Test ID: S-124 | Sample Type: Saliva | Technology: LC-MS/MS | Results Time: 3–5 Working Days After Laboratory Receives Sample | Laboratory: ZRT Laboratory – CLIA Certified | Hormone Specialist Doctor Interpretation: Included | Suitable For: Adults and Children
What Does This Test Measure?
Saliva — 4 Hormones (LC-MS/MS): Estradiol (E2), Testosterone (T), Progesterone (Pg), DHEAS (DS).
4 markers total — the four key hormones most directly responsible for hormonal acne in the female body, measured via bioavailable saliva.
Related Symptoms
Acne that worsens before or during a period, breakouts concentrated on the lower face, jaw, chin, or neck, persistent adult acne unresponsive to skincare or antibiotics, acne alongside irregular or painful periods, acne that worsened after stopping the contraceptive pill, PCOS, perimenopausal acne, acne during periods of high stress, excess facial hair, oily skin or scalp, or PMS with mood swings.
Did You Know?
Hormonal acne in women is not a skin problem — it is a visible symptom of internal hormonal imbalance. Even mildly elevated testosterone, or normal testosterone in the context of low oestradiol, stimulates excess sebum production, clogs pores, and drives the inflammation that produces breakouts. Treating the skin without addressing the hormonal root cause rarely produces lasting results.
Why This Test Is Particularly Important for Women
- Hormonal acne follows the menstrual cycle — classically worsening in the luteal phase when progesterone peaks and oestradiol drops
- It concentrates on the lower face, jaw, and chin — the androgen-sensitive zones most reactive to testosterone and DHEAS fluctuations
- It persists or worsens into the 30s and 40s as oestrogen declines relative to androgens during perimenopause
- It is strongly associated with PCOS — characterised by elevated androgens, insulin resistance, and suppressed progesterone
- Elevated DHEAS from chronic stress drives acne independently of ovarian hormones — explaining why breakouts worsen during high-stress periods even when cycle hormones appear normal
Who Should Consider This Test?
- Acne that worsens before periods or in the second half of the cycle
- Breakouts concentrated on the lower face, jaw, chin, or neck
- Persistent adult acne that has not responded to skincare or antibiotics
- Acne alongside irregular, painful, heavy, or absent periods
- Diagnosed or suspected PCOS
- Acne that worsened during perimenopause or after stopping the contraceptive pill
- Acne alongside excess facial or body hair, hair thinning, or oily skin and scalp
- Acne that worsens during periods of high stress
- Wanting to understand the hormonal root cause before or instead of medication
How Your Results Can Help Guide Your Next Steps
Acne That Worsens Around Your Period
Relevant measurements: Testosterone and DHEAS, with oestradiol and progesterone providing cycle-related context
Your report shows the measured levels at your collection time. Menstrual-cycle timing is particularly important when interpreting oestradiol and progesterone.
How to use your results: Record breakouts and period dates over two or three cycles. Read the laboratory comments alongside this diary to identify findings needing follow-up. Predictable cyclical acne can also support a discussion about suitable acne treatments, including hormonal options where appropriate.
Persistent Acne and Oily Skin
Relevant measurements: Testosterone and DHEAS
These measurements add information about hormones associated with androgen activity. A normal result does not exclude hormone-sensitive acne.
How to use your results: Review any highlighted findings and disclose medicines, hormone treatments and supplements. Unexpected results may need confirmation with blood testing. Meanwhile, use a gentle cleanser, non-comedogenic moisturiser and sunscreen, and avoid picking spots.
Acne With Irregular Periods or Increased Facial Hair
Relevant measurements: Testosterone and DHEAS
This combination is more suggestive of possible androgen excess than acne alone and warrants a broader assessment.
How to use your results: Bring your report, cycle history and details of hair-growth changes to a medical appointment. Established assessment for PCOS and related conditions uses clinical information and appropriate blood tests; this saliva panel cannot confirm PCOS.
Acne After Stopping Contraception or During Perimenopause
Relevant measurements: Testosterone and DHEAS, with Estradiol and progesterone adding context
Changes in hormonal exposure can coincide with changes in acne. Your collection date, menstrual status and treatment history help explain the measurements.
How to use your results: Record when the skin changes began and any contraception or treatment changes. The report can add information to a review of your symptoms, while suitable skincare and treatment address the breakouts themselves.
What Do Estradiol and Progesterone Add?
These measurements broaden the profile, but a single result cannot establish that low progesterone or an oestrogen–androgen imbalance is causing acne. Their interpretation depends strongly on cycle timing and treatment use.
How the Specialist Comments Help
Your results and laboratory comments help you understand:
- Where each measurement falls relative to its reference range
- How cycle timing and treatment history affect interpretation
- Which findings may warrant further investigation
Use the report to guide informed next steps, rather than choosing hormone supplements from the numbers alone.
What Should You Do Next?
Track your breakouts, maintain consistent gentle skincare and review the laboratory comments. Seek medical assessment for abnormal findings, irregular periods, increased facial hair, or acne that is painful, scarring or resistant to treatment.
Your results can contribute to that assessment while you pursue effective acne care.
Not Sure Which Test Is Right for You?
Email us at info@hormonelab.co.uk with your gender, age, symptoms, medications, and any current treatments. We will forward your enquiry to our doctors and respond within 24 hours.
How It Works
- Order your kit — delivered directly to your door
- Collect your saliva sample following the detailed instructions provided; cycle timing guidance is included (luteal phase, days 19–21, is generally recommended)
- Post your sample to ZRT Laboratory using the return instructions provided
- Receive your full report by email within 3–5 working days
What You Receive
- All four hormone results with female-specific reference ranges
- Graphical and numerical hormone data for easy interpretation
- Written interpretation of your specific hormonal acne pattern by a Hormone Specialist PhD Doctor
- Personalised treatment and lifestyle guidance
- Laboratory fee included — no hidden charges
Why We Use ZRT Laboratory
All testing is performed by ZRT Laboratory — a globally recognised, CLIA-certified diagnostic laboratory founded in 1998 by Dr. David Zava, PhD. ZRT has performed over 11 million tests and is trusted by healthcare professionals in 96+ countries.
- Pioneers of at-home dried blood spot (DBS) and saliva hormone testing
- Advanced LC-MS/MS technology for clinical-grade accuracy
- Qualified for the CDC Hormone Standardization (HoSt) Program
- Personalised reference ranges based on age and sex
Through our partnership with ZRT Laboratory, Hormone Lab UK delivers internationally recognised, research-backed hormone testing to people across the UK and Europe — from the comfort of home.
Frequently Asked Questions
Why saliva instead of blood?
Saliva measures bioavailable (free, active) hormones — the fraction actually reaching your skin cells and sebaceous glands. Blood tests measure total hormone including the bound, inactive fraction, which can miss the imbalances most relevant to acne.
When in my cycle should I collect?
Collection during the luteal phase (days 19–21 of a 28-day cycle) is generally recommended for the most clinically useful results. Detailed guidance is included in your kit.
Can I use this test if I am on the contraceptive pill or HRT?
Hormonal medication can significantly alter results. Follow the timing guidance in the kit or consult your clinician before testing while on hormonal medication.
Will a specialist review my report?
Yes. A Hormone Specialist PhD Doctor adds personalised commentary to every report.
Does the price include the laboratory fee?
Yes. The full laboratory analysis fee is included. There are no additional charges. You are only responsible for posting your samples to the laboratory.
How long is the kit valid for?
The kit must be used within 12 months of the purchase date.
Saliva Sample Collection Instructions
Collect your saliva samples at home using the materials provided in your kit. Check your Test Requisition Form and kit instructions to confirm whether your test requires one, two or four samples. You may not need every tube supplied.
Read all instructions before you begin. If you use hormone treatment, also read the Hormone Users section.
1. Check Your Collection Times
| Samples required | When to collect |
|---|---|
| One | Morning |
| Two | Morning and before bed |
| Four | Morning, before lunch, before dinner and before bed |
Use the large 10 mL tube for your morning sample and the smaller 5 mL tubes for any later samples. Collect the required samples on the same day unless your kit instructions say otherwise.
2. Choose Your Collection Day
Mark your collection day on your calendar. List all medicines, supplements and hormone treatments on your Test Requisition Form.
Men, children and women who do not menstruate: Collect on any day of the month. If you use hormones, follow the treatment-timing instructions below.
Women who menstruate: If your test measures estradiol, progesterone or testosterone, use the following schedule:
| Usual menstrual-cycle length | When to collect |
|---|---|
| 23–26 days | Day 17, 18 or 19 |
| 27–30 days | Day 21, 22 or 23 |
| 31–34 days | Day 25, 26 or 27 |
| Shorter or longer regular cycles | 5–7 days before your next expected period |
| Infrequent or unpredictable cycles | Any day when you are not bleeding |
Day 1 is the first day of menstrual flow, not spotting. Follow any different timing instructions supplied for your particular test.
3. Hormone Users
Skip this section if you do not use hormones.
Record every hormone treatment on your Test Requisition Form. This helps the laboratory choose suitable reference ranges and provide relevant comments.
Do not stop prescribed hormone treatment for testing. If collection requires changing your usual dosing time, check with your prescriber first.
Topical and Oral Hormones
- Continue your prescribed treatment on the day before collection.
- Allow at least 12 hours between an evening dose and your morning sample. For example, if collecting at 8 am, take or apply the previous evening’s dose by 8 pm.
- Oral progesterone is an exception: you may take it immediately before bed.
- For at least two days before collection, apply topical hormones using gloves or an applicator rather than bare hands.
- Avoid applying hormones to your face, lips or neck.
Troches and Under-the-Tongue Hormones
Hormones that dissolve in the mouth can contaminate saliva samples. Saliva hormone testing is not recommended while using these treatments. Ask your healthcare professional about an alternative, such as blood spot testing. Contaminated samples may be partially or fully rejected.
Patches, Vaginal Rings, Pellets and Injections
The laboratory advises collecting halfway between doses or replacements. For example, this may be approximately three days after applying a weekly patch or two weeks after a monthly injection.
Check the appropriate collection time for your particular treatment with your prescriber.
Steroid Medicines
If you take glucocorticoids, such as hydrocortisone or prednisone, ask your healthcare professional when to collect your samples.
Prevent Hormone Contamination
Traces of hormone creams or gels can transfer from your hands, towels or household surfaces into your sample.
- Change your sheets, pillowcases and towels the night before collection.
- Avoid touching bathroom surfaces that may contain hormone residue.
- Wash your hands thoroughly and dry them with a clean towel.
4. Prepare for Collection
Three days before collection: Avoid anti-ageing or anti-wrinkle facial creams and biotin/vitamin B7 supplements, including hair and nail formulas.
The night before collection: Stay normally hydrated, but avoid drinking excessive amounts of fluid.
Before your morning sample: Do not eat, drink anything other than water, or brush your teeth.
Before later samples: Do not eat, drink anything other than water, or brush your teeth for at least two hours before collection.
5. Collect Your Samples
- Wash your hands with soap and water, then dry them with a clean towel.
- Rinse your mouth with water and wait five minutes.
- Begin your morning collection within 30 minutes of waking, using the large tube.
- Let saliva pool naturally in your mouth, then transfer it into the tube.
- Fill the tube at least halfway with liquid saliva, excluding bubbles. This usually takes 15–30 minutes, depending on saliva flow.
- Screw the cap on securely.
- Label the tube with your name, collection date and collection time, then place it back in its bag.
- Repeat at each later collection time required for your test, using the smaller tubes.
If saliva flow is slow: Try yawning, smelling food without eating it, or pressing the tip of your tongue against your teeth. To reduce bubbles, securely cap the tube and gently tap it on a hard surface.
6. Complete Your Paperwork and Pack Your Samples
- Complete your Test Requisition Form, including your symptoms, medical history, medicines, supplements and hormone treatments.
- Check that every required tube is clearly labelled, securely closed and at least halfway full of liquid saliva.
- Place your samples, completed form and any additional paperwork inside the plastic kit box.
- Include payment only if required under your kit’s arrangements.
- Close the box securely and place it inside the return packaging.
- Attach the prepaid return label if provided, or arrange the required postage.
- Return your samples using the carrier and return address specified in your kit instructions.
7. Storage and Collection Mistakes
Freeze samples if you will not ship them within 24 hours of collection. Samples remain stable under average shipping conditions, including transit over weekends and holidays.
If you need to repeat a collection, rinse the affected tube with hot water only—do not use soap. Shake out the remaining water and leave the tube to air-dry before collecting again at the correct time.
If you ate or brushed your teeth before collecting your morning sample, restart the following morning.
