Test ID: SB-644F | Sample Type: Saliva + Dried Blood Spot | 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 | Collect Sample At Home: No Clinic Visit Required
What Does This Test Measure?
Saliva — 4-Point Cortisol Profile: Morning, Noon, Evening, and Night Cortisol.
Blood Spot — Sex Hormones & SHBG (LC-MS/MS): Estradiol (E2), Estriol (E3), Estrone (E1), Progesterone, Testosterone, DHEAS, Cortisol, SHBG.
Blood Spot — Full Thyroid Panel: TSH, Free T3, Free T4, Total T4, TPO Antibodies, Thyroglobulin Antibodies.
18 markers total — a complete picture of the full daily cortisol rhythm, SHBG-adjusted sex hormone bioavailability, and autoimmune thyroid function in a single at-home kit.
Related Symptoms
Persistent fatigue, unexplained weight gain, PMS, heavy or irregular periods, breast tenderness, perimenopausal or menopausal symptoms (hot flushes, night sweats, low mood), low libido, brain fog, anxiety, insomnia, hair thinning, dry skin, feeling cold, chronic stress, burnout, symptoms of thyroid dysfunction with inconclusive standard blood results, or normal hormone results that do not match symptoms (elevated SHBG is frequently the explanation).
Who Should Consider This Test?
- Persistent fatigue or exhaustion that does not improve with rest
- Unexplained weight gain or difficulty losing weight
- Feeling cold, temperature sensitivity, or slow metabolism
- Hair thinning, dry skin, or brittle nails
- PMS, heavy, irregular, or absent periods, or breast tenderness
- Perimenopausal or menopausal symptoms: hot flushes, night sweats, low mood
- Low libido or reduced sexual interest
- Brain fog, poor concentration, or memory issues
- Anxiety, irritability, or emotional volatility — especially in the second half of the cycle
- Insomnia, night waking, or unrefreshing sleep
- Chronic stress or burnout
- Diagnosed or suspected PCOS, Hashimoto’s thyroiditis, or estrogen dominance
- Currently on HRT or the contraceptive pill (where SHBG assessment is essential for accurate hormone interpretation)
- Currently on levothyroxine and wanting complete thyroid monitoring alongside hormones and cortisol
- Previous thyroid or hormone testing with normal results that do not match symptoms
- Women over 35 seeking a comprehensive hormonal, SHBG, cortisol rhythm, and thyroid baseline without a cardiometabolic panel
Why This Test Is Particularly Important for Women
- The 4-point cortisol rhythm is the master regulator of SHBG, sex hormone bioavailability, and thyroid T3 activation — elevated cortisol at any time point suppresses progesterone, elevates SHBG, drives estrogen dominance, and impairs T4-to-T3 conversion simultaneously; only four-time-point measurement reveals which phase of the day is responsible
- SHBG is the bioavailability gatekeeper for all sex hormones in women — elevated SHBG from cortisol excess, thyroid disease, HRT, or the pill binds and inactivates estradiol and testosterone regardless of production levels; a woman with normal total hormone values but elevated SHBG has full hormonal deficiency symptoms and needs SHBG to interpret results accurately
- Thyroid dysfunction in women is systematically under-detected by TSH alone — cortisol-driven T3 suppression, SHBG-related thyroid binding changes, and Hashimoto’s autoimmunity (present years before TSH becomes abnormal) are all invisible to standard thyroid testing; FT3, FT4, TT4, TPO, and Tg antibodies alongside cortisol and SHBG are all required
- Night cortisol elevation worsens Hashimoto’s autoimmunity directly — elevated night cortisol drives TPO and Tg antibody activity through sleep-phase immune dysregulation; this pattern is only detectable by 4-point cortisol assessment and is the most underassessed driver of Hashimoto’s progression in women
- Progesterone deficiency, estrogen dominance, and SHBG elevation are all cortisol-driven and thyroid-compounded — the entire sequence from cortisol elevation to symptom onset is only characterisable when all three systems are measured simultaneously
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 saliva at four time points (morning before 9am, noon, evening, night) and blood spot via finger-prick. Guidance on optimal cycle timing is included
- Post your samples to ZRT Laboratory using the return instructions provided
- Receive your full report by email within 3–5 working days
What You Receive
- 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
- SHBG-adjusted free hormone bioavailability assessment for estradiol and testosterone
- Estrogen-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
- Integrated interpretation by a Hormone Specialist PhD Doctor
- Personalised next-step recommendations
- 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
Does this test include cardiometabolic markers?
No. This profile covers the 4-point cortisol rhythm, sex hormones + SHBG, and the full thyroid panel. Women who also want fasting insulin, HbA1c, HDL, triglycerides, cholesterol, and hsCRP should consider the Female Comprehensive Hormone, Thyroid & CardioMetabolic Test (SB-652), which adds six cardiometabolic markers to this complete panel.
Why do I need SHBG alongside my hormone results?
SHBG binds and inactivates estradiol and testosterone. A woman with normal total estradiol and testosterone but elevated SHBG — caused by cortisol, thyroid disease, HRT, or the pill — may have full hormonal deficiency symptoms despite normal-range values. SHBG is essential for accurate interpretation of every sex hormone result, particularly in women on HRT or the contraceptive pill.
Why is TSH alone not enough to assess thyroid health in women?
TSH measures the pituitary signal to the thyroid, not the active hormone reaching cells. Cortisol-driven T3 suppression produces functional hypothyroidism with a normal TSH. Hashimoto’s causes progressive thyroid damage for years before TSH becomes abnormal. SHBG and estrogen changes alter thyroid hormone binding without affecting TSH. All three patterns are invisible to TSH alone.
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 estradiol and testosterone and increases thyroid-binding globulin. Without SHBG measurement, hormone and thyroid results in women on HRT or the pill cannot be accurately interpreted.
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 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 estrogen values. Morning saliva should be collected before 9am for optimal cortisol awakening response accuracy.
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.
