Female Comprehensive Hormone Profile I | Specialist Doctor Report Included

Test ID: SB-644 | Saliva 4-Point Cortisol + Blood Spot LCMS Hormones 7 with SHBG + Full Thyroid Panel

The Female Comprehensive Hormone Profile I is an advanced at-home health assessment for women measuring 18 key hormones and markers across three interconnected systems: the full daily cortisol stress rhythm by 4-point saliva testing, a complete blood spot LCMS sex hormone panel including SHBG, and a full thyroid panel including autoimmune antibodies. Using saliva 4-point cortisol, blood spot LCMS sex hormones, SHBG, and a full thyroid antibody panel, this profile delivers the hormonal and thyroid picture that standard NHS testing cannot — without the cardiometabolic panel included in higher-tier profiles.

In women, the cortisol daily rhythm, sex hormones, SHBG, and thyroid function are mechanistically inseparable. The morning cortisol awakening response sets oestrogen receptor sensitivity, progesterone availability, SHBG hepatic synthesis, and thyroid T3 activation for the entire day. Cortisol elevation at any time point suppresses progesterone via pregnenolone steal, creates oestrogen dominance, elevates SHBG to reduce bioavailable oestradiol and testosterone, and impairs thyroid T4-to-T3 conversion — all simultaneously. Hashimoto’s thyroiditis is present in women for years before TSH becomes abnormal and is directly worsened by the same cortisol and SHBG changes this panel measures. No standard blood panel assesses all three systems together. This one does.

Test from home with confidence — no clinic visit required. Results within 3–5 working days.

Why Cortisol Rhythm, SHBG, and Thyroid Health Must Be Assessed Together in Women

• The 4-point cortisol rhythm is the master regulator of SHBG, sex hormone bioavailability, and thyroid T3 activation in women — the morning cortisol awakening response determines oestrogen receptor sensitivity, progesterone availability, SHBG synthesis rate, and the thyroid’s capacity to convert T4 to active T3 before any other system begins functioning; elevated cortisol at any of the four time points suppresses progesterone, elevates SHBG, drives oestrogen dominance, and impairs T4-to-T3 conversion simultaneously; only four-time-point measurement reveals which phase of the day is responsible and which hormonal or thyroid mechanism is the primary driver
• SHBG is the bioavailability gatekeeper for all sex hormones in women — and is directly controlled by cortisol and thyroid status — elevated SHBG from cortisol excess, thyroid disease, oestrogen, or HRT/pill use binds and inactivates oestradiol and testosterone regardless of how much the ovaries and adrenals produce; a woman with normal total oestradiol and testosterone but elevated SHBG has full hormonal deficiency symptoms; measuring SHBG alongside the 4-point cortisol rhythm and full thyroid panel identifies the specific mechanism driving SHBG elevation and the downstream hormonal consequences
• Thyroid dysfunction in women is systematically under-detected by TSH alone and is directly driven by cortisol and SHBG changes — cortisol-driven T4-to-T3 conversion impairment produces functional hypothyroidism with normal TSH; elevated SHBG from thyroid disease or HRT alters the free-to-total thyroid hormone ratio; Hashimoto’s autoimmunity is present for years before TSH becomes abnormal and is worsened by cortisol dysregulation at any time point; all three patterns are invisible to TSH alone and directly measurable by this panel
• Progesterone deficiency, oestrogen dominance, and SHBG elevation are all cortisol-driven and thyroid-compounded in women — cortisol suppresses progesterone via pregnenolone steal; progesterone deficiency removes the counterbalance to oestrogen, creating oestrogen dominance; low thyroid function independently elevates SHBG, worsening the oestradiol and testosterone deficiency that follows; and the entire sequence — from cortisol elevation to symptom onset — is only characterisable when all three systems are measured simultaneously
• Night cortisol elevation worsens Hashimoto’s autoimmunity directly through sleep-deprivation immune dysregulation in women — elevated night cortisol suppresses overnight progesterone and oestradiol synthesis, impairs sleep-phase immune regulation, and drives TPO and Tg antibody activity; women with night cortisol elevation consistently show faster Hashimoto’s progression and more severe thyroid symptom burden; this is only detectable by the 4-point cortisol assessment in this panel

What This Test Measures — 18 Markers Across Three Systems

Saliva — 4-Point Cortisol Profile (4 markers)

• Morning Cortisol (Cortisol Awakening Response): Sets oestrogen receptor sensitivity, progesterone availability, SHBG hepatic synthesis rate, and thyroid T3 activation for the entire day. An exaggerated morning response drives progesterone suppression, oestrogen dominance, SHBG elevation, and morning thyroid T3 impairment; a blunted awakening response signals HPA burnout, reduced thyroid T3 activation, and diminished oestrogen receptor responsiveness that persists through the entire day.
• Noon Cortisol: Elevated noon cortisol drives progesterone depletion, SHBG rise, visceral fat deposition, and aromatase-driven oestrone excess; directly impairs thyroid T4-to-T3 conversion at the cellular level during the peak metabolic activity window — the mechanism by which chronic midday occupational or psychological stress accelerates hormonal and thyroid deterioration in women.
• Evening Cortisol: Should decline significantly to allow progesterone, oestradiol, and growth hormone to rise during early sleep cycles. Elevated evening cortisol suppresses overnight sex hormone production, maintains SHBG elevation into the night, prevents the progesterone rise that drives restorative sleep, and sustains thyroid T3 impairment — producing next-day fatigue, mood instability, and worsening hormonal function regardless of morning values.
• Night Cortisol: Suppresses overnight progesterone and oestradiol synthesis; drives SHBG elevation through sleep-phase hepatic cortisol-SHBG coupling; impairs the sleep-phase immune regulation that controls Hashimoto’s TPO and Tg antibody activity; and directly worsens thyroid autoimmune progression through sleep-deprivation-mediated immune dysregulation — making night cortisol the most underassessed driver of Hashimoto’s in women.

Blood Spot LCMS — Sex Hormones & SHBG (8 markers)

• Oestradiol (E2): The primary premenopausal oestrogen — protecting cardiovascular health, bone density, insulin sensitivity, thyroid hormone binding, and mood stability. Declining E2 in perimenopause simultaneously triggers hormonal symptoms and thyroid vulnerability. SHBG determines how much E2 is actually bioavailable — making the E2 + SHBG combination the definitive oestrogenic status assessment in women. Measured by blood spot LCMS for accuracy across the full hormonal range.
• Oestriol (E3): Reflects oestrogen conversion and metabolic processing. The E3-to-E2 and E3-to-E1 ratios reveal how oestrogen is being metabolised — relevant for thyroid interaction, immune modulation, and overall hormonal balance in women.
• Oestrone (E1): The dominant postmenopausal oestrogen, produced by adipose conversion of androgens. Elevated E1 in women with visceral fat or cortisol-driven adrenal excess drives oestrogenic load; declining E1 in lean postmenopausal women reflects total oestrogenic deficit and accelerating thyroid vulnerability.
• Progesterone (Pg): The essential counterbalance to oestrogen — anti-inflammatory, thyroid-supportive, SHBG-modulating, sleep-promoting, and cortisol-protective. Low progesterone from anovulation, chronic stress, luteal phase deficiency, or perimenopause drives oestrogen dominance, allows cortisol-driven thyroid suppression to go unopposed, and directly worsens Hashimoto’s autoimmune activity. The most commonly undertreated hormonal deficiency in perimenopausal women.
• Testosterone (T): Essential in women for energy, libido, muscle mass, metabolic rate, and bone density. Low testosterone reduces lean mass and worsens metabolic resilience. SHBG critically determines how much testosterone is bioavailable — making the T + SHBG combination the definitive androgenic status assessment in women.
• DHEAS (DS): The primary adrenal androgen precursor in women, declining from the mid-30s and depleted under chronic cortisol elevation. Low DHEAS reduces oestrogen and testosterone precursor availability, impairs stress resilience, and has direct anti-inflammatory and thyroid-supportive effects. The 4-point cortisol rhythm reveals the HPA dysregulation mechanism driving DHEAS depletion.
• Cortisol (C) — Blood Spot LCMS: The single blood spot cortisol measurement by LCMS provides a direct comparator to the 4-point saliva cortisol rhythm, enabling cross-matrix validation and confirming the diurnal pattern with blood spot LCMS precision — the most complete cortisol assessment available in an at-home test without a cardiometabolic panel.
• Sex Hormone Binding Globulin (SHBG): The bioavailability gatekeeper for all sex hormones in women. Elevated SHBG — driven by cortisol, thyroid disease, oestrogen, and HRT/pill use — binds and inactivates oestradiol and testosterone regardless of their production levels, causing full hormonal deficiency symptoms in women with normal total hormone values. Essential for interpreting oestradiol, testosterone, and progesterone accurately in women on HRT or the contraceptive pill, or with thyroid disease, cortisol dysregulation, or perimenopause.

Blood Spot — Full Thyroid Panel (6 markers)

• TSH: Essential first-line thyroid marker — but in women, TSH alone misses cortisol-driven T3 suppression, SHBG-related thyroid binding changes, and Hashimoto’s autoimmunity present years before TSH becomes abnormal. Necessary but not sufficient.
• Free T3 (FT3): The active thyroid hormone — the most clinically important marker for women with thyroid symptoms and normal TSH. Low FT3 with normal TSH is the hallmark of cortisol-driven thyroid suppression — directly identifiable by correlating the 4-point cortisol rhythm with the FT3 result in a single integrated report.
• Free T4 (FT4): The thyroid’s primary output hormone. Low FT4 with normal TSH indicates early thyroid insufficiency — particularly relevant for women on HRT or the pill, where elevated SHBG increases thyroid-binding globulin and alters T4 availability — a relationship this panel contextualises directly.
• Total T4 (TT4): Provides full T4 context including the bound fraction — important where oestrogen and SHBG levels affect thyroid hormone binding, particularly during perimenopause, HRT, and thyroid medication use.
• TPO Antibodies (Anti-TPO): The primary diagnostic marker for Hashimoto’s thyroiditis in women. Frequently elevated years before TSH becomes abnormal; associated with progressive thyroid decline, fatigue, weight gain, hair loss, and depression; and directly worsened by cortisol dysregulation at any time point — directly measurable alongside the 4-point cortisol rhythm in this panel.
• Thyroglobulin Antibodies (Anti-Tg): Essential second Hashimoto’s marker. Some women have elevated Tg antibodies with normal TPO — making both necessary for complete autoimmune thyroid assessment. Night cortisol elevation worsens Tg antibody activity through sleep-deprivation immune dysregulation — detectable only by the 4-point cortisol assessment in this panel.

Who Should Consider This Test?

This test is particularly relevant for women who:

• Have persistent fatigue or exhaustion that does not improve with rest
• Experience unexplained weight gain or difficulty losing weight
• Feel cold, have temperature sensitivity, or notice a slow metabolism
• Have hair thinning, dry skin, or brittle nails
• Experience PMS, heavy, irregular, or absent periods, or breast tenderness
• Are experiencing perimenopausal or menopausal symptoms: hot flushes, night sweats, low mood
• Have low libido or reduced sexual interest
• Experience brain fog, poor concentration, or memory issues
• Have anxiety, irritability, or emotional volatility — especially in the second half of the cycle
• Struggle with insomnia, night waking, or unrefreshing sleep
• Are under chronic stress or experiencing burnout
• Have diagnosed or suspected PCOS, Hashimoto’s thyroiditis, or oestrogen dominance
• Are on HRT or the contraceptive pill (where SHBG assessment is essential for accurate hormone interpretation)
• Are on levothyroxine and want complete thyroid monitoring alongside hormones and cortisol
• Have had thyroid or hormone testing with normal results that do not match symptoms
• Want a comprehensive hormonal and thyroid assessment without a cardiometabolic panel
• Are women over 35 seeking a hormonal, SHBG, cortisol rhythm, and thyroid baseline

How This Profile Differs From Other Hormone Lab UK Tests

The Female Comprehensive Hormone Profile I (SB-644F) provides the 4-point cortisol rhythm, full LCMS sex hormones + SHBG, and full thyroid panel — without the cardiometabolic panel (fasting insulin, HbA1c, HDL, triglycerides, cholesterol, hsCRP). It is the ideal choice for women who want the complete cortisol-SHBG-hormone-thyroid assessment and do not currently require cardiometabolic markers, or who are adding targeted metabolic testing separately.

Women who want the cardiometabolic panel alongside this assessment should consider the Female Comprehensive Hormone, Thyroid & CardioMetabolic Profile (SB-646F), which adds six cardiometabolic markers to this complete panel.

Key Features

• 18-marker tri-system panel: 4-point saliva cortisol rhythm, blood spot LCMS sex hormones + SHBG, and full thyroid panel including TPO and Tg antibodies
• 4-point cortisol profile — morning, noon, evening, and night — the only method revealing the full daily cortisol rhythm and its SHBG-mediated and thyroid-mediated effects on female hormonal balance
• Blood spot LCMS sex hormones — gold standard accuracy across the full hormonal range
• SHBG included — essential for accurate interpretation of oestradiol and testosterone in women on HRT, the pill, or with thyroid disease or cortisol dysregulation
• All three oestrogens (E1, E2, E3) for complete oestrogen metabolism and dominance assessment
• Full 6-marker thyroid panel including TPO and Tg autoimmune antibodies for Hashimoto’s screening
• Results within 3–5 working days after lab receipt
• Expert analysis by a Hormone Specialist PhD Doctor
• Clear graphical and numerical results with personalised commentary
• All-inclusive price — laboratory fees included, no hidden costs
• Valid for 12 months from purchase

How It Works

1. Order the kit online — delivered directly to your door.
2. Collect your saliva samples at four time points (morning, noon, evening, night) for the cortisol rhythm panel, and your blood spot sample via a simple finger-prick for the LCMS hormone, SHBG, and thyroid panels. Guidance on optimal cycle timing and morning collection for cortisol accuracy is included.
3. Post your samples to the lab using the return instructions in your kit.
4. Receive your results within 3–5 working days with specialist commentary and clear next-step guidance.

What Your Report Includes

• All 18 marker results with female-specific reference ranges
• Visual cortisol rhythm chart showing your full four-point daily curve
• Visual charts for all six sex hormones, SHBG, and the full thyroid panel
• Integrated clinical interpretation of how your cortisol rhythm, sex hormones, SHBG, and thyroid markers interact as a single female hormonal system
• SHBG-adjusted free hormone bioavailability assessment for oestradiol and testosterone
• Oestrogen-progesterone dominance ratio analysis in cortisol and SHBG context
• Cortisol-thyroid T3 conversion interaction assessment — mapping each cortisol time point to FT3 and functional thyroid status
• Hashimoto’s autoimmunity assessment (TPO + Tg antibodies) in cortisol and SHBG context
• Night cortisol – Hashimoto’s progression risk assessment
• Specialist commentary by a Hormone Specialist PhD Doctor
• Personalised next-step recommendations

Frequently Asked Questions

What does this test measure?

4-point saliva cortisol (morning, noon, evening, night) + Oestradiol (E2), Oestriol (E3), Oestrone (E1), Progesterone, Testosterone, DHEAS, Cortisol, SHBG (blood spot LCMS) + TSH, Free T3, Free T4, Total T4, TPO Antibodies, Thyroglobulin Antibodies (blood spot) — 18 markers in total.

Does this test include cardiometabolic markers?

No. This profile covers the cortisol rhythm, sex hormones, SHBG, and full thyroid panel. Women who also want fasting insulin, HbA1c, HDL, triglycerides, cholesterol, and hsCRP should consider the Female Comprehensive Hormone, Thyroid & CardioMetabolic Profile (SB-646F), which adds six cardiometabolic markers to this complete panel.

Why is TSH alone not enough to assess thyroid health in women?

TSH measures the pituitary’s signal to the thyroid — not the active T3 reaching cells. Cortisol-driven T3 suppression produces functional hypothyroidism with normal TSH. Hashimoto’s autoimmunity causes progressive thyroid damage for years before TSH becomes abnormal. SHBG and oestrogen changes alter thyroid hormone binding, affecting T4 availability without changing TSH. All three patterns produce full thyroid symptoms and are invisible to TSH alone — all three are directly assessed by this panel alongside the cortisol rhythm and SHBG that drive them.

Why do I need SHBG alongside my hormone results?

SHBG binds and inactivates oestradiol and testosterone. A woman with normal total oestradiol and testosterone but elevated SHBG — caused by cortisol, thyroid disease, HRT, or the pill — may have full hormonal deficiency symptoms despite normal-range hormone values. SHBG is essential for interpreting every sex hormone result accurately — particularly in women on HRT or the contraceptive pill, where SHBG is profoundly elevated and bioavailable hormone levels may be far lower than total values suggest.

Is this test suitable for women on HRT or the contraceptive pill?

Yes — and it is particularly valuable for these women. HRT and the pill significantly elevate SHBG, which inactivates oestradiol and testosterone and increases thyroid-binding globulin, affecting FT4 interpretation. Without SHBG measurement, hormone and thyroid results in women on HRT or the pill cannot be accurately interpreted. This panel provides SHBG alongside the full hormone, cortisol, and thyroid assessment needed for complete clinical picture.

Is this test suitable for women with PCOS or Hashimoto’s?

Yes. In PCOS, testosterone, SHBG, 4-point cortisol, and thyroid antibodies together provide the complete androgenic, cortisol, and autoimmune picture that no standard test achieves. In Hashimoto’s, TPO and Tg antibodies are assessed alongside the 4-point cortisol rhythm — including night cortisol, which directly drives Hashimoto’s progression through sleep-phase immune dysregulation.

When in my cycle should I collect?

Guidance on optimal cycle timing is included in your kit. For most women, blood spot collection in the luteal phase (days 19–21 of a 28-day cycle) provides the most clinically meaningful progesterone and oestrogen values. Morning saliva should be collected before 9am for optimal cortisol awakening response accuracy.

When will I get my results?

Within 3–5 working days after your samples reach the laboratory.

Are there hidden costs?

No. Laboratory analysis and specialist review are fully included. You are responsible for postage to the lab.

How long is the kit valid?

12 months from purchase.

Why We Partner with ZRT Laboratory

At Hormone Lab UK, every home test kit is analysed by ZRT Laboratory, a globally recognised, CLIA-certified diagnostic and research laboratory specialising in hormone testing, thyroid testing, fertility testing, adrenal function, neurotransmitter analysis, cardiometabolic health, heavy metals, and wellness testing. Founded in 1998 by renowned biochemist and breast cancer researcher Dr. David Zava, PhD, ZRT has become one of the world’s leading laboratories for advanced functional health testing.

With more than 11 million laboratory tests performed and healthcare professionals in over 96 countries relying on its expertise, ZRT is recognised for scientific excellence, analytical accuracy, and continuous innovation. The laboratory pioneered at-home saliva hormone testing, introduced the first commercially available dried blood spot (DBS) hormone tests, and developed Dried Urine Testing (DUTS), helping make advanced laboratory diagnostics more accessible and clinically meaningful.

Every sample is analysed using state-of-the-art LC-MS/MS and ICP-MS technology under rigorous quality control standards. ZRT collaborates with the CDC, NIH, and leading universities, supporting ongoing research and advances in laboratory medicine.