Male CardioMetabolic & Hormone Profile | Specialist Doctor Report Included

Test ID: SB-645 | Saliva 4-Point Cortisol + Blood Spot LCMS Hormones 7 with SHBG & CardioMetabolic Panel

The Male CardioMetabolic & Hormone Profile is an advanced at-home health assessment for men 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 six-marker cardiometabolic panel. It combines the 4-point saliva cortisol awakening response and diurnal rhythm with blood spot LCMS sex hormones, SHBG, and fasting insulin — providing the hormonal and metabolic picture that standard NHS testing cannot achieve without thyroid assessment.

In men, testosterone, cortisol, SHBG, and insulin are mechanistically inseparable. The morning cortisol awakening response sets Leydig cell testosterone output, hepatic SHBG synthesis, and insulin sensitivity for the entire day. Chronic cortisol elevation depletes testosterone via pregnenolone steal and direct Leydig cell suppression, simultaneously elevates SHBG to inactivate the testosterone that remains, and drives insulin resistance, visceral fat accumulation, triglyceride elevation, and hsCRP. The result is a man with normal total testosterone, elevated SHBG, suppressed free testosterone, insulin resistance, and cardiovascular inflammation — all caused by the same cortisol pattern, but invisible without measuring all three systems at once.

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

Why Cortisol Rhythm, SHBG, and CardioMetabolic Health Must Be Assessed Together in Men

• The 4-point cortisol rhythm determines free testosterone availability via SHBG in men — cortisol elevation at any time point — morning, noon, evening, or night — triggers hepatic SHBG synthesis, which binds and inactivates testosterone regardless of how much the testes produce; a blunted morning cortisol awakening response impairs Leydig cell stimulation; elevated noon cortisol drives aromatase activity, raising oestradiol and further elevating SHBG; elevated night cortisol suppresses overnight testosterone production; only four-time-point measurement reveals which phase of the day is driving the SHBG-mediated testosterone deficiency and cardiometabolic deterioration
• SHBG is the most commonly missed cause of low testosterone symptoms in men with “normal” blood results — total testosterone measured without SHBG cannot distinguish between a man with adequate free testosterone and a man with all testosterone bound and inactivated by elevated SHBG; elevated SHBG — driven by cortisol, oestradiol excess, age, caloric restriction, and hepatic dysfunction — produces full androgenic deficiency symptoms including fatigue, low libido, erectile dysfunction, poor recovery, and brain fog in men whose total testosterone falls within the standard reference range
• Cortisol drives every cardiometabolic risk marker simultaneously in men — through hepatic insulin receptor dysregulation, cortisol causes insulin resistance, raising fasting insulin years before HbA1c becomes abnormal; through visceral fat promotion, it drives aromatase-mediated oestradiol conversion, SHBG elevation, and HPG axis suppression; through hepatic lipid dysregulation, it raises triglycerides and suppresses HDL; and through all these pathways simultaneously, it elevates hsCRP — the convergence marker of androgenic and cardiometabolic deterioration in men
• Insulin resistance and free testosterone decline are mutually reinforcing in men — elevated insulin promotes visceral fat and aromatase-driven testosterone-to-oestradiol conversion, raising SHBG and suppressing the HPG axis; low free testosterone worsens insulin sensitivity, promoting further visceral fat; fasting insulin is the earliest detectable marker of this cycle — elevated years before HbA1c or fasting glucose becomes abnormal — and directly linked to erectile dysfunction, declining androgenic function, and rising cardiovascular risk in men
• hsCRP is the convergence biomarker of cortisol, SHBG-mediated testosterone deficiency, and insulin resistance in men — elevated simultaneously by cortisol at any of the four time points, low free testosterone, insulin resistance, visceral fat, and oestradiol excess; a stronger independent predictor of cardiovascular events and all-cause mortality in men than LDL cholesterol; and directly elevated by the same cortisol-SHBG-insulin mechanism this panel is designed to characterise

What This Test Measures — 18 Markers Across Three Systems

Saliva — 4-Point Cortisol Profile (4 markers)

• Morning Cortisol (Cortisol Awakening Response): Sets Leydig cell testosterone output, hepatic SHBG synthesis rate, and insulin sensitivity for the entire day. An exaggerated morning response drives testosterone suppression, SHBG elevation, and morning insulin resistance; a blunted awakening response signals HPA burnout, reduced Leydig cell responsiveness, and impaired morning metabolic priming.
• Noon Cortisol: Elevated noon cortisol drives visceral fat deposition, aromatase-mediated testosterone-to-oestradiol conversion, SHBG elevation, triglyceride rise via hepatic lipid dysregulation, and HDL suppression — the direct mechanism by which chronic midday occupational stress accelerates androgenic decline and cardiometabolic deterioration in men during the working day.
• Evening Cortisol: Should decline significantly to allow testosterone and growth hormone to rise during early sleep cycles. Elevated evening cortisol suppresses overnight testosterone production, elevates SHBG through hepatic cortisol-SHBG coupling, maintains insulin resistance into the night, and independently raises hsCRP — producing next-day fatigue, reduced recovery, and worsening androgenic and metabolic function regardless of morning values.
• Night Cortisol: Suppresses the deep sleep phases during which the majority of daily testosterone is produced and growth hormone mediates fat metabolism. Drives overnight visceral fat accumulation, fasting insulin elevation, hsCRP rise, and aromatase-mediated oestradiol and SHBG excess — compounding every androgenic and cardiometabolic risk factor measured by the following morning’s blood spot.

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

• Oestradiol (E2): Present in men via aromatase conversion of testosterone. Physiologically important for bone density, cardiovascular protection, and cognitive function — but excess oestradiol from visceral fat, cortisol elevation, or insulin resistance suppresses testosterone via the HPG axis, elevates SHBG, causes gynaecomastia, raises triglycerides, and elevates cardiovascular risk. The oestradiol-to-free-testosterone ratio, calculated using SHBG, is the primary androgenic and cardiometabolic health indicator in men. Measured by blood spot LCMS for the highest available accuracy.
• Oestriol (E3): Reflects oestrogen conversion pathways and aromatase activity in men. Elevated E3 indicates increased oestrogen precursor load or conversion; the E3-to-E2 ratio provides aromatase activity context beyond what E2 alone reveals.
• Oestrone (E1): Produced by androgen conversion in adipose tissue. Elevated oestrone in men with visceral fat drives systemic oestrogenic load, compounds HPG suppression, elevates SHBG, and is associated with increased cardiometabolic and inflammatory risk.
• Progesterone (Pg): Present in men in small but clinically important amounts. Acts as a natural 5-alpha reductase inhibitor, blocking DHT conversion; has direct anti-oestrogenic, anti-inflammatory, and cardioprotective effects; and supports insulin sensitivity and sleep quality. Low progesterone is associated with elevated DHT, prostate risk, anxiety, and increased cardiometabolic inflammation in men.
• Testosterone (T): The primary male androgen — driving energy, libido, muscle mass, bone density, insulin sensitivity, HDL maintenance, and cardiovascular health. Measured by blood spot LCMS for highest accuracy. Interpreted alongside SHBG to calculate free testosterone bioavailability — the clinically definitive androgenic assessment that testosterone measurement without SHBG cannot provide.
• DHEAS (DS): The primary adrenal androgen precursor in men, declining from the mid-30s and depleted under chronic cortisol elevation. Low DHEAS reduces testosterone precursor availability, impairs stress resilience, and has direct anti-inflammatory and insulin-sensitising 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 the most complete cortisol assessment available in an at-home test without thyroid assessment.
• Sex Hormone Binding Globulin (SHBG): The bioavailability gatekeeper for testosterone in men. Elevated SHBG — driven by cortisol elevation, oestradiol excess, age, and caloric restriction — binds and inactivates testosterone regardless of its total production, causing full androgenic deficiency symptoms in men with normal total testosterone values. SHBG is essential for calculating free testosterone, interpreting the oestradiol-testosterone ratio, and identifying whether symptoms are driven by SHBG elevation, production failure, or HPG suppression — distinctions only possible when SHBG is measured alongside the 4-point cortisol rhythm.

Blood Spot — CardioMetabolic Panel (6 markers)

• Fasting Insulin: The earliest detectable marker of insulin resistance in men — elevated years before HbA1c or fasting glucose becomes abnormal. Directly promoted by cortisol at any time point, low free testosterone (worsened by elevated SHBG), and visceral fat. Elevated fasting insulin drives aromatase activity, increases oestradiol conversion and SHBG elevation, independently raises cardiovascular risk, and is closely linked to erectile dysfunction and androgenic decline. The most actionable early metabolic marker for men with hormonal and energy symptoms.
• HbA1c: Reflects average blood sugar over 8–12 weeks. Men with chronically elevated cortisol, low free testosterone, and elevated SHBG have markedly elevated risk of pre-diabetes and type 2 diabetes; HbA1c provides the medium-term blood sugar context that anchors the fasting insulin and cortisol rhythm assessment.
• HDL Cholesterol: The protective cardiovascular fraction directly maintained by free testosterone and suppressed by SHBG-mediated testosterone deficiency, insulin resistance, and cortisol elevation — three pathways all assessed comprehensively by this panel.
• Triglycerides: Elevated by cortisol at any of the four time points, insulin resistance, and oestradiol excess simultaneously. Rise before LDL changes and are a primary cardiometabolic risk marker particularly relevant for men with visceral fat, hormonal decline, and elevated SHBG.
• Total Cholesterol: Provides overall lipid context. Rising cholesterol in men with fatigue, low libido, and elevated SHBG is frequently a combined hormonal and cortisol event rather than a purely dietary one — best understood alongside the hormone levels this panel measures directly.
• hsCRP (High-Sensitivity C-Reactive Protein): One of the strongest independent predictors of cardiovascular events and all-cause mortality in men. Elevated simultaneously by low free testosterone, SHBG-mediated androgenic deficiency, cortisol dysregulation at any time point, insulin resistance, visceral fat, and oestradiol excess — all pathways directly assessed by this panel. The convergence biomarker of the male hormonal-metabolic system.

Who Should Consider This Test?

This test is particularly relevant for men who:

• Have persistent fatigue or exhaustion that does not improve with rest or sleep
• Experience unexplained weight gain or difficulty losing body fat, particularly around the abdomen
• Have low libido or reduced sexual interest
• Experience erectile dysfunction or reduced sexual performance
• Have poor recovery from exercise, training, or sustained high workload
• Experience brain fog, poor concentration, or reduced cognitive sharpness
• Have low mood, reduced motivation, or mild depression
• Experience sugar cravings, energy crashes, or afternoon slumps
• Have elevated cholesterol, triglycerides, or blood sugar on previous testing
• Struggle with insomnia, night waking, or unrefreshing sleep
• Are under chronic stress, burnout, or sustained high-pressure workload
• Have been told their testosterone is “normal” but continue to experience androgenic symptoms (elevated SHBG is frequently the explanation)
• Are currently on TRT and want to monitor SHBG, oestradiol, and cardiometabolic markers alongside testosterone
• Have a family history of heart disease, diabetes, or metabolic syndrome
• Are men over 35 seeking a comprehensive androgenic, stress-rhythm, and cardiometabolic health baseline without thyroid assessment
• Want the full cortisol-SHBG-testosterone-insulin picture before deciding whether to add thyroid testing

Key Features

• 18-marker tri-system panel: 4-point saliva cortisol rhythm, blood spot LCMS sex hormones + SHBG, and full cardiometabolic panel
• 4-point cortisol profile — morning, noon, evening, and night — the only method that reveals the full daily cortisol rhythm and its SHBG-mediated impact on free testosterone and cardiometabolic health
• Blood spot LCMS sex hormones — gold standard accuracy across the full androgenic range
• SHBG included — essential for calculating free testosterone and identifying the mechanism of androgenic deficiency in men with normal total testosterone
• All three oestrogens (E1, E2, E3) for complete oestrogenic load and aromatase activity assessment
• 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, and cardiometabolic panels, following the detailed instructions. Morning saliva should be collected before 9am for optimal cortisol awakening response accuracy.
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 male-specific reference ranges
• Visual cortisol rhythm chart showing your full four-point daily curve
• Visual charts for all six sex hormones, SHBG, and all six cardiometabolic markers
• Integrated clinical interpretation of how your cortisol rhythm, testosterone, SHBG, oestradiol, and cardiometabolic results interact as a single male hormonal-metabolic system
• SHBG-adjusted free testosterone bioavailability assessment — the definitive androgenic status calculation
• Oestradiol-to-free-testosterone ratio analysis in SHBG and cortisol context
• Cortisol-SHBG coupling assessment — directly mapping each cortisol time point to SHBG elevation and free testosterone suppression
• Insulin resistance pattern assessment (fasting insulin + HbA1c)
• Cardiovascular risk profile in full androgenic and SHBG hormonal 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) + Fasting Insulin, HbA1c, HDL Cholesterol, Triglycerides, Total Cholesterol, hsCRP (blood spot) — 18 markers in total.

Does this test include thyroid assessment?

No. This profile assesses cortisol rhythm, sex hormones, SHBG, and cardiometabolic markers — providing the complete androgenic and metabolic picture without thyroid markers. For men who want thyroid assessment alongside this panel, the Male Advanced Hormone, Thyroid & CardioMetabolic Test (SB-649M) adds a full 6-marker thyroid panel including TPO and Tg antibodies with a single cortisol measurement, and the Male Comprehensive Hormone, Thyroid & CardioMetabolic Profile (SB-646M) adds the full thyroid panel alongside the 4-point cortisol rhythm and SHBG.

Why do I need SHBG tested alongside my testosterone?

SHBG binds and inactivates testosterone in the bloodstream. A man with normal total testosterone but elevated SHBG — caused by cortisol, oestradiol excess, age, or caloric restriction — has full symptoms of androgen deficiency despite a “normal” result. SHBG is the most common reason men are told their testosterone is normal but continue to experience fatigue, low libido, and poor recovery. This panel identifies both the SHBG level and, through the 4-point cortisol rhythm, the most likely mechanism driving it.

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

A single cortisol value cannot identify which part of the day is driving androgenic or cardiometabolic deterioration. A blunted morning awakening response impairs Leydig cell testosterone output all day; elevated noon cortisol drives aromatase and SHBG; elevated evening cortisol suppresses overnight testosterone; night cortisol elevation directly reduces the sleep phases during which testosterone is produced. Each pattern has different hormonal and metabolic consequences — and different intervention targets.

Can I use this test if I am on TRT?

Yes. This test is particularly valuable for men on TRT who want to monitor SHBG, oestradiol, cortisol rhythm, and cardiometabolic markers alongside testosterone. TRT increases aromatisation and raises oestradiol, which elevates SHBG and can reduce the free testosterone benefit of treatment. The 4-point cortisol rhythm identifies whether cortisol management would improve TRT efficacy and reduce cardiometabolic inflammation.

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.