Female Comprehensive Hormone, Thyroid & CardioMetabolic Profile | Specialist Doctor Report Included

Test ID: SB-646 | Saliva 4-Point Cortisol + Blood Spot LCMS Hormones 7 with SHBG + Full Thyroid & CardioMetabolic Panel

The Female Comprehensive Hormone, Thyroid & CardioMetabolic Test is the most complete at-home health profile available for women anywhere in the UK, measuring 24 key hormones and markers across four interconnected systems in a single kit: the full daily cortisol stress rhythm, a complete blood spot LCMS sex hormone panel including SHBG, the full thyroid panel including autoimmune antibodies, and a six-marker cardiometabolic panel. It is the only at-home test to combine a 4-point saliva cortisol assessment with blood spot LCMS sex hormones, SHBG, a full thyroid antibody panel, and fasting insulin — providing the complete hormonal-thyroid-metabolic picture that standard NHS testing cannot.

In women, these four systems are a single integrated regulatory network. The morning cortisol awakening response sets thyroid T3 activation, oestrogen receptor sensitivity, and insulin sensitivity for the entire day. Cortisol suppresses progesterone via pregnenolone steal, drives oestrogen dominance, impairs thyroid T4-to-T3 conversion, elevates SHBG, and causes insulin resistance — simultaneously. Oestrogen decline in perimenopause removes thyroid-binding protection, insulin sensitisation, and HDL support at the same time. Hashimoto’s thyroiditis is worsened by insulin resistance and cortisol dysregulation and is present in women for years before TSH becomes abnormal. And SHBG — elevated by cortisol, oestrogen, and hypothyroidism — determines how much of every sex hormone is actually bioavailable. No standard blood panel tests all four systems together. This one does.

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

The Female Hormonal System: Why All Four Must Be Tested Together

• The 4-point cortisol rhythm is the master regulator of all three other systems in women — the cortisol awakening response sets daily thyroid T3 activation, oestrogen receptor sensitivity, and insulin sensitivity before any other system operates; elevated cortisol at any time point suppresses progesterone via pregnenolone steal, impairs thyroid T4-to-T3 conversion, elevates SHBG, promotes visceral fat and insulin resistance, raises triglycerides, suppresses HDL, and elevates hsCRP; only four-time-point measurement maps the full daily rhythm — a single cortisol value cannot identify morning-normal/evening-elevated patterns, blunted awakening response with midday excess, or night cortisol elevation that suppresses overnight sex hormone production and worsens Hashimoto’s autoimmunity
• SHBG is the bioavailability gatekeeper for every sex hormone in women — elevated SHBG binds and inactivates oestradiol and testosterone regardless of their total production; cortisol, thyroid disease, oestrogen, and insulin all independently alter SHBG levels in women; a woman with normal oestradiol and testosterone but elevated SHBG has the hormonal symptoms of oestrogen and androgen deficiency; SHBG measurement is essential for interpreting every sex hormone result in women, particularly those on HRT or the contraceptive pill where SHBG is profoundly elevated
• Thyroid dysfunction in women is systematically under-detected by TSH alone and worsened by every other system assessed here — cortisol-driven T3 suppression produces functional hypothyroidism with normal TSH; Hashimoto’s autoimmunity is present for years before TSH becomes abnormal and is directly worsened by elevated cortisol and insulin resistance; oestrogen alters thyroid hormone binding; and SHBG changes alter the free-to-total thyroid hormone ratio; all four interactions are only visible when all four systems are assessed simultaneously
• Insulin resistance in women is hormonally multi-factorial and detectable years before standard tests — cortisol drives hepatic insulin resistance; progesterone deficiency and oestrogen decline remove insulin-sensitising effects; PCOS creates insulin resistance even in lean women; hypothyroidism compounds all three; and elevated SHBG may conceal the testosterone-insulin relationship in PCOS; fasting insulin is elevated years before HbA1c or fasting glucose becomes abnormal — the most actionable early marker of a process that worsens every other system assessed by this panel
• hsCRP is the convergence biomarker of all four systems in women — elevated simultaneously by cortisol dysregulation at any time point, progesterone deficiency and oestrogen imbalance, Hashimoto’s autoimmunity, insulin resistance, and visceral fat; a stronger independent predictor of cardiovascular disease in women than LDL cholesterol; and a direct measure of the integrated inflammatory load that only a four-system assessment can fully attribute and target

What This Test Measures — 24 Markers Across Four Systems

Saliva — 4-Point Cortisol Profile (4 markers)

• Morning Cortisol (Cortisol Awakening Response): Sets thyroid T3 activation, oestrogen receptor sensitivity, insulin sensitivity, and progesterone availability for the entire day. An exaggerated morning response drives progesterone suppression, oestrogen dominance, and morning insulin resistance; a blunted awakening response signals HPA burnout, impaired thyroid activation, and reduced immune and reproductive hormone responsiveness that persists through the day.
• Noon Cortisol: Elevated noon cortisol drives visceral fat deposition, impairs thyroid T4-to-T3 conversion, promotes aromatase-driven oestrogen excess, raises triglycerides via hepatic lipid dysregulation, and suppresses HDL — the direct mechanism by which chronic midday stress accelerates cardiometabolic and thyroid deterioration in women during the working day.
• Evening Cortisol: Should decline significantly to allow oestrogen, progesterone, and growth hormone to rise during early sleep cycles. Elevated evening cortisol suppresses overnight sex hormone production, elevates SHBG, maintains insulin resistance into the night, and impairs thyroid cellular uptake — producing next-day fatigue, mood instability, and worsening metabolic function regardless of the morning value.
• Night Cortisol: Drives sleep-phase suppression of progesterone and oestrogen synthesis; promotes visceral fat accumulation, fasting insulin elevation, and hsCRP rise overnight; and directly worsens Hashimoto’s autoimmune activity through sleep-deprivation-mediated immune dysregulation — the mechanism by which poor sleep quality is both a symptom and a driver of autoimmune thyroid progression in women.

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

• Oestradiol (E2): The primary premenopausal oestrogen — driving reproductive health, bone density, cardiovascular protection, insulin sensitivity, thyroid hormone binding, and mood stability. Declining E2 in perimenopause simultaneously triggers hormonal symptoms, thyroid vulnerability, and the cardiovascular risk shift that characterises the menopausal transition. Measured by blood spot LCMS for accuracy across the full hormonal range from peak premenopausal to postmenopausal levels.
• 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 cardiovascular, cancer, and thyroid risk assessment in women.
• Oestrone (E1): The dominant postmenopausal oestrogen, produced by adipose conversion of androgens. Elevated E1 in women with visceral fat drives oestrogenic load and metabolic inflammation; declining E1 in lean postmenopausal women reflects total oestrogenic deficit and accelerating thyroid and cardiometabolic vulnerability.
• Progesterone (Pg): The essential counterbalance to oestrogen — anti-inflammatory, cardioprotective, thyroid-supportive, sleep-promoting, and insulin-sensitising. Low progesterone from anovulation, chronic stress, luteal phase deficiency, or perimenopause drives oestrogen dominance, worsens insulin resistance, elevates hsCRP, allows cortisol-driven thyroid suppression to go unopposed, and is the most commonly inadequately treated 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 insulin resistance; elevated testosterone in PCOS drives insulin resistance, visceral fat, and cardiometabolic risk. SHBG critically alters the interpretation of testosterone in women — making the combined T + SHBG result the definitive assessment of androgenic status.
• 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 insulin-sensitising effects. DHEAS decline is a significant contributor to the thyroid and cardiometabolic deterioration of perimenopause and postmenopause.
• 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 cortisol validation and the most clinically complete cortisol assessment available in an at-home test. Confirms the diurnal pattern identified by the saliva rhythm with the precision of blood spot LCMS measurement.
• Sex Hormone Binding Globulin (SHBG): The bioavailability gatekeeper for all sex hormones in women. Elevated SHBG — driven by cortisol, oestrogen, thyroid disease, and HRT/pill use — binds and inactivates oestradiol and testosterone regardless of their production levels, causing full hormonal deficiency symptoms in women with normal-range total hormone values. SHBG is essential for interpreting oestradiol, testosterone, and progesterone results accurately — and for calculating true free hormone availability in women on HRT or the contraceptive pill.

Blood Spot — Full Thyroid Panel (6 markers)

• TSH: Essential first-line thyroid marker — but in women, TSH alone misses cortisol-driven T3 suppression, oestrogen-related thyroid binding changes, SHBG-thyroid interactions, 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, which increase thyroid-binding globulin and alter T4 availability — a relationship that SHBG measurement in this panel contextualises directly.
• Total T4 (TT4): Provides full T4 context including the bound fraction — important for women where oestrogen and SHBG levels affect thyroid hormone binding and the free-to-total T4 ratio, 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, and depression; and directly worsened by insulin resistance and cortisol dysregulation — both measured by this panel across four time points and six cardiometabolic markers.
• 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-mediated immune dysregulation — directly measurable by the 4-point cortisol rhythm in this panel.

Blood Spot — CardioMetabolic Panel (6 markers)

• Fasting Insulin: The earliest detectable marker of insulin resistance in women — elevated years before HbA1c or fasting glucose becomes abnormal. Driven by cortisol at any time point, low progesterone, oestrogen decline, PCOS, and hypothyroidism. Elevated fasting insulin promotes visceral fat, raises triglycerides, suppresses HDL, worsens thyroid antibody activity, elevates SHBG in some women (worsening androgenic deficiency in PCOS), and drives the hormonal cycle of oestrogen dominance. The most actionable early metabolic marker available to women with hormonal and thyroid symptoms.
• HbA1c: Reflects average blood sugar over 8–12 weeks. Women’s risk of pre-diabetes and type 2 diabetes rises markedly in perimenopause and postmenopause as oestrogen’s insulin-sensitising effects are lost; HbA1c contextualises the fasting insulin result with medium-term blood sugar trajectory and anchors the full cortisol-thyroid-insulin interaction assessment.
• HDL Cholesterol: The protective cardiovascular fraction supported by oestradiol and suppressed by elevated cortisol, insulin resistance, and hypothyroidism simultaneously. HDL fall in perimenopausal women is a predictable, directly hormonal event — measurable alongside oestradiol, cortisol, and thyroid markers in a single panel.
• Triglycerides: Elevated by cortisol at any of the four time points, insulin resistance, oestrogen decline, and hypothyroidism simultaneously — all assessed here. Often rise before LDL changes and are a primary cardiometabolic risk marker particularly relevant for perimenopausal, postmenopausal, PCOS, and hypothyroid women.
• Total Cholesterol: Directly elevated by oestrogen decline and hypothyroidism. Rising cholesterol in perimenopausal or postmenopausal women is frequently a combined hormonal and thyroid event — best understood alongside the oestradiol, cortisol, and thyroid markers this panel measures directly.
• hsCRP (High-Sensitivity C-Reactive Protein): A stronger independent predictor of cardiovascular disease in women than LDL cholesterol. Elevated simultaneously by cortisol dysregulation at any time point, progesterone deficiency, oestrogen decline, Hashimoto’s autoimmunity, and insulin resistance — all five pathways directly and comprehensively assessed by this panel. The convergence biomarker of the female hormonal-thyroid-metabolic system.

Who Should Consider This Test?

This is the most appropriate test for women who:

• Have persistent fatigue, low energy, or exhaustion that does not improve with rest
• Experience unexplained weight gain or difficulty losing weight despite diet and exercise
• Feel cold, have temperature sensitivity, or notice a slow metabolism
• Have hair thinning, dry skin, or brittle nails
• Experience sugar cravings, energy crashes, or afternoon slumps
• Have elevated cholesterol or triglycerides on previous testing
• Experience PMS, heavy, irregular, or absent periods, or breast tenderness
• Are experiencing perimenopausal or menopausal symptoms: hot flushes, night sweats, low mood, vaginal dryness
• Have low libido, reduced sexual interest, or difficulty with arousal
• 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 currently on HRT or the contraceptive pill (especially where SHBG assessment is essential for accurate hormone interpretation)
• Are currently on levothyroxine and want complete thyroid monitoring alongside hormone levels
• Have had previous thyroid or hormone testing with normal results that do not match their symptoms
• Have a family history of thyroid disease, diabetes, heart disease, or metabolic syndrome
• Are women over 35 seeking the most comprehensive at-home hormonal, thyroid, and cardiometabolic health assessment available

Key Features

• 24-marker quad-system panel: 4-point saliva cortisol rhythm, blood spot LCMS sex hormones + SHBG, full thyroid panel, and full cardiometabolic panel — the most comprehensive at-home female health test available in the UK
• 4-point cortisol profile — morning, noon, evening, and night — the only measurement method that reveals the full daily cortisol rhythm and its effects on all other systems
• Blood spot LCMS sex hormones — gold standard accuracy across the full hormonal range
• SHBG included — the bioavailability key for interpreting oestradiol, testosterone, and progesterone in women on HRT, the pill, or with PCOS
• 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
• Six cardiometabolic markers — fasting insulin, HbA1c, HDL, triglycerides, total cholesterol, hsCRP
• 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, thyroid, and cardiometabolic panels, following the detailed instructions. 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 24 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, the full thyroid panel, and all six cardiometabolic markers
• Integrated clinical interpretation of how your cortisol rhythm, sex hormones, SHBG, thyroid markers, and cardiometabolic results interact as a single female hormonal-metabolic system
• SHBG-adjusted free hormone bioavailability assessment for oestradiol and testosterone
• Oestrogen-progesterone dominance ratio analysis in cortisol context
• Cortisol-thyroid T3 conversion interaction assessment — directly mapping each cortisol time point to FT3 and functional thyroid status
• Hashimoto’s autoimmunity assessment (TPO + Tg antibodies) in cortisol, insulin, and SHBG context
• Insulin resistance pattern assessment (fasting insulin + HbA1c)
• Cardiovascular risk profile in full female hormonal and thyroid context (HDL, triglycerides, cholesterol, hsCRP)
• 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) + Fasting Insulin, HbA1c, HDL Cholesterol, Triglycerides, Total Cholesterol, hsCRP (blood spot) — 24 markers in total.

How does this test differ from the Female Advanced Hormone, Thyroid & CardioMetabolic Test?

The Female Comprehensive test (SB-646F) adds three significant capabilities over the SB-649F: the full 4-point cortisol daily rhythm (morning, noon, evening, night) replacing a single cortisol value — essential for identifying which part of the day is driving cortisol-related hormonal, thyroid, and metabolic symptoms; SHBG measurement — the bioavailability gatekeeper that determines how much of every sex hormone is actually active in tissue; and a blood spot LCMS cortisol comparator for cross-matrix cortisol validation. It is the most comprehensive at-home female health assessment available.

Why do I need SHBG tested alongside my hormones?

SHBG binds and inactivates sex hormones in the bloodstream. A woman with normal oestradiol and testosterone production but elevated SHBG — caused by cortisol, thyroid disease, HRT, or the contraceptive pill — may have full symptoms of hormonal deficiency despite normal total hormone values. SHBG is essential for interpreting oestradiol, testosterone, and progesterone accurately in any woman on hormonal contraception or HRT, or with PCOS, thyroid disease, or cortisol dysregulation.

Why is a 4-point cortisol rhythm more informative than a single cortisol measurement?

A single cortisol measurement captures only the level at one moment and cannot identify the pattern — whether the morning awakening response is blunted or exaggerated, whether cortisol elevates at midday or evening, or whether it is suppressing overnight sex hormone production. A blunted morning + elevated evening pattern produces completely different hormonal, thyroid, and metabolic effects than an elevated morning + declining-normally pattern — yet both may show a similar single measurement. The four-point rhythm reveals which phase of the day is driving the cortisol-related components of your symptoms.

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

Yes — and it is the most appropriate test for these women. HRT and the pill significantly elevate SHBG, which alters the bioavailability of all sex hormones and increases thyroid-binding globulin, affecting FT4 interpretation. Without SHBG measurement, hormone results in women on HRT or the pill cannot be accurately interpreted. This is the only at-home test that provides SHBG alongside the full hormone, cortisol, thyroid, and cardiometabolic panel.

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

Yes — this is the most comprehensive assessment available for both. In PCOS, the combination of testosterone, SHBG, fasting insulin, 4-point cortisol, and thyroid antibodies provides the complete picture of androgenic, metabolic, and autoimmune status that no standard test achieves. In Hashimoto’s, TPO and Tg antibodies are assessed alongside the cortisol rhythm and insulin markers that directly drive autoimmune thyroid progression.

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.