Blood Spot and Saliva Test Kits


Symptoms of hormone imbalance can be clarified through the use of saliva test kits and/or blood spot test kits. These easy to use saliva test kits are performed in the privacy of your home, convenient, inexpensive (no doctor’s visit required), and an accurate means of testing steroid hormones & cortisol.

Saliva/Blood Spot Testing Kits

(Please note: Saliva/Blood Spot Testing Kits are not eligible for return.)

Testing your hormones through saliva is convenient, inexpensive, and above all, an accurate means of testing steroid hormones. Scientific studies continue to show a strong correlation between steroid hormone levels in saliva and the amount of hormone in the blood that is active or "bioavailable." It is this fraction of total hormone that is free to enter the target tissues in the brain, uterus, skin, and breasts.

Another advantage to saliva testing is that it can be done anywhere anytime. Testing that relies on blood drawn in the doctor's office makes it harder to obtain samples at specific times (such as in the early morning) or multiple times during the day. Also, hormones in saliva are very stable and can actually be stored at room temperature for up to a week without affecting the accuracy of the result. For the consumer this means maximum flexibility in sample collection and shipment.

Individual hormones we test in saliva include: $50/individual hormone tested

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

Profiles we offer in Saliva:

  • Female/Male Saliva Profile I - $170.00
    (Five (5) Tests: Estradiol (E2), Progesterone (Pg), Testosterone (T),
    DHEA-S, and morning Cortisol (C1))
  • Female/Male Saliva Profile II - $200.00
    (Six (6) tests: Female/Male Saliva Profile I (E2, Pg, T, DS, and C1)
    + PM Cortisol.)
  • Female/Male Saliva Profile III - $260.00
    (Eight (8) tests: Female/Male Saliva Profile I (E2, Pg, T, DS, and C1) + noon,
    evening, and night Cortisol.)
  • Hormone Trio - $125.00
    (Three (3) Tests: Estradiol (E2), Progesterone (Pg), Testosterone (T).)
  • Adrenal Stress - $170.00
    (DHEA-S and diurnal cortisol (morning, noon, evening, nighttime)
  • Diurnal Cortisol - $135.00
    (Tests morning, noon, evening, and nighttime Cortisol)

Profiles we offer in the Saliva/Blood Spot Combo Kit:

  • Comprehensive Male Profile I  - $345.00
    E2, T, DS, Diurnal 4x Cortisol
    Blood spot: PSA, TSH, fT3, fT4, TPO
  • Comprehensive Male Profile II - $380.00
    Blood spot: E2, T, SHBG, DS, PSA, TSH, fT3, fT4, TPO
    Saliva: Diurnal 4x Cortisol
  • Comprehensive Female Profile I - $345.00
    Saliva: E2, Pg, T, DS, Diurnal 4x Cortisol
    Blood spot: TSH, fT3, fT4, TPO
  • Comprehensive Female Profile II - $380.00
    Blood spot: E2, Pg, T, DS, SHBG, TSH, fT3, fT4, TPO
    Saliva: Diurnal 4x Cortisol


Weight Management Profile - $335.00
The Weight Management Profile detects hormonal imbalances, thyroid and Vitamin D deficiencies linked to weight gain, obesity, and difficulty maintaining weight. Provides early detection of insulin resistance, metabolic syndrome, Type 2 diabetes. Includes blood spot:TSH, D2, D3, In, HbA1c; saliva: E2, Pg, T, DHEA(S), Diurnal 4x Cortisol.

Weight Management Profile + Thyroid - $405.00
The Weight Management Profile detects hormonal imbalances, thyroid and Vitamin D deficiencies linked to weight gain, obesity, and difficulty maintaining weight. Provides early detection of insulin resistance, metabolic syndrome, Type 2 diabetes. Includes Blood spot: TSH, D2, D3, In, HbA1c; Saliva: E2, Pg, T, DHEA(S), Diurnal 4x Cortisol.

Weight Management Profile + Cardio - $405.00
The Weight Management Profile detects hormonal imbalances, thyroid and Vitamin D deficiencies linked to weight gain, obesity, and difficulty maintaining weight. Provides early detection of insulin resistance, metabolic syndrome, Type 2 diabetes. Includes blood spot:TSH, D2, D3, In, HbA1c; saliva: E2, Pg, T, DHEA(S), Diurnal 4x Cortisol.

Weight Management Profile + Thyroid + Cardio - $475.00
The Weight Management Profile detects hormonal imbalances, thyroid and Vitamin D deficiencies linked to weight gain, obesity, and difficulty maintaining weight. Provides early detection of insulin resistance, metabolic syndrome, Type 2 diabetes. Includes blood spot:TSH, D2, D3, In, HbA1c; saliva: E2, Pg, T, DHEA(S), Diurnal 4x Cortisol.

Fertility Profile - $400.00
Assesses hormones associated with fertility. Includes Blood spot: E2, Pg, T, SHBG, DS, TSH, fT3, fT4, TPO, FSH, LH;
Saliva: Diurnal 4x Cortisol.

Essential Thyroid Profile - $175.00
Overall assessment of thyroid function. Includes: free Thyroxine (fT4), free Triiodothryronine (fT3), Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase Antibody (TPO). (Blood Spot Test)

Comprehensive Elements Profile - $340.00
Essential elements are only healthy when within optimal ranges. Levels too low or high can negatively impact our health, so it's important to know if our levels are outside the ideal range. This profile offers the top four most toxic heavy metals and reveals levels of certain nutritional elements. Tests in this profile include Dried Urine: Iodine, Bromine, Selenium, Arsenic, Cadmium, Mercury, Creatinine; and Blood Spot: Zinc, Copper, Magnesium, Cadmium, Lead, Mercury, Selenium.

Iodine Panel (Dried Urine) - $80.00
Iodine (I), Creatinine (Crtn)

Hormone Symptom Check Lists

Before deciding which hormones or hormone profiles to order please review the symptoms check list:
PDF Download-Symptom Checklist Women
PDF Download-Symptom Checklist Men



Hormonal imbalances play a part in many health-related problems. The following common conditions (listed alphabetically) are associated with hormonal imbalance.

Adrenal Insufficiency

The adrenal glands normally secrete cortisol in response to stress, exercise and excitement, and in reaction to low blood sugar.  However, too much physical or emotional stress over a prolonged period can cause the glands to reduce their output of adrenal hormones. This is of particular significance for women in midlife, as the adrenal glands become the main source of hormone production after menopause.
Common symptoms: fatigue, anxiety, nervousness, bone loss, increased abdominal fat, high blood sugar, allergies / asthma, arthritis, sleep disturbances, memory lapses, sugar cravings, chemical sensitivities, low energy.
Main hormones involved: cortisol, DHEA, progesterone.
Suggested test profile:  Diurnal Cortisol (Saliva) or Female/Male Saliva Profile II (Saliva)

Unlike menopause, the production of male hormones does not stop abruptly, but instead, hormone production by the testes (the male equivalent of the ovaries) tapers steadily with age. This physiological decrease can cause changes in sexual function, mood, energy level, and body composition.
Common symptoms: lower sex drive, erectile dysfunction, decreased muscle strength and mass, bone loss, decreased mental clarity, low energy level, fatigue, and other symptoms of male hormone imbalance.
Main hormones involved: testosterone, estrogen.
Suggested test profile: 
Female/Male Saliva Profile I (Saliva)  or Male Blood Profile II (Blood)

Benign Prostatic Hyperplasia (BPH)

Usually an age-related condition, BPH refers to a benign enlargement of the prostate gland.  Clearly defined risk factors include age and androgen levels, with most recent research indicating an association with estradiol levels.  Dihydrotestosterone and estrogens are known to stimulate prostate growth.
Common symptoms: urinary urgency, frequency, hesitancy, or retention; weak urine stream; dribbling; sleep disturbance; enlarged prostate on digital rectal exam.
Main hormones involved: testosterone, estradiol, PSA, SHBG
Suggested test profile:
Male Blood Profile II (Blood)

Breast Conditions

Breast tissue contains estrogen receptors. High levels of estrogen or an estrogen/progesterone imbalance (estrogen dominance) can be linked to premenstrual breast tenderness, fibrocystic breast changes, and breast cancer.
Common symptoms: breast pain, breast lumps.
Main hormones involved: estrogen, progesterone
Suggested test profile: 
Female/Male Saliva Profile II or III (Saliva)

CardioMetabolic Risk Syndrome

The cluster of modifiable risk factors and markers that identify individuals at increased risk for cardiovascular disease (myocardial infarction, stroke, peripheral arterial disease) and type 2 diabetes. This syndrome is a major risk factor for cardiovascular disease.
Common symptoms: hypertension/elevated blood pressure, abdominal obesity, atherogenic dyslipidemia (low HDL cholesterol, elevated triglycerides, elevated LDL cholesterol),
prothrombotic/proinflammatory state, insulin resistance/glucose intolerance.
Main hormones involved: insulin, total cholesterol, LDL cholesterol, Hemoglobin A1c (HbA1c), high-sensitivity C-Reactive Protein (hsCRP), triglycerides
Suggested test profile: 
CardioMetabolic Profile I (Blood) plus Diurnal Cortisol (Saliva) or CardioMetabolic Profile I (Blood) plus Female/Male Saliva Profile III (Saliva) or CardioMetabolic Profile I (Blood) plus Vitamin D, 25-OH, Total (Blood)


During a normal menstrual cycle the lining of the uterus, called the endometrium, thickens. This tissue is normally sloughed off during a woman’s period. With endometriosis, the endometrial tissue grows in places outside the uterus and can become inflamed. This usually occurs on the ovaries and other structures in the pelvis, such as the bladder. Endometrial tissue responds to estrogen. High levels of this hormone may aggravate the condition.
Common symptoms: pelvic pain, inflammation, menstrual irregularities, fertility problems
Main hormones involved: estrogen, progesterone
Suggested test profile: 
Female/Male Saliva Profile II or III (Saliva)

Erectile Dysfunction

Often referred to as “impotence”, erectile dysfunction is the inability to achieve and maintain an erection for satisfactory sexual intercourse.  As many as 30 million men in the US have some form of this problem.  Erectile dysfunction may be due to several factors, including testosterone deficiency and excessive stress hormones such as cortisol and elevated insulin.
Common symptoms:  inability to achieve or maintain an erection, decreased frequency of morning erections.
Main hormones involved: total testosterone, free testosterone, estradiol, SHBG, cortisol
Suggested test profile:
Male Blood Profile II

Estrogen Dominance

Estrogen and progesterone levels must be balanced to work together efficiently. Factors such as estrogens in foods and the environment, synthetic hormone use (HRT), and obesity expose women to excess estrogen. Also, progesterone levels tend to drop off sooner and more abruptly with age and lack of ovulation than does estrogen. These factors can result in too much estrogen relative to the amount of progesterone produced in the body. This imbalance is a common cause of symptoms during perimenopause and menopause, and can also occur after childbirth or during periods of high stress that can cause significant hormonal shift. Estrogen dominance may also be associated with thyroid problems and breast disease. In men, estrogen dominance may occur during andropause when testosterone levels decline relative to rising estrogen levels, increasing risks for prostrate problems and/or disease.
Common symptoms: heavy or irregular periods, tender breasts, bloating, irritability, mood swings, weight gain, sleep disturbances, and other symptoms of female hormone imbalance.
Main hormones involved: estrogen, progesterone
Suggested test profile: 
Female/Male Saliva Profile I, II, or III (Saliva) or Male Blood Profile II (Blood)

In this condition, the thyroid gland doesn’t produce enough thyroid hormone (T3/T4) or, thyroid hormones are blocked from performing their function by existing hormone imbalances. Low thyroid hormone levels cause body metabolism to slow down. Thyroid levels may be low for many years before symptoms become clearly noticeable. They are often confused with general age-related changes and are more common among women.
Common symptoms: fatigue; sluggishness, depression, low libido, cold hands and feet, feeling cold all the time, weight gain, inability to lose weight, thinning hair, brittle nails, dry skin.
Main hormones involved: thyroid hormones (T3/T4), thyroid stimulating hormone (TSH)
Suggested test profile: 
Complete Thyroid Profile (Blood)


In women, an imbalance of the female hormones can disrupt ovulation. It can also interfere with the ability of a fertilized egg to implant and develop in the uterus. Infertility can be associated with polycystic ovarian syndrome (PCOS) and endometriosis. In men, infertility may be associated with hormone imbalance that corresponds to low or poor sperm counts/function.
Common symptoms: problems becoming pregnant; inability to maintain a pregnancy.
Main hormones involved: estradiol, progesterone, testosterone, DHEA, cortisol, thyroid, FSH
Suggested test profile: 
Fertility Profile I (Saliva/Blood)

Difficulty initiating and maintaining sleep is a very common problem.  Causes of insomnia are numerous and may be related to hormone imbalance, medications, chronic disease, sleep apnea, and psychiatric conditions such as anxiety and depression.  Estrogen and progesterone deficiency in women, testosterone excess in men, and production of excessive stress hormones (cortisol) in men and women can cause or contribute to insomnia.
Common symptoms: inability to fall asleep or stay asleep, daytime fatigue.
Main hormones involved: estradiol, progesterone, testosterone, cortisol, thyroid
Suggested test profile:
Female/Male Saliva Profile III (Saliva)

 Insulin Resistance

The hormone, insulin, enables cells to convert food to energy. When cells become resistant to the effects of insulin or they lose their ability to respond to insulin (i.e., they become insulin resistant), the pancreas responds by making more of the hormone. This leads to overly high levels of insulin and glucose in the blood. Excess insulin signals cells to hold onto fat instead of using it for energy. This can lead to obesity, high blood pressure, abnormal triglyceride levels, problems processing blood glucose, polycystic ovarian syndrome (PCOS), and Type 2 Diabetes.Common symptoms: fatigue, foggy thinking, nervousness, increased abdominal fat, bloating, food cravings, hypoglycemia.
Main hormones involved: insulin, total cholesterol, LDL cholesterol, Hemoglobin A1c (HbA1c), high-sensitivity C-Reactive Protein (hsCRP), triglycerides.
Suggested test profile:  CardioMetabolic Profile I (Blood) plus Diurnal Cortisol (Saliva) or CardioMetabolic Profile I (Blood) plus Female/Male Saliva Profile III (Saliva)

Menopause and Perimenopause

Menopause refers to the normal decline in ovarian function that signals the end of a woman’s reproductive years. Once a woman has gone 12 consecutive months without a menstrual period, she is considered to have gone through menopause. The average age of menopause is 51. However, women can experience menopause-related changes much earlier. The time leading to the eventual end of menstruation, called perimenopause, is marked by fluctuating hormone levels (particularly estrogen and progesterone) and multiple symptoms.
Common symptoms: hot flashes, night sweats, mood swings, irritability, vaginal dryness, weight gain, memory lapses, and other symptoms of female hormone imbalance.
Main hormones involved: estrogen, progesterone, testosterone
Suggested test profile: 
Female/Male Saliva Profile I (Saliva)


Both men and women lose bone mass as they age. In women, declining production of estrogen and progesterone after menopause speeds up this process.  Decreasing levels of testosterone in women and men also play a role since these hormones stimulate prolonged bone growth. Existing imbalances of cortisol can also contribute to bone loss.
Common symptoms: thinning, brittle bones; fractures; loss of height.
Main hormones involved: estrogen, progesterone, testosterone, DHEA, cortisol, thyroid hormones
Suggested test profile: 
Female/Male Saliva Profile II or III (Saliva)

Polycystic Ovarian Syndrome (PCOS)

PCOS, is a condition in which cysts form in the ovaries, disrupting the process of ovulation. Infertility and other menstrual problems can occur as a result. Although the cause of the condition is unknown, it is marked by several hormonal imbalances, including the overproduction of androgens (testosterone) by the ovaries. Pituitary (FSH, LH), thyroid, and adrenal hormones are often out of balance as well. In addition, there is a strong link between PCOS, insulin resistance, and Type II Diabetes.

Common symptoms: infertility, menstrual irregularities, increased facial hair, acne, high blood pressure, male pattern balding, excess weight around the waist, high insulin levels, ovarian cysts.

Main hormones involved: estradiol, progesterone, testosterone, DHEA, thyroid, insulin

Suggested test profile: Female/Male Saliva Profile II (Saliva) or Fertility Profile I (Saliva/Blood)

Premenstrual Syndrome (PMS)

Female hormone levels rise and fall during the course of a normal menstrual cycle. These changes are responsible for triggering ovulation and menstruation. When hormones are in balance, a woman is less likely to experience PMS symptoms. For women who have one or more hormones out of balance, hormonal shifts during the menstrual cycle can bring uncomfortable physical or emotional symptoms. When PMS is severe, it can interfere with a woman’s daily functioning and quality of life.

Common symptoms: painful periods, bloating, breast tenderness, fatigue, irritability, tension, mood swings, depression, increased appetite, forgetfulness.

Main hormones involved: estrogen, progesterone

Suggested test profile:  Female/Male Saliva Profile I (Saliva)

Sexual Dysfunction

For men, sexual dysfunction may include decreased libido, erectile dysfunction, decreased ejaculation or other ejaculation disorders.  Women with sexual dysfunction may experience vaginal dryness, low libido, or anorgasmia (lack of orgasm).  Sexual dysfunction is often associated with chronic stress.  Although psychosocial factors are often related to sexual dysfunction in both women and men, hormone balance should also be assessed.

Common symptoms: low libido, erectile dysfunction, ejaculatory problems, anorgasmia.

Main hormones involved: estrogen, tesosterone, cortisol

Suggested test profile: Female/Male Saliva Profile I or II (Saliva)

Vitamin D Deficiency

Disorders linked to Vitamin D deficiency include stroke, cardiovascular disease, osteoporosis, osteomalacia, several forms of cancer, some autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and Type 2 Diabetes, and even Type 1 Diabetes (particularly in infants and children), depression, and schizophrenia2-12. A major culprit is inadequate sun exposure of the skin, usually for climatic or cultural reasons (even in countries near the equator, women in particular must have much of their skin area covered), and through the popular use of sunscreen. Vitamin D status is therefore an important screening test, especially for people who spend much of their time indoors, or who live in colder climates. Vitamin D testing may also be used to monitor supplementation to ensure that adequate blood levels are achieved.

Those at risk: elderly, dark-skinned, obese, those with limited sunlight exposure, breast-fed infants.

Main hormones involved:  Vitamin D2 and D3

Suggested test profile: Vitamin D, 25-OH, Total (Blood)

  1. Decide which hormone profile or specific hormone(s) you would like to test. (See Above)
  2. Order specific Saliva or Blood Spot Testing Kit.  All kits are pre-paid meaning that you do not have to send in any money with your test.
  3. Once test kit arrives, collect sample(s). Send sample(s) to lab (complete instructions included in kit).  Note:  Once the test has been mailed to the lab please allow at least 14 business days from the time the lab receives the results for processing.  This time varies and may be more or less.
  4. Receive comprehensive lab report emailed to you from OAW.
  5. Optional: Telephone consult with Naturopathic Practitioner (NP) Loretta Lanphier ($100.00/30 minutes) or your health care practitioner regarding the test results.  Consultations must be prepaid and are done by scheduled appointment only (phone 832.295.0560 to schedule your appointment). We do not diagnose any health concern.
  6. Saliva/Blood Spot Testing Kits are not eligible for return under any circumstances. All test kits must be used within 3 months of purchase.


What time of month should I collect my sample?

Men can collect at any time of the month.
Women who:

  • Do not have menstrual cycles can 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 cycles should collect day 19, 20 or 21 (counting the 1st day of bleeding as day 1)
  • Have irregular, unpredictable menstrual cycles can 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.

Are there specific herbal supplements/vitamins that can affect hormone levels?

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

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 two 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.

When can I test if I am taking hormones?

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): 36 hours after last dosage
  • 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.

When should I test if I am taking oral contraceptives?

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.

Should I avoid using non-prescription (over-the-counter) anti-aging cream before I test?

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

Should I collect a sample if I am sick?

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

When taking birth control pills, what tests are helpful?

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.

How do I collect a blood spot sample?

Within 30 minutes of waking, a few drops of blood from a quick and nearly painless nick of the finger, using the kit enclosed lancets, are placed on a filter paper. 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.

How do I collect my saliva?

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.

How much saliva do I need to collect?

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

How are the large and small test tubes in the kit to be used?

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).

What do I do if I'm having a difficult time collecting enough saliva?

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.

I ate breakfast and/or brushed my teeth and then started collecting my saliva. Should I start over again?

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.

Should vigorous exercise be avoided the day before saliva collection for cortisol (adrenal function)?

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.

I have diabetes and have to eat when I get up. Can I eat before I take the test?

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.

Due To State Law

California State residents:

CA State health law does not allow the testing of specimens collected or mailed from California without a written order from a health care professional licensed to prescribe in California (M.D.; N.D.; D.C.; D.O.; N.P.; and L.Ac.). These sites will help you order online, with a health care provider licensed in the state of California.

Maryland State residents:

MD State health law prohibits ZRT Laboratory from processing Internet orders for Maryland State residents at this time.

New York State residents:

NY State health law prohibits ZRT Laboratory from processing Internet orders for New York State residents at this time.

All Testers:

ZRT is a CLIA certified lab that provides the service of collecting and analyzing specimen samples. You will be submitting health information and ordering tests for informational purposes only. ZRT has a contracted licensed physician who will review your request and authorize the testing service you are purchasing. You are responsible for taking the test results to your primary care physician for any additional interpretation and neither the physician authorizing the test, nor ZRT, are diagnosing or treating any condition through your use of this service.

Lab Quality Standards

While quality assurance in customer service, materials and resources is important, quality assurance in the laboratory is mandatory.  ZRT strives to maintain reliable, consistent and accurate results.  The following are some of the many quality assurances that are part of the ZRT difference:

C.L.I.A. certified since 1999: No. 38D0960950
   Clinical Laboratory Improvement Amendments (C.L.I.A.) regulates laboratories nationwide and certifies them in laboratory procedures.

• ZRT participates in C.A.P. (College of American Pathologists) testing
   Blind samples are used to assess the precision and accuracy of laboratory procedures.

• Innovative robotic technology
   Decreases the possibility of human error.

• 8 controls in every 96 test assay kit
   Known samples are tested to ensure consistent results.

• Certified medical technologists perform all assays
With backgrounds from some of the best known labs in the country and more than 130 years of combined experience.

• Assays are reviewed by the lab supervisor or director
If ZRT quality standards are not met, the entire assay is repeated.

• ZRT physicians review all results
This includes reviewing symptoms, supplementation and other medications, as well as lab results.  If results do not correlate with clinical information they are sent back for confirmation.

• Superior laboratory leadership
Staff includes 3 PhDs (molecular biochemistry, biophysics, and biochemistry) and one Master of Science in forensic chemistry.

• Publishing and Research
   ZRT innovative testing has been published in peer-reviewed journals for its part in research, as well as for establishing excellent blood spot testing methodology.

• PhD memberships in professional organizations
   American Association of Clinical Chemists, American Diabetes Association, the American Society for Bone and Mineral Research, American Association of Bioanalysts, the Endocrine Society, American Association for Cancer Research and the American Chemical Society.

Published Articles About Saliva & Blood Spot Testing

“Physical Competition Increases Dehydroepiandrosterone (DHEA) and Androstenedione rather than Testosterone among Juvenile Boy Soccer Players.” McHale TS, Zava DT, Hales D, Gray PB. Adaptive Human Behavior & Physiology, July 2015; online ahead of print.

Summary: Using highly sensitive liquid chromatography/tandem mass spectrometry, the saliva steroids DHEA, androstenedione, cortisol, and testosterone were assayed in saliva samples from boys aged 8-10 collected during soccer practice and soccer match competition. Testosterone levels were below the sensitivity of the assay in most cases (<3 pg/mL), but a statistically significant rise in DHEA was seen during both practice and match play, while androstenedione significantly increased during match play only. Cortisol/DHEA ratios were calculated, and these showed a significant decrease during practice but not during match play. This is the first known study of the impact of athletic competition on salivary steroids in juvenile boy athletes, and it indicates that adrenal hormone release is affected by physical competition and is different to hormonal changes seen in adult males. See full article.

“Vitamin D Deficiency and Its Predictors in a Country with Thirteen Months of Sunshine: The Case of School Children in Central Ethiopia.”  Wakayo T, Belachew T, Vatanparast H, Whiting SJ. PLoS ONE, 2015;10(3):e0120963.

Summary: ZRT’s blood spot vitamin D testing was used in this study examining vitamin D status in schoolchildren living in the sunny climate of Ethiopia.  Vitamin D deficiency, defined as 25-hydroxyvitamin D levels <50 nmol/L (equivalent to <20 ng/mL) was significantly more prevalent in children living in an urban environment (61.8%) compared with those in a rural setting (21.2%).  Significant predictors of vitamin D deficiency included body fatness, having a TV/computer at home, maternal education, and socioeconomic status.  This study highlights lifestyle factors that can predispose people to vitamin D deficiency even in countries with high sun exposure. See full article.

"Associations Between Vitamin D Levels and Depressive Symptoms in Healthy Young Adult Women." Kerr DCR, Zava DT, Piper WT, Saturn SR, Frei B, Gombart AF. Psych Res 2015; March [in press].

Summary: To investigate the relationship between vitamin D sufficiency and depression, 180 healthy young women completed surveys to assess depressive symptoms at baseline and then once a week for 4 weeks, and serum vitamin D levels were determined at baseline and 4 weeks.   A high rate of vitamin D insufficiency, defined as levels <30 ng/mL, was seen, occurring in 42% and 46% of the women at baseline and week 4, respectively.  Lower vitamin D levels were related to clinically significant depressive symptoms. Purchase full article.

"A Pilot Study Evaluating the Effectiveness of a Mindfulness-Based Intervention on Cortisol Awakening Response and Health Outcomes Among Law Enforcement Officers." Christopher MS, Goerling RJ, Rogers BS, Hunsinger M, Baron G, Bergman AL, Zava DT. J Police Criminal Psych 2015; January [in press].

Summary: The effectiveness of an 8-week mindfulness-based resilience training program was studied in 43 police officers to determine its potential for mitigating job-related stress. Cortisol was tested in saliva samples collected 0, 30, and 45 minutes after waking on a day prior to starting the program, and again within 5 days after completing the program, to assess the cortisol awakening response as a stress marker. The program significantly improved mindfulness, resilience, stress, burnout, emotional factors, and mental and physical health. The cortisol awakening response was not significantly different after the program compared to before, however the area under the curve for cortisol at the three time points was lower after the program and correlated significantly with the improvement in mental health symptoms. Purchase full article.

"Steroid Hormone Testing in Different Body Fluids." Zava DT. Townsend Letter 2015; January.

Summary: This article examines the issues surrounding hormone testing for progesterone after topical delivery. Despite demonstrable clinical efficacy, serum and urine progesterone levels do not increase after application of topical progesterone, whereas saliva and capillary blood spot tests do show a dose-dependent increase that indicates efficient tissue uptake of the hormone. The article concludes that saliva and capillary blood spot testing, but not serum or urine testing, can be used to monitor topical progesterone therapy. See full article.

“Proinflammatory Cytokines and DHEA-S in Women with Fibromyalgia: Impact of Psychological Distress and Menopausal Status.”  Sturgeon JA, Darnall BD, Zwickey HL, Wood LI, Hanes DA, Zava DT, Mackey SC. J Pain Res, 2014;7:707-16.

Summary: Serum levels of proinflammatory cytokines (interleukins 6, 8, and 10 and TNF-α) and blood spot DHEA-S were measured in pre- and postmenopausal women suffering from fibromyalgia, and their relationships with reported pain intensity and level of psychological distress were examined.  There were significant relationships between IL-8 and pain-related symptoms and depression, and the ratio of IL-6 to IL-10 was significantly lower in individuals with greater levels of depressive symptoms.  Although the decline in DHEA-S levels with age has been suggested to be related to the onset of fibromyalgia symptoms across the lifespan, in this study DHEA-S levels did not correlate with pain intensity, psychological distress or cytokine levels. See full article.

"The trouble with topical progesterone and testing." Zava DT. Townsend Letter 2014; January.

Summary: This article examines the issues surrounding hormone testing for progesterone after topical delivery. Despite demonstrable clinical efficacy, serum and urine progesterone levels do not increase after application of topical progesterone, whereas saliva and capillary blood spot tests do show a dose-dependent increase that indicates efficient tissue uptake of the hormone. The article concludes that saliva and capillary blood spot testing, but not serum or urine testing, can be used to monitor topical progesterone therapy. See full article.

"Editorial: Percutaneous absorption of progesterone." Zava DT, Groves MN, Stanczyk FZ. Maturitas 2014; 77:91-92.

Summary: This editorial discusses the absorption of progesterone when applied to the skin in topical formulations, referring to our study recently published in Menopause (Du et al., 2013). A reliance on serum levels to assess progesterone absorption from topical formulations could lead to over-use of progesterone in an attempt to achieve levels that counteract the proliferative actions of estrogens used in menopausal hormone therapy. Saliva and capillary blood spot are better choices than serum testing for topically delivered progesterone. Purchase full article

"Theodore Zava Responds.” Zava TT. Townsend Letter 2013; November.

Summary: This is a response to a letter criticizing the conclusions made in our previous article, published in Townsend Letter in January 2013, concerning evaluation of the iodine loading test. The response answers all of the concerns raised in this letter and urges its authors to ensure that their patients are correctly assessed for whole-body iodine sufficiency. See full article.

"Percutaneous progesterone delivery via cream or gel application in postmenopausal women: a randomized cross-over study of progesterone levels in serum, whole blood, saliva, and capillary blood."  Du JY, Sanchez P, Kim L, Azen CG, Zava DT, Stanczyk FZ. Menopause 2013; 20(11):1169-1175.

Summary: Saliva, capillary blood spot, serum, and whole venous blood levels of progesterone were measured after application of progesterone cream or gel in 10 postmenopausal women in this randomized, cross-over study using ZRT testing.  While serum and whole venous blood levels rose slightly, peaking at around 8 hours after application, saliva levels peaked earlier and were 10 fold higher than serum and venous whole blood levels; capillary blood spot levels were 100-fold higher than serum and whole venous blood, peaking at 8 hours after application.  The much higher levels in saliva and blood spot than in serum and venous blood indicate a high level of absorption of progesterone cream and its transport to tissues, and demonstrate the lack of utility of serum measurements, which underestimate progesterone absorption, to monitor topical progesterone treatment. See article abstract.

"Evaluation of the Iodine Loading Test: Urine Iodine Excretion Kinetics after Consumption of 50 mg Iodine/Iodide."  Zava T.  Townsend Letter 2013; January. 

Summary: This study at ZRT Laboratory analyzed iodine excretion before and after a 50 mg loading dose of iodine/iodide, to determine whether a popular "iodine loading test" can accurately determine iodine sufficiency.  The study concluded that the cutoff of 90% excretion used in this test does not allow it to realistically assess whole body iodine sufficiency or deficiency.  See full article.

“Iodine and creatinine testing in urine dried on filter paper.” Zava TT, Kapur S, Zava DT.  Anal Chim Acta 2013; 764:64-69.

Summary: This paper describes ZRT Laboratory’s novel test in dried urine for iodine and creatinine.  This test makes urine collection for iodine testing simple and convenient, unlike typical liquid urine collections over 24 hours. See full article.

"Testosterone implants in women: Pharmacological dosing for a physiologic effect." Glaser R, Kalantaridou S, Dimitrakakis C. Maturitas 2013;74(2):179-84. 

Summary: ZRT dried blood spot testing was used in this study investigating testosterone levels in women who received subcutaneous testosterone implants.  Testosterone levels were found to fluctuate throughout the day in a similar manner to the circadian variation seen with endogenous testosterone release.  See article abstract.

"Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention." Garland CF, French CB, Baggerly LL, Heaney RP. Anticancer Research 2011; 31(607-612).

Summary: This study used ZRT's Vitamin D testing to examine the relationship of measured vitamin D status to vitamin D supplementation, both as practiced by health conscious individuals and as related to cancer prevention. See full article.

"Assessment of Japanese iodine intake based on seaweed consumption in Japan: A literature-based analysis." Zava TT, Zava DT. Thyroid Res 2011; 4 (1):14.

Summary: This thorough review of the pertinent literature clears up much of the confusion surrounding the iodine content of the Japanese diet.  The authors present a combined analysis based on dietary recall studies, surveys, urinary iodine testing, and the iodine content of various seaweeds, and estimate the average Japanese iodine intake to be between 1 and 3 milligrams per day. See full article.

“Agreement of blood spot card measurements of vitamin D levels with serum, whole blood specimen types and a dietary recall instrument.”  Larkin EK, Gebretsadik T, Koestner N, Newman MS, et al.  PloS ONE 2011;6(1).

Summary: This study found relatively good agreement between 25-hydroxy vitamin D measurements using blood spot cards, serum, and whole blood samples.  The authors note that dried blood spot samples are less invasive than traditional venipuncture and provide a convenient method for assessing vitamin D status in population studies and in children.  See full article.

“Low salivary testosterone levels in patients with breast cancer.” Dimitrakakis C, Glaser R, Zava D, Marinopoulos S, Tsigginou A, Antsaklis A. BMC Cancer 2010; 10(547):1-8.  

Summary: The role of endogenous hormones in breast cancer was studied using saliva testing of 347 women with breast cancer and 184 age-matched control women.  The women with breast cancer had significantly lower salivary testosterone, estriol, and DHEA-S levels than the controls, while estradiol and estrone levels were higher in the breast cancer cases than the controls.  The authors suggest that bioavailable testosterone protects against the proliferative effects of estrogens on breast tissue. See full article.

"Female social and sexual interest across the menstrual cycle: the roles of pain, sleep and hormones.” Guillermo CJ, Manlove HA, Gray PB, Zava DT, Marrs CR. BMC-Womens Health 2010; 10(19):1-10.  

Summary: Saliva testing was used to study changing hormone levels throughout the menstrual cycle in healthy women, who were either taking oral contraceptives or were not using oral contraceptives.  Hormones tested were DHEA-S, progesterone, cortisol, testosterone, estradiol, and estriol.  Estrogen levels correlated with socio-sexual and physical activity during menstruation and the luteal phase in the non-OC users, but these activities were more closely associated with progesterone, cortisol, and DHEA-S in the OC users throughout the cycle.  OC users showed higher overall social and physical attraction.  The authors conclude that a broader range of hormones could be associated with sexual attraction than previously thought. See full article.

“Postprandial insulin and triglycerides after different breakfast meal challenges: use of finger stick capillary dried blood spots to study postprandial dysmetabolism.”  Kapur S, Groves MN, Zava DT, Kapur S.  Journal of Diabetes Science and Technology 2010; 4(2):236-243.

Summary: Dried blood spot technology was used to study the phenomenon of postprandial dysmetabolism, which has been characterized by sustained high levels of insulin and triglycerides in the blood after eating.  This has been found to increase risk of atherosclerosis and coronary heart disease, but routine monitoring of dysmetabolism in the general population is hampered by the inconvenience of blood collection.  The study demonstrated the ease of repeated blood spot collection at various times after eating typical breakfast meals.  It also showed differences in levels of insulin and triglycerides after eating the different meals, which varied in nutritional content.  Dried blood spots were found to be a convenient and simple tool to look at the effects of different diets on postprandial dysmetabolism.  This method could therefore be used in larger-scale studies of the effects of diet on cardiometabolic risk. See article abstract. To purchase the full article, visit the journal’s website at

“Poster presentation report: safety of maternal testosterone therapy during breast feeding.”  Glaser RL, Newman M, Parsons M, Zava D, Glaser-Garbrick D.   International Journal of Pharmaceutical Compounding, 2009: 13(4):314-7.

Summary: This article summarizes a poster presentation from the 13th Annual International Congress on Steroidal Hormones and Cancer in September 2008 (the poster is included in the list below).  The study found that in a woman undergoing testosterone supplementation for relief of depression, anxiety, irritability, memory loss, aches, and pains, testosterone was not passed on to her nursing infant during breast feeding.  Blood spot testosterone levels were measured in the mother, her infant, and breast milk.  Testosterone levels were increased during therapy in the mother’s blood, but not in the breast milk or in the infant’s blood. See article abstract. To purchase the full article, visit the journal’s website at

“The physiologic role and use of estriol.”  Paoletti JE.  International Journal of Pharmaceutical Compounding, 2009: 13(4):270-5.

Summary: Estriol is one of the three main circulating estrogens in the body.  The author explains the role of estriol in the body, particularly in protecting against breast cancer, and therefore the importance of balancing the estradiol/estriol ratio in women using bioidentical hormone restoration therapy. See article abstract. To purchase the full article, visit the journal’s website at

“A liquid chromatography/tandem mass spectrometry method for determination of 25-hydroxy vitamin D2 and 25-hydroxy vitamin D3 in dried blood spots: a potential adjunct to diabetes and cardiometabolic risk screening.” Mark S. Newman, Theodore R Brandon, Margaret N. Groves, William L. Gregory, Sanjay Kapur, David T. Zava. Journal of Diabetes Science and Technology 2009; 3(1):156-62. 

Summary: This study demonstrated an excellent correlation between levels of 25-hydroxy vitamin D2 and 25-hydroxyvitamin D3 in blood spots and serum, allowing the blood spot assay to be used for accurate assessments of vitamin D status in screening situations. Low levels of vitamin D have been linked to both type I and type II diabetes, and vitamin D deficiency is also emerging as a risk factor for cardiovascular disease. The paper discusses these implications. See the article abstract. To purchase the full article, visit the journal’s website at

“Differentiation and treatment of hypothyroidism, functional hypothyroidism and functional metabolism.” Paoletti JE. International Journal of Pharmaceutical Compounding, 2008; 12(6): 489-497. 

Summary: This article looks at the different levels at which thyroid production, metabolism, and dysfunctions of utilization can lead to classical symptoms of hypothyroidism. An understanding of how to use and interpret thyroid function measurements to allow determination of where the problems exist, and how to choose appropriate treatment, is presented also. See the article abstract. To purchase the full article, visit the journal’s website at

“Pilot study: absorption and efficacy of multiple hormones delivered in a single cream applied to the mucous membranes of the labia and vagina.” Glaser RL, Zava DT, Wurtzbacher D. Gynecologic and Obstetric Investigation 2008; 66(2):111-8. 

Summary: This is the first study to document absorption of multiple hormones applied topically to the vagina by measuring their levels in both saliva and blood. Hormones included in the cream were estriol, estradiol, progesterone, DHEA, and testosterone. There was a measurable increase in health-related quality of life after using the cream in the 12 postmenopausal women involved in the study. See the article abstract. To access the full article, visit the publisher’s website.

"Cardiometabolic risk factors assessed by a finger stick dried blood spot method." Sanjay Kapur, PhD, Sonia Kapur, PhD, and David Zava, PhD. Journal of Diabetes Science and Technology 2008; 2(2): 236-241. 

Summary: This article describes analytical methods for measurement of insulin, high-sensitivity C-reactive protein, and triglycerides from dried blood spots and validation of these methods by comparison with analysis performed in serum. The article shows that dried blood spot samples may be used as the sample of choice when convenience is desired and in situations where conventional blood collection is not available. See the article abstract. To access the full article, visit the journal’s website at

“Analysis of the Use of Dried Blood Spot Measurements in Disease Screening." Ramakrishnan Lakshmy, Ph.D. Journal of Diabetes Science and Technology 2008; 2(2): 242-243. 

Summary: The use of dried blood spots for the measurement of insulin, high sensitivity C-reactive protein, and triglycerides is reported in this article. A good correlation between measurement of these analytes in dried blood and serum suggests that the method is valid and has the potential to be used for the screening of cardiometabolic risk factors. While this article is not a ZRT publication, it is included here because it mentions ZRT's Research Director, Sanjay Kapur, and his article listed above indicating that there is good correlation between dried capillary blood and serum obtained through venipuncture. See the article abstract. To access the full article, visit the journal’s website at

"A comparison of blood spot vs. plasma analysis of gonadotropin and ovarian steroid hormone levels in reproductive-age women." Edelman A, Stouffer R, Zava DT, Jensen JT. Fertility and Sterility 2007; 88(5): 1404-1407. 

Summary: This article documents a study comparing LH, FSH, progesterone, and estradiol levels obtained from blood spot versus plasma and concludes that blood spot testing can be just as valid as blood serum testing in documenting circulating hormone levels seen during ovulatory cycles. See the article abstract. To access the full article, click here for purchase options: Elsevier Full-Text Article link.

“Correcting misconceptions about compounding bioidentical hormones: a review of the literature.”  Paoletti J.  International Journal of Pharmaceutical Compounding 2007;11(4):269-272.

To purchase the full article, visit the journal’s website at

“Saliva hormone testing.” David Zava, PhD, Townsend Letter for Doctors and Patients 2004; January:120-124.

Summary: This review discusses the rationale for, as well as advantages and disadvantages, of saliva testing. It describes and explains the phenomenon of higher saliva than serum levels of hormones when they are delivered topically, and details how salivary hormone testing can help detect hormone imbalances that affect health and wellbeing. See full article.

“A perspective on hormone replacement for women: picking up the pieces after the Women’s Health Initiative Trial.”  Gillson GR, Zava DT.  Part 1 – International Journal of Pharmaceutical Compounding 2003;7(4):250-256. Part II – International Journal of Pharmaceutical Compounding 2003;7(5):330-358.

To purchase the full articles, visit the journal’s website at

“The hormonal link to breast cancer: the estrogen matrix.”  Zava, DT.  International Journal of Pharmaceutical Compounding 2002:6(4):250-254.

Summary: The biochemical and hormonal imbalances that increase the levels of unopposed estrogens in breast tissue, and therefore increase the risk of breast cancer, are described.  Factors leading to increased risk include obesity, conventional HRT, pollutants, stress, and adrenal dysfunction. To purchase the full article, visit the journal’s website at

“Overall self-confidence, self-confidence in mathematics, and sex-role stereotyping in relation to salivary free testosterone in university women.” Johnson W, Zava D, McCoy N. Perceptual and Motor Skills 2000; 91(2):391-401. 

Summary: The relationship between salivary free testosterone levels and measures of self-confidence was studied in 40 young women. See the article abstract.

“Estrogen and progestin bioactivity of foods, herbs, and spices.”  Zava DT, Dollbaum CM, Blen M.  Proceedings of the Society for Experimental Biology and Medicine 1998;217(3):369-378. 

Summary: This study demonstrates that various common foods, herbs, and spices contain phytoestrogens and phytoprogestins, which then exert biological activity when consumed. See the article abstract.


How does saliva testing work?

The 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 the lab has received your sample, results will be returned to OAW in approximately 5 to 7 business days.

What saliva tests does OAW offer?

We offer the following seven hormones in saliva:

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

How accurate is saliva testing compared to blood and urine testing?

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. The World Health Organization has used this method of hormone testing in worldwide comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. 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.

Which saliva tests will give me a comprehensive picture of my hormone levels?

The 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.

Should I test estriol and/or estrone?

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.


Blood Spot testing is the future of blood testing. The process requires only blood from a nearly painless finger prick and several tests can be run from a single sample. Blood spot testing provides results on a par with those from serum tests but without the cost and inconvenience of conventional blood drawing.  In addition, collection times can be optimized for fasting baseline hormone levels and assessment of HRT dosing and diurnal hormone testing.

Why would I choose blood spot testing over saliva or blood serum testing?

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 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

How are finger-stick dried blood spot and venipuncture blood serum different?

First, one 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.

Are hormone results from blood spots different from conventional venipuncture serum?

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.

Are there any special precautions to take when collecting blood spots?

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 two days prior to collection. Skip use of 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.

Can whole blood from serum venipuncture be used for the dried blood spot test?

Again, this is a yes and no answer. 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.

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

Saliva testing measures the free or bioavailable fraction of hormone. Does blood spot testing measure the same thing?

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.


Where do I begin to determine whether my hormones are balanced?

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.

My symptoms suggest that I have a hormone imbalance, but how do I find out for sure?

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.

What is the link between polycystic ovaries and hormonal imbalance?

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.

What is the link between uterine fibroids and hormonal imbalance?

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.

What is the link between hormonal imbalance and breast cancer?

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.

What can hormone testing tell me if I have breast cancer?

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.

What is the link between thyroid function and hormonal imbalance?

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 the blood spot Thyroid Panel.

What can I do to prevent estrogen dominance?

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.

What is insulin resistance and how do you test for it?

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.

Am I a candidate for the fasting insulin 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.

What is adrenal fatigue and how is it tested?

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.



What is Bioidentical Hormone Replacement Therapy (BHRT)?

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.

Why do women experience vasomotor symptoms such as hot flashes and night sweats?

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.

I am referred to as “postmenopausal” in the comment section of my saliva test report but I do not believe I am in menopause. Am I classified this way because my hormone levels suggest that or because I had a hysterectomy?

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.

What about phyto (plant) estrogens for menopause relief?

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.

What about using soy products for menopause relief?

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.



Do men have a menopause?

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 androgen levels in men and help to counter andropause symptoms.

Do you test for hormonal imbalances in men?

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.

Which hormone tests are recommended for men?

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 II also tests our Complete Thyroid Profile (TSH, fT3, fT4, TPO).

My husband has symptoms of low testosterone. Can saliva hormone testing help?

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.


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