not link to sites other than education-related or non-profit sites of our choosing. Businesses wanting ZRT to link to their sites should contact info@zrtlab.com, and we will consider their requests on an individual basis. Relevant businesses wanting to link their sites to ZRT's must observe the policies described in Terms of Use under Terms and Conditions, Section 6, Links.

Note: Samples should be sent as soon as possible after collection but will remain stable under average shipping conditions, including over weekends and holidays.

Most test kits contain a UPS or US Postal Service return label for sample returns within the US. Testers may choose to purchase an alternate form of shipping at their own expense. ZRT does not typically cover the cost of samples being returned from outside of the US.

International testers will need to purchase return shipping at their own expense. These samples are not bio-hazardous so as long as they are packaged according to the Collection Instructions, there should not be any restrictions imposed by customs.

SALIVA samples should be sent as soon as possible after collection and will remain stable under average shipping conditions, including over weekends and holidays and during hot temperatures. If sample(s) will not be sent the day of collection, please store in the freezer and note dates in Section 5 of the Test Requisition.

DRIED BLOOD SPOT or DRIED URINE samples should be kept at room temperature and will remain stable for shipping over weekends and holidays, and during hot temperatures.

International Testers – Due to vast differences in international postal systems, we are not usually able to provide international return mailers.

In most cases, a prepaid return label is provided by ZRT Laboratory inside the test kit(s). If you do not have one, you may send the sample to us via any method of your choosing. (A method where you are able to track your package is recommended.) Please note that ZRT Laboratory does not reimburse shipping charges. If you received your kit from a healthcare professional, you may contact their office to see if they are able to provide a replacement label. If you received your kit directly from ZRT Laboratory, you may contact Customer Service toll free at (866)600-1636. Please be aware that having a shipping label mailed can take up to 7 business days to arrive, which may further delay the testing and validity of your sample.

SALIVA samples should be sent as soon as possible after collection and will remain stable under average shipping conditions, including over weekends and holidays and during hot temperatures. If sample(s) will not be sent the day of collection, please store in the freezer and note dates in Section 5 of the Test Requisition.

DRIED BLOOD SPOT or DRIED URINE samples should be kept at room temperature and will remain stable for shipping over weekends and holidays, and during hot temperatures.

If your test kit contains a prepaid UPS label (usually 2Day or Ground service) keep the Customer Return Receipt which includes the tracking information, and affix the shipping label to the bag included inside the kit. The UPS Tracking number can then be used to see whether your package has been delivered to ZRT Laboratory.

Enter your UPS Tracking Number here to find out if your sample(s) has been delivered:

If you did not have a tracking number or cannot find it, you may contact Customer Service toll free at 866.600.1636 to see if your sample has been received.

For online orders, see Shipping & Returns under Policies.

Click here to find the nearest UPS drop box or location.

Men can collect at any time of the month.

Women who:

• Do not have menstrual cyclescan collect any day. This would include women with hysterectomy, amenorrhea (abnormal absence of menses in women of reproductive age) and/or uterine/endometrial alblation (destruction of the uterine lining).
• Have 'normal' menstrual cyclesshould collect day 19, 20 or 21 (counting the 1st day of bleeding as day 1)
• Have irregular, unpredictable menstrual cyclescan collect any day they are not bleeding.
• Have some kind of cycle regularity but not at the typical lengths should follow these guidelines for collection: Long cycles – test at day 19-21 or from day 19 to 5 days prior to when the period is expected. For example, if the cycle is 35 days, collection can be done anytime between day 19 to day 30. Short cycles – collection should be done a couple of days prior to when bleeding starts. For example, someone with 14 day cycles should collect on day 12.

While vitamins may improve your symptoms, they do not generally change lab results. However, please list all hormones, supplements and vitamins that you are taking on your requisition form.

The following products are available over-the-counter and may affect lab results (this is not an exhaustive list): progesterone, pregnenolone, DHEA, 7-Keto-DHEA (see special notice), hydrocortisone (cortisol). Continue to use topical hormones daily as prescribed, but avoid applying them to the face and neck areas for 3 days prior to testing. Rub in topical hormones without using fingers (e.g. wrist to wrist) for at least 2 days prior to collection. Skip use of anti-aging creams that may contain hormone traces.

NOTE: 7-Keto-DHEA is a variant form of DHEA and can create false elevations of DHEA and testosterone test results. Please discontinue use of sublingual 7-Keto-DHEAS for 3 days prior to testing. If using pill form, follow the oral collection instructions.

Do NOT stop current hormone therapy prior to collection. Continue to use hormones daily as usual and follow the guidelines below for optimal timing of collection.

Hormone type sample collection guidelines:

• Pills, Gels, Creams, Sprays (oral, topical*, vaginal): 12-24 hours AFTER last dose – do not apply to face or neck
• Sublinguals and Troches (dissolve under tongue): Saliva testing is not appropriate for sublingual hormone users because of direct contamination. Blood spot testing is the preferred option for these patients.
• Patches: 1-2 days after applying patch
• Injections/Pellets: Midpoint between injection/pellet inserts

The following also qualify as hormones (not limited to):

Birth control, melatonin, hydrocortisone, steroid injections, flonase, prednisone, creams containing pregnenolone, placental derivatives or stem cells. If using any of these, collect as above.

If you collect outside the recommended time frame above, this may result in hormone levels lower or higher than ZRT reference ranges for hormone users.

Topical hormones, please note:

• Do NOT use bare hands for topical hormone application for at least two days prior to saliva collection (apply hormones using latex gloves or preferably hormone-loaded syringe or applicator).
• Do not apply hormones to face or neck. Apply hormones to areas of the body that can be covered by clothing to avoid transfer of hormones from fingers to face, lips, or mouth.
• Wash hands thoroughly with soap and water after each application of hormones and dry with clean towel.
• False-high saliva results can result when hormones from contaminated surfaces (faucets, counters, door knobs) or towels are transferred inadvertently from fingers/hands and then to face, lips, or mouth.

Since oral contraceptives suppress ovarian hormone levels, timing of the sample collection is less important. If you are discontinuing oral contraceptives, allow for withdrawal bleeding and wait until your next spontaneous cycle to test. Collect sample on day 19-21 of your cycle.

Yes. Discontinue anti-wrinkle creams at least 3 days before collection. You may substitute moisturizing creams that are safe for infants during the three days.

No. You should wait until you are healthy before collecting.

Saliva testing for DHEA-S and cortisol as well as blood spot testing for thyroid, Vitamin D, and CardioMetabolic markers is definitely beneficial for women taking oral birth control pills. Collect your sample on day 20 of your cycle, counting your first day of bleeding as day 1.

Please note, if you and your medical professional decide to discontinue your oral contraceptives, you should wait until your next menstrual period to collect. It may take approximately 7 weeks before you are able to collect your sample after discontinuing the pill as failure to ovulate is common in many women immediately after discontinuing birth control pills.

Within 30 minutes of waking, collect a few drops of blood from a quick and nearly painless nick of the finger (using the kit enclosed lancets) on a ZRT collection card. Once collected, allow your blood spot samples to dry for half an hour and then send them back to ZRT for processing. For more information, please watch the Collection Video, refer to the Collection Instructions included in your kit or read the Blood Spot FAQs.

You should collect your sample within 30 minutes of waking prior to eating, drinking, exercising, flossing or brushing your teeth, or taking hormones. For more information, please watch the Collection Video, refer to the Collection Instructions included in your kit or read the Saliva FAQs.

To ensure accurate results, all tubes should be at least ½ full (preferably ¾ full) excluding bubbles.

The large test tube, when filled ½ to ¾ full, can test the following hormones: estradiol, estriol, estrone, progesterone, testosterone, DHEA-S, and morning cortisol.

The small tubes are used for those testing more than one cortisol level. To perform a complete adrenal function test, cortisol is collected four times throughout the same day (morning, noon, evening, and at bedtime).

If you are having difficulty collecting saliva, we have a few recommendations:

Note: Too many bubbles are often caused by spitting too frequently into the tube. To avoid bubbles, try pooling saliva in your mouth for several minutes before spitting. If your sample contains a large percentage of bubbles, cap the tube and tap it on a hard surface to disperse bubbles into liquid.

• Drink extra water the day/night before collection to encourage the production of more saliva.
• If your mouth is dry, try pressing the tip of your tongue against your teeth or the roof of your mouth. Smelling (not eating) a lemon or other foods can also produce saliva flow.
• Allow saliva to pool in mouth before collecting.
• Chewing gum (even sugarless) is not advised as it may contaminate the sample.
• If you are still unable to collect enough saliva in one day, cap the tube, place in the refrigerator or freezer, and add more saliva at the same time the next day until the tube is at least half full. You may continue collecting in this way for up to 3 days.

Yes. You should begin collection the next morning. Just rinse the tube with warm water (no soap), allow to air dry, and collect within 20-30 minutes after waking and before eating, drinking, brushing or flossing your teeth.

Collection should be done on a day when you are engaging in your normal, routine activity. Any exercise will affect cortisol levels. Therefore, if you routinely engage in strenuous exercise and want to see what happens to your cortisol with exercise, then testing on that day is acceptable. However, if you do not routinely exercise or do not wish to see the effect of exercise on your cortisol levels, refrain from vigorous exercise (e.g., running, biking, etc.) on the day of testing.

People with diabetes who are doing saliva testing should discuss this question with their medical professional. If you do choose to eat before collecting your sample, cortisol levels will be affected. In any case, it is always important to rinse your mouth prior to collecting your saliva. Do NOT brush your teeth prior to collecting as this may cause micro-bleeding in your mouth that could change sex hormone results.

Blood spot testing provides results that correlate extremely well to serum testing results in terms of accuracy, but without the cost and inconvenience of conventional blood drawing.

There is no more wasted time and resources going to a lab for a painful blood draw as you collect your sample either at home or in your doctor’s office. In preparation for our CardioMetabolic testing and morning cortisol, which both must be done upon waking, blood spot testing is particularly convenient after an all-night fast. Blood spot testing is also a preferred method for those supplementing with troches or sublingual hormones. Use of these particular oral supplements can cause false high saliva testing results due to high concentrations of hormone in the oral mucosa for several days following your last dosage. Blood spot testing allows people who use these oral supplements to continue taking their hormones while testing. Blood spot testing is also preferable for those who have dry mouth conditions such as Sjogren’s Syndrome or who otherwise have difficulty collecting enough saliva for testing. In addition, some of ZRT’s tests are only offered in blood spot, such as thyroid, CardioMetabolic, and Vitamin D.

Choose Blood Spot testing if you:

• Use troche or sublingual (dissolved under the tongue) hormones
• Cannot create enough saliva
• Would rather perform a finger stick
• Want to measure a hormone that is only tested in blood spot

Dried blood spot is "whole" blood drawn from the end of the finger. This is mostly capillary blood as opposed to blood drawn from the arm, which is venous blood. The former contains nutrients, hormones, and oxygen to feed the tissues. The latter is partially spent of these life-giving components and is returning to the heart, lungs, and gastrointestinal tract to pick up another load.

Second, dried blood spots are comprised of whole blood complete with blood cells, whereas serum is the watery component that remains after lab technicians separate blood cells from venipuncture blood (i.e., blood drawn from veins using a syringe). Therefore, any hormones bound to any removed blood cells during the separation process are lost. Consequently, test results from blood spots reflect a more accurate assessment of your correct capillary blood hormone levels than test results from serum. Since capillary blood is what feeds the cells of your body, hormones detected in capillary blood reflect a more accurate assessment of hormone levels that affect your body’s tissues.

Yes and no.

The answer is “No” when hormones are produced within the body (endogenously), or are slowly delivered into the body with a transdermal patch (e.g., estradiol patch) or by pellet insertion. In these situations, hormone test results are remarkably similar from finger-stick dried blood spots and serum. In fact, hormone ranges established for blood spots are nearly identical to those of serum.

The answer is “Yes” when steroid hormones are delivered rapidly into the body through the skin or mucous membranes (e.g., topical or sublingual estradiol, progesterone, and testosterone). When hormones enter the body through the skin or mucous membranes, capillary blood and tissue levels far exceed the levels seen in venous blood. So when topicals or sublinguals are used for hormone supplementation, blood spot testing (using capillary blood from the finger) is a more accurate representation of the amount of hormone delivered to tissues.

Yes. Use care if you are applying hormones topically with your hands. Topical hormones can concentrate in the fingers when hormones are applied with the hands, resulting in false high results. It may take 12-24 hours for the hormones in the hands to equilibrate with other tissues in the body. Therefore, when using topical hormones, rub them in without using fingers (e.g. wrist to wrist) for at least 2 days prior to collection. Refrain from using anti-aging creams that may contain hormone traces. It is important to continue to use the hormones as usual during this time; just avoid hand exposure. For additional information on collection when using hormones, see the Blood Spot Testing Collection Instructions in your test kit.

Yes and no. For peptide hormone analysis (e.g., insulin, LH, FSH, etc.), results are the same for finger-stick capillary whole blood, venipuncture whole blood and serum.

If you are looking at endogenously produced steroid hormones (estradiol, progesterone, testosterone, DHEA-S, cortisol), the results are the same. However, if you have used one of these steroid hormones topically or sublingually, blood spot testing, showing capillary blood hormone levels, gives values much higher and more accurate than the venipuncture blood spot sample. This is because blood cells and serum that exit the capillary beds and return to the venous blood are “spent” of the bioavailable fraction of hormone. In this case, capillary blood more accurately represents tissue levels of the topically delivered hormone.

Yes, but ZRT performs more tests in blood spot than in saliva.

In saliva, we test:

• AM Cortisol (C1)
• PM Cortisol (C4)
• Diurnal Cortisol (C1, C2, C3, C4)
• DHEA-S (DS)
• Estradiol (E2)
• Estriol (E3)
• Estrone (E1)
• Progesterone (Pg)
• Testosterone (T)

In blood spot, we test:

• AM Cortisol (C1)
• Cholesterol, total
• HDL Cholesterol
• LDL Cholesterol
• VLDL Cholesterol
• DHEA-S (DS)
• Estradiol (E2)
• Fasting Insulin
• Follicle Stimulating Hormone (FSH)
• Hemoglobin A1c (HbA1c)
• High-Sensitivity C-Reactive Protein (hs-CRP)
• Insulin (fasting)
• Insulin-like Growth Factor (IGF-1)
• Luteinizing Hormone (LH)
• Progesterone (Pg)
• Prostate Specific Antigen (PSA)
• Sex Hormone Binding Globulin (SHBG)
• Testosterone (T), total
• Thyroid Peroxidase Antibodies (TPO)
• Thyroid Stimulating Hormone (TSH)
• Thyroxine (T4) free
• Triglycerides (TG)
• Triiodothyronine (Free T3)
• Vitamin D, 25-OH, Total

Blood spot testing measures the total amount of hormone available to tissues, but when divided by the amount of Sex Hormone Binding Globulin (SHBG), this ratio then determines how much of the hormone is bioavailable. So, by combining estradiol or testosterone with SHBG testing, it is possible to determine the bioavailable fraction of these hormones indirectly. This is why we included the SHBG test in our Female and Male Hormone Profiles in Blood Spot.

ZRT's at home test kits include everything you need for collection and can be ordered online or by phone (some restrictions may apply). When your sample has been collected, return the filled tube(s) with the completed paperwork in the pre-addressed, pre-paid packaging and mailer bag provided with the kit. Once ZRT has received your sample, results will be returned to you and/or your health care provider in approximately 5 to 7 business days. Please view Collection Videos to learn more.

We test the following seven hormones in saliva:

• Estradiol (E2)
• Estrone (E1)
• Estriol (E3)
• Progesterone (Pg)
• Testosterone (T)
• DHEA-S
• Cortisol (C)

Saliva testing has been used in scientific testing for decades and has been shown to be highly accurate. It is the most reliable way to measure free, bioavailable hormone activity — those hormones actually doing their job at the cell level. Standard blood and urine tests do not measure bioavailable hormone levels. Numerous scientific studies have shown a strong correlation between the levels of steroid hormones in the blood stream and the bio-available levels of steroid hormones in saliva. Peter T. Ellison, Ph.D. of the Department of Human Evolutionary Biology, at Harvard University, Cambridge, MA, has used this method of hormone testing in cross-cultural comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. (Human Reproduction vol.8 no.12 pp.2248-2258, 1993; Human Reproduction Vol.17, No.12 pp. 3251–3253, 2002.) His research in the field is the subject of his 2001 publication, On Fertile Ground: A Natural History of Human Reproduction (Harvard University Press). In addition, saliva hormone testing more accurately reflects tissue uptake and response of hormones delivered through the skin in creams, gels, or patches than blood or urine tests.

Our basic panel, Female/Male Saliva Profile I, includes estradiol, progesterone, testosterone, DHEA-S and cortisol. This will give you an overall sense of hormonal balance or imbalance as these five hormones work closely together.

Female/Male Saliva Profile II provides a more comprehensive idea of hormonal interactions. Of the four tubes included in this kit, two are used: one large tube for testing all the hormones of the basic panel (Female/Male Saliva Profile I discussed above), and a smaller tube for collecting a cortisol sample at bedtime as well. This panel is recommended for those with mild to moderate symptoms of fatigue, stress, sleep disturbance, allergies, and food cravings.

With severe symptoms, Female/Male Saliva Profile III, the most comprehensive of our saliva panels, is recommended. This test analyzes complete adrenal function by testing cortisol levels throughout the day. The Female/Male Saliva Profile III test kit contains four tubes, one large tube for testing all the hormones of the basic panel in the morning, and three small tubes for noon, evening, and bedtime collections of cortisol.

Since estradiol is the more predominant and potent of the estrogens, this is the most commonly measured estrogen in testing. Estrone and estriol are typically only tested for those who are supplementing with them.

ZRT's at home test kits include everything you need for collection and can be ordered online or by phone (some restrictions may apply). When your sample has been collected and allowed to dry completely, return the dried strips and completed paperwork in the pre-addressed, pre-paid packaging and mailer bag provided with the kit. Once ZRT has received your sample, results will be returned to you and/or your health care provider in approximately 5 to 7 business days. Please view our Collection Videos to learn more.

The following tests are commercially available as a dried urine test:

• Elements
• Sleep Balance Profile
• Metabolites
• Neurotransmitters

You do NOT need to change your regular diet or stop taking supplements. Following your typical dietary and/or supplement routine will ensure that your results are an accurate reflection of your average daily levels.

If your health care provider orders your test, your results are returned to them within 5 to 7 business days from the date we receive your sample. In this case, you can obtain a copy of your test results from your provider. If you order your test directly, your results are returned to you within 5 to 7 business days from the date we receive your sample. The test report includes:

• A graph showing where your hormone levels fall within set ranges. Levels can be either within or out of normal range.
• A second graph detailing the symptoms you listed on your self-evaluation form. Symptoms are grouped according to the indicated category of hormonal imbalance. Symptoms are also correlated with the hormone levels identified through ZRT testing.
• A comment field providing an individualized review of your hormone evaluation.

Since our laboratory is located in Oregon, we follow Oregon reporting rules which require that we release results to patients, upon request, after a 7 day wait. If the request comes in before results are completed, the wait period begins after completion. If the results are completed at the time of the request, the wait period begins at the time of the request. Results can also be obtained through the ordering health care provider and we strongly encourage patients to do so.

To ensure correct interpretation of your test results, we advise you to discuss them with your health care provider.

We recommend that you have your results evaluated by a knowledgeable health care provider who, depending upon your test results, may take steps to correct and monitor any hormone imbalances detected during testing. To locate a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing, click Find a Provider.

Because we are a testing and research laboratory, we cannot recommend specific physicians. Please refer to our Find a Provider locator to find a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing.

As we are a research and testing laboratory, we do not make recommendations for any specific products. There are many different types of creams and gels that are available over the counter but not all are reliable. We suggest researching the list of natural hormone creams approved by Dr. John Lee, MD. It is also beneficial to speak with a compounding pharmacist skilled in the formulation of bioidentical hormone supplements tailored to individual needs. Please refer to our Find a Provider locator to find a compounding pharmacist in your area who is familiar with ZRT testing and can formulate bioidentical hormone supplements for you.

If you are currently on hormone therapy, it is advisable to test your present hormone levels to identify any existing hormone imbalances before making any changes to the dosage.

If your doctor is interested but unsure about prescribing bioidentical hormones, you can put him or her in touch with a compounding pharmacist. These professionals are thoroughly trained in modern compounding methods and skilled in the use of bioidentical hormone therapy. They can provide your physician information about safe dosing guidelines for bioidentical hormone supplementation. Please refer to our Find a Provider locator to find a compounding pharmacist in your area who is familiar with ZRT testing.

To get a general idea of whether or not your hormones are balanced, record the symptoms you are currently experiencing using our Symptom Assessment Checklists. Your symptoms may point to a deficiency or excess of certain hormones.

To confirm your symptoms of hormonal imbalance, we recommend measuring those hormones associated with the symptoms you noted using our Symptom Assessment Checklist or on the test kit requisition form. You might consider ordering our Female/Male Saliva Profile I that tests estradiol, progesterone, testosterone, DHEA-S and AM cortisol. This panel, along with the more comprehensive Female/Male Saliva Profile II and Female/Male Saliva Profile III, provide you with a broader picture of your present hormone levels and identify specific imbalances. For the most comprehensive assessment of hormonal imbalance, including tests for reproductive, adrenal, and thyroid hormone testing, consider ordering one of our Comprehensive Profiles.

Polycystic ovaries occur when numerous growths/cysts develop on the ovaries. This is commonly associated with a hormonal imbalance such as estrogen dominance and/or an excess of male hormones. In many cases, these cysts are benign and can shrink or even disappear when the hormone imbalance is corrected. The ovaries should be removed if the cysts are cancerous or causing pain and do not respond to treatment.

Estrogen dominance, an imbalance caused by excess estrogen in the relative absence of progesterone, can cause the uterine lining to grow undetected. This can lead to the growth of tough, fibrous, non-cancerous lumps called fibroids. While the average fibroid is an undetectable lump in the wall of the uterus, about the size of a hen’s egg, larger fibroids often cause irregular bleeding and heavy or painful periods. Fibroids are the most common physical reason for excessive bleeding during menstruation.

Fibroids can grow dramatically during perimenopause when they are stimulated by hormonal imbalances and fluctuations in the body. Large fibroids secrete estradiol, the most potent form of estrogen, leading to estrogen dominance. Monitoring your estrogen levels through routine hormone testing and taking appropriate steps to maintain a proper balance of estrogen to progesterone is especially important. Please note: recent information cautions against the use of progesterone for the treatment of larger fibroids. With all fibroids, hormone supplementation should be kept as low as possible.

There are many factors associated with hormonal imbalance and increased risk of breast cancer including:

• Declining levels of progesterone with age and/or with removal of the ovaries in hysterectomy
• Environmental, “xeno”-hormones in the form of pollutants and pesticides
• Oral contraceptives
• Synthetic hormone replacement therapy

These factors can contribute to an excess of estrogen in the body known as “estrogen dominance.” Since estrogen stimulates cell growth, a predominance of it, especially in the absence of adequate levels of progesterone (common in the menopausal years with the waning of ovulation), presents an increased risk of cancer, particularly in the breast.

Saliva testing in women with breast cancer often reveals a unique hormone profile. If you are interested in understanding your hormone status in regard to breast cancer, we recommend our Female/Male Saliva Profile II. This profile includes estradiol, progesterone, testosterone, DHEA-S, AM (morning) and PM (night) cortisols. For the most comprehensive assessment of hormonal imbalance, including tests for reproductive, adrenal, and thyroid hormone testing, consider ordering one of our Comprehensive Profiles.

Hypothyroidism or low thyroid is more common in women than men and often occurs during the perimenopausal and postmenopausal years. Approximately 26% of women in or near menopause are diagnosed with hypothyroidism. When estrogen is not counterbalanced with progesterone, a predominance of estrogen can inhibit the action of thyroid hormone at the cell level. Saliva hormone testing often reveals that women who are estrogen dominant tend to have menopausal symptoms associated with symptoms typically associated with low thyroid such as: feeling cold all the time, weight gain or inability to lose weight, thinning hair, sleep disturbances and fatigue, mood swings, depression, mental confusion, hair loss and low libido. Levels of the primary thyroid hormones can be tested as part of ZRT’s blood spot Thyroid Panel.

First, we recommend testing your hormones using Female/Male Saliva Profile I to determine the extent of estrogen dominance. If your progesterone/estradiol (Pg/E2) ratio is low, this indicates that progesterone levels are inadequate in relation to estrogen levels. This is a clear indication of estrogen dominance. If this is the case, it would be a good idea to talk to your health care provider about supplementing with bioidentical progesterone to balance estrogen levels. It is also helpful to monitor your symptoms and your hormone levels regularly while following a program of hormone balance. Other important steps to take include: reducing the use of pesticides, pollutants, and chemicals in your home; eating organic foods that are free of hormones and PCB sprays; maintaining an ideal weight (excess fat increases estrogen production); exercising regularly; and avoiding unnecessary stress whenever possible.

Insulin resistance occurs when cells “resist” the action of insulin to transport glucose into the cells of the body for energy production. Excess stress and lack of exercise in combination with simple sugars and carbohydrates cause the body to produce extra insulin in an attempt to normalize blood sugar levels. This results in overly high levels of insulin in the blood. Insulin resistance is associated with obesity, increased risk for Type 2 diabetes, and cardiovascular disease.

Blood spot testing provides a simple way to measure fasting insulin levels, particularly in people at risk for the condition. The test offers insight into imbalances in individuals who have symptoms despite a normal blood glucose test.

The following people are all strong candidates for testing:

• Individuals with known or suspected hypoglycemia, insulin resistance, diabetes, pre-diabetes, family history of diabetes, being overweight or obese.
• Women with irregular periods, scalp hair loss, increased facial or body hair, or polycystic ovarian syndrome.
• Individuals with symptoms of anxiety, palpitations, profuse sweating, fatigue, irritability, weakness, shakiness, dizziness, food or sugar cravings, excess weight around the waist, or high blood sugar levels.

Many people today suffer from the adrenal glands' inability to respond to stress. This condition stems from various factors including chronic stress, sleep deprivation, excess caffeine and carbohydrates, chronic pain, extreme exercise, and a generally unbalanced lifestyle. Also known as adrenal insufficiency, the problem shows up with a set of symptoms ranging from chronic fatigue to infertility. Those with a hectic lifestyle are potentially at risk, but the problem is more prevalent among medical professionals, police officers, executives, teachers, single working parents, or anyone who has a very stressful lifestyle.

Adrenal fatigue is tested by measuring cortisol, a key stress response hormone. Cortisol is produced by the adrenal glands 24 hours a day, although output varies at different times throughout the day. Cortisol output is highest upon waking to energize us for the day ahead and declines steadily throughout the day, reaching its lowest point at night in preparation for sleep. Individuals with adrenal fatigue have a flattened cortisol profile. This means that there is no morning surge of the hormone. Cortisol can be collected once in the morning or twice a day (morning and bedtime). It may be necessary to measure cortisol four times a day if levels are out of range and symptoms indicate the need to test adrenal function throughout the day.

Bioidentical hormones (BHRT) are hormone supplements made from natural, plant-based substances. They are identical in structure and function to those produced in the body. Bioidentical hormones are available by a doctor’s prescription through a compounding pharmacist who can tailor hormone supplements to meet individual needs. Natural progesterone, for example, is a bioidentical hormone as opposed to progestin, which is the synthetic version (denoting the “pro” in PremPro). Progesterone is available in a topical form over the counter. Progesterone is also available by prescription when combined with natural estrogens and other hormones by compounding pharmacists. To locate a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing, click Find a Provider.

These symptoms typically result from an estrogen deficiency and/or an imbalance between progesterone and estrogen. This type of imbalance is common in the perimenopausal years.

You were labeled postmenopausal based on the hysterectomy. Once a woman has had a hysterectomy, the surgery, regardless of her age, has forced her body into menopause. If the ovaries are also removed, hormone production from that primary source stops overnight. Regardless of whether the ovaries are removed, it is often the case that removal of the uterus significantly reduces blood flow to the ovaries, which in turn shuts down ovarian function within a few years of the surgery.

Phytoestrogens are part of the family of plant phytochemicals. These compounds have been shown to have health-supporting effects in the body. Phytoestrogens have weak estrogen-like activity. They can bind to and turn on estrogen receptors. But, since their binding power is much weaker than more potent estrogens like estradiol, their effect is more subtle and they do not carry the risks of estrogen replacement therapy. Many women searching for safe alternatives to HRT, like Black Cohosh and Dong Quai, are successfully using the phytoestrogens found in soy products and herbs for relief from the hot flashes and night sweats of menopause. However, it is important to consult with a qualified health care provider before using these plants medicinally over a prolonged period. Also, many of these herbs are contraindicated during pregnancy.

Soy needs to be used wisely. While soy contains phytoestrogens that can help balance your hormones, soy also has other phytochemicals called “phytates” that can block the absorption of necessary nutrients like zinc and iodine. This can disable necessary enzymes. The best way to eat soy is in its fermented form such as miso, tempeh, or tofu (especially in combination with fish proteins and seaweeds rich in minerals). Fermentation reduces the nutrient blocking effect of soy.

Other ideal plant sources that aid menopause relief are cruciferous vegetables like broccoli, cauliflower, and cabbage. These foods contain a substance called indole-3 carbinol, which encourages healthy estrogen metabolism. Onions, garlic, peppers, tomatoes, and citrus fruits also have properties that promote hormone balance.

Declining levels of testosterone and DHEA are commonly seen in men beginning in the fourth decade of life. These anabolic hormones are particularly important in men, as they are the major players in maintaining both physical and mental health. For example, they increase energy and decrease fatigue; they help in maintaining erectile function and normal sex drive; and they increase the strength of all structural tissues in the skin, bones, and muscles, including the heart. Proper levels of androgens also help to prevent depression and mental fatigue.

Yes, men do experience age-related changes in their hormone levels.

This hormonal decline, referred to as andropause, often coincides with symptoms of aging in males. The term andropause, named after the male hormones known as androgens, is the counterpart to menopause in women when production of estrogens and progesterone by the ovaries begins to decline. But, the drop is more gradual in men than the hormonal “roller coaster” so often experienced by women during menopause.

Stress management, exercise, proper nutrition, dietary supplements (particularly zinc and selenium), and androgen replacement therapy with physician guidance have all been shown to raise androgenlevels in men and help to counter andropause symptoms.

Yes. Undiagnosed hormonal imbalances are often linked to increased risks for prostate disease, low sex drive, rapid aging and poor quality of life in general. By having your hormones tested in saliva (Female/Male Saliva Profile I) or in blood spot (Male Blood Profiles I or II), one can identify the specific hormonal excesses and deficiencies associated with specific symptoms. Test results can facilitate safe, appropriate prescribing and adjustment of hormone therapy as needed.

For the best, most-comprehensive assessment of male hormone levels during the andropause years and/or for those men having suspected imbalances of thyroid and/or adrenal function, we recommend our Comprehensive Male Profile II. This profile tests all reproductive (sex) hormones, thyroid, and adrenal hormones with the added bonus of a PSA measurement (essential in men supplementing with testosterone to determine their prostate health status). We also provide a 5-hormone panel in saliva (Female/Male Saliva Profile I) that tests estradiol, progesterone, testosterone, DHEA-S, and cortisol levels. We also recommend Male Blood Profiles (I and II) in blood spot, both of which include: E2, T, SHBG, PSA, DS, C, estradiol, testosterone, SHBG, DHEA-S, and morning cortisol. Male Blood Profile IIalso tests our Complete Thyroid Profile (TSH, fT3, fT4, TPO).

Saliva testing can measure present hormone levels to identify the extent to which testosterone levels are low. Our test reports indicate an expected range enabling a person to compare his levels to the normal range. Saliva testing can also identify additional androgen hormone levels (such as DHEA-S and cortisol), which may contribute to a low testosterone reading. In blood spot, the level of testosterone available to the cells can be measured in concert with PSA, which is an important prerequisite for initiating testosterone supplementation. We can also provide informational materials for his physician and follow-up resources.

Yes! You will also receive additional information on hormones that you would not get from a standard serum test for infertility. For example, ZRT will test your stress hormone, cortisol, four times throughout the day to determine if your levels contribute to infertility. Low or high levels of cortisol can wreak havoc on the reproductive system and lead to infertility.

In a normal menstrual cycle, you would ovulate around day 14, counting day one as the first day of your period. If you have a fairly regular cycle of about 28 days, complete the test on day 21 and we will determine if you ovulated and produced adequate hormones to sustain a pregnancy. If your cycle is consistent, but is shorter or longer than 28 days, estimate when you would begin your period and count backwards 7 days. That would be equivalent to a collection on day 21 of your cycle.

Yes, that is certainly an option. However, ZRT developed this test to avoid the inconvenience of going to the lab drawing station or doctor’s office on specific days and specific times, and accrue the costs of scheduling a doctor visit and taking time off work. The ZRT blood collections are done early in the morning in the convenience and stress-free environment of your home, and are dependent on the timing of your cycle, which may not coincide with your doctors’ availability.

If you get your period irregularly, then wait until you have a period and collect your first sample 21 days after you begin bleeding. Then if you have your period on day 28, collect on day 3. If not, collect on day 38 (10 days after your first collection).

The lancets we use give a quick and nearly painless finger prick. However, if nervousness is an issue, ask someone such as your healthcare provider or a friend to help you. Once you've completed one finger prick, the next will seem simple.

A good bloodspot is no more than one drop per circle. It forms like a raindrop from your finger which can be lightly dropped onto the paper. Be careful not to touch your finger to the paper, but let the blood fall naturally. When the blood drop is adequate size, it should form a circle that fills almost the entire ring (about ¼”). Make sure not to overlap spots or put two drops of blood on top of each other.

Increasing your blood circulation will help greatly – just warming up your hands helps, but swinging your arms around or doing jumping jacks will get your blood flowing. It is also important to have the blood spot card immobilized in a place that is easy to reach once you have started the blood flow. Tape the card to the edge of a low table so your arm and hand hang downwards. Once you’ve pricked your finger with the lancet, place the hand over the card and begin collecting. If bleeding slows, very gently “milk” your finger from the top to the finger tip. Don’t squeeze the finger hard, as this will stop blood flow.

Yes. The ranges of bloodspot hormones are essentially identical to serum, so the hormone levels should be familiar to your doctor.

No, ZRT does not sell therapeutic products or provide treatment recommendations. However, we are happy to consult with your healthcare provider with regard to what treatment might be best for you.

If you don’t currently see a healthcare professional that specializes in fertility, use the “Find A Provider” function on our website to find a healthcare provider in your area. You may also want to talk to your OBGYN who can help you find a fertility specialist should one be needed.

Yes, and while we don’t recommend this test for issues related to male infertility, cortisol, thyroid, vitamin D3, testosterone and estradiol levels can all indicate infertility problems in men.

AMH is a very good test that is popular for assessing ovarian egg reserves. ZRT is looking into this test, but has not developed it yet. Elevated LH and FSH on day three of the menstrual cycle will give similar information as these tests indirectly indicate low egg reserve.

ZRT has worked with many healthcare providers who want to help women with fertility issues, but don’t know what tests to offer. We are using the same testing methods we have used for nearly fifteen years and have combined them in a convenient test that will help you find answers specifically related to infertility.

ZRT has worked with thousands of healthcare providers over the past fifteen years, and has provided tests for thousands of women that helped them find their reasons for infertility. We have many stories of women who now are moms because ZRT testing gave them answers to what their hormone problems were and helped guide their treatment. If you have a story like this, please let us know at info@zrtlab.com.

The key stress hormones secreted by our adrenal glands are cortisol, epinephrine and norepinephrine. ZRT can assess each of these by creating a diurnal curve (or four-point curve, or circadian pattern), achieved by taking four daily collections – typically done upon waking, before lunch, before dinner and before bed – and charting them on a 24-hour graph. Learn more about diurnal cortisol curves or diurnal epinephrine and norepinephrine curves.

Like our adrenal glands, which operate on a diurnal cortisol curve, melatonin also has a diurnal pattern. A normal curve shows melatonin rising during the night to peak during the early hours of the morning – generally 2am to 3am. Levels then drop with the onset of daylight and remain low throughout the day. Learn more about diurnal melatonin curves.

The hypothalamic-pituitary-adrenal axis (HPA axis) is a complex set of interactions among these three endocrine glands that affect many bodily functions, including our response to stress. Many of today’s health care providers are leaning away from the use of terms like “adrenal fatigue” and “adrenal exhaustion” to describe chronic stress conditions, turning instead to the more accurate and medically appropriate term HPA axis dysfunction to describe the many negative conditions related to the stress response. For more information, we recommend health care providers watch Dr. Thomas Guilliams’ Advances in the Treatment of HPA Axis Dysfunction webinar. For patients, we recommend Dr. Richard Shames’ Three-Legged Stool of Hormone Balance webinar.

The cortisol awakening response – also called CAR – reveals more detailed clues that help in assessing adrenal hormone dysfunction. During a normal cortisol awakening response, adrenal hormone levels should increase 50% in the first 30 minutes after waking for the day and then begin to progressively drop through the afternoon and evening. Learn more.