Frequently Asked Questions about Hormone Testing

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Blood Spot Testing Questions
Why would I choose blood spot testing over saliva or blood serum testing?

Blood spot testing provides results that correlate extremely well to serum testing results in terms of accuracy, but without the cost and inconvenience of conventional blood drawing. There is no more wasted time and resources going to a lab for a painful blood draw as you collect your sample either at home or in your doctor’s office. In preparation for our CardioMetabolic testing and morning cortisol, which both must be done upon waking, blood spot testing is particularly convenient after an all night fast. Blood spot testing is also a preferred method for those supplementing with troches or sublingual hormones. Use of these particular oral supplements can cause false high saliva testing results due to high concentrations of hormone in the oral mucosa for several days following your last dosage. Blood spot testing allows people who use these oral supplements to continue taking their hormones while testing. Blood spot testing is also preferable for those who have dry mouth conditions such as Sjogren’s Syndrome or who otherwise have difficulty collecting enough saliva for testing. In addition, some of ZRT’s tests are only offered in blood spot, such as thyroid, CardioMetabolic, and Vitamin D.

How are finger-stick dried blood spot and venipuncture blood serum different?

First, one is “whole” blood drawn from the end of the finger. This is mostly capillary blood as opposed to blood drawn from the arm, which is venous blood. The former contains nutrients, hormones, and oxygen to feed the tissues. The latter is partially spent of these life-giving components and is returning to the heart, lungs, and gastrointestinal tract to pick up another load.

Second, dried blood spots are comprised of whole blood complete with blood cells, whereas serum is the watery component that remains after lab technicians separate blood cells from venipuncture blood (i.e., blood drawn from veins using a syringe). Therefore, any hormones bound to any removed blood cells during the separation process are lost. Consequently, test results from blood spots reflect a more accurate assessment of your correct capillary blood hormone levels than test results from serum. Since capillary blood is what feeds the cells of your body, hormones detected in capillary blood reflect a more accurate assessment of hormone levels that affect your body’s tissues.

Are hormone results from blood spots different from conventional venipuncture serum?

Yes and no. The answer is “No” when hormones are produced within the body (endogenously), or are slowly delivered into the body with a transdermal patch (e.g., estradiol patch) or by pellet insertion. In these situations, hormone test results are remarkably similar from finger-stick dried blood spots and serum. In fact, hormone ranges established for blood spots are nearly identical to those of serum. The answer is “Yes” when steroid hormones are delivered rapidly into the body through the skin or mucous membranes (e.g., topical or sublingual estradiol, progesterone, and testosterone). When hormones enter the body through the skin or mucous membranes, capillary blood and tissue levels far exceed the levels seen in venous blood. So when topicals or sublinguals are used for hormone supplementation, blood spot testing, using capillary blood from the finger, is a more accurate representation of the amount of hormone delivered to tissues.

Are there any special precautions to take when collecting blood spots?

Yes. Use care if you are applying hormones topically with your hands. Topical hormones can concentrate in the fingers when hormones are applied with the hands, resulting in false high results. It may take 12-24 hours for the hormones in the hands to equilibrate with other tissues in the body. Therefore, when using topical hormones, rub them in without using fingers (e.g. wrist to wrist) for at least two days prior to collection. Skip use of anti-aging creams that may contain hormone traces. It is important to continue to use the hormones as usual during this time; just avoid hand exposure. For additional information on collection when using hormones, see the Blood Spot Testing Collection Instructions in your test kit.

Can whole blood from serum venipuncture be used for the dried blood spot test?

Again, this is a yes and no answer. For peptide hormone analysis (e.g., insulin, LH, FSH, etc.), results are the same for finger-stick capillary whole blood, venipuncture whole blood, and serum. If you are looking at endogenously produced steroid hormones (estradiol, progesterone, testosterone, DHEA-S, cortisol), the results are the same. However, if you have used one of these steroid hormones topically or sublingually, blood spot testing, showing capillary blood hormone levels, gives values much higher and more accurate than the venipuncture blood spot sample. This is because blood cells and serum that exit the capillary beds and return to the venous blood are “spent” of the bioavailable fraction of hormone. In this case, capillary blood more accurately represents tissue levels of the topically delivered hormone.

Why would I want to use the blood spot test instead of the saliva test?
  • If you are using hormones as a troche or sublingual (dissolved under the tongue)
  • If a false-high value results due to direct contamination of the oral mucosa when not enough time has elapsed from last use of hormone(s) until saliva collection
  • If you cannot create enough saliva
  • If you would rather perform a finger stick
  • If you want to measure a hormone that is only tested in blood spot
Are the same tests available for blood spot as saliva?

Yes, and ZRT performs more tests in blood spot than in saliva.
In saliva, we test:

  • AM Cortisol (C1)
  • PM Cortisol (C4)
  • Diurnal Cortisol (C1, C2, C3, C4)
  • DHEA-S (DS)
  • Estradiol (E2)
  • Estriol (E3)
  • Estrone (E1)
  • Progesterone (Pg)
  • Testosterone (T)

In blood spot, we test:

  • AM Cortisol (C1)
  • holesterol, total
  • HDL Cholesterol
  • LDL Cholesterol
  • VLDL Cholesterol
  • DHEA-S (DS)
  • Estradiol (E2)
  • Fasting Insulin
  • Follicle Stimulating Hormone (FSH)
  • Hemoglobin A1c (HbA1c)
  • High-Sensitivity C-Reactive Protein (hs-CRP)
  • Insulin (fasting)
  • Insulin-like Growth Factor (IGF-1)
  • Luteinizing Hormone (LH)
  • Progesterone (Pg)
  • Prostate Specific Antigen (PSA)
  • Sex Hormone Binding Globulin (SHBG)
  • Testosterone (T), total
  • Thyroid Peroxidase Antibodies (TPO)
  • Thyroid Stimulating Hormone (TSH)
  • Thyroxine (T4) free
  • Triglycerides (TG)
  • Triiodothyronine (Free T3)
  • Vitamin D, 25-OH, Total
Saliva testing measures the free or bioavailable fraction of hormone. Does blood spot testing measure the same thing

Blood spot testing measures the total amount of hormone available to tissues, but when divided by the amount of Sex Hormone Binding Globulin (SHBG), this ratio then determines how much of the hormone is bio-available. So, by combining estradiol or testosterone with SHBG testing, it is possible to determine the bio-available fraction of these hormones indirectly. This is why we included the SHBG test in our Female Hormone Profiles in Blood Spot.

Hormone Imbalance Questions
Where do I begin to determine whether my hormones are balanced?

To get a general idea of whether or not your hormones are balanced, record the symptoms you are currently experiencing using our Symptoms of Hormone Imbalance. Your symptoms may point to a deficiency or excess of certain hormones.

My symptoms suggest that I have a hormone imbalance, but how do I find out for sure?

To confirm your symptoms of hormonal imbalance, we recommend measuring those hormones associated with the symptoms you noted using  our Symptoms of Hormone Imbalance (Hormone Imbalance Symptoms) or on the test kit requisition form. You might consider ordering our Female Saliva Profile I that tests estradiol, progesterone, testosterone, DHEA-S and AM cortisol. This panel, along with the more comprehensive Female Saliva Profile II and Female Saliva Profile III, provide you with a broader picture of your present hormone levels and identify specific imbalances. For the most comprehensive assessment of hormonal imbalance, including tests for reproductive, adrenal, and thyroid hormone testing, consider ordering one of our Comprehensive Profiles.

What is the link between polycystic ovaries and hormonal imbalance?

Polycystic ovaries occur when numerous growths/cysts develop on the ovaries. This is commonly associated with a hormonal imbalance such as estrogen dominance and/or an excess of male hormones. In many cases, these cysts are benign and can shrink or even disappear when the hormone imbalance is corrected. The ovaries should be removed if the cysts are cancerous or causing pain and do not respond to treatment. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 639.

What is the link between uterine fibroids and hormonal imbalance?

Estrogen dominance, an imbalance caused by excess estrogen in the relative absence of progesterone, can cause the uterine lining to grow undetected. This can lead to the growth of tough, fibrous, non-cancerous lumps called fibroids. While the average fibroid is an undetectable lump in the wall of the uterus, about the size of a hen’s egg, larger fibroids often cause irregular bleeding and heavy or painful periods. Fibroids are the most common physical reason for excessive bleeding during menstruation.

Fibroids can grow dramatically during perimenopause when they are stimulated by hormonal imbalances and fluctuations in the body. Large fibroids secrete estradiol, the most potent form of estrogen, leading to estrogen dominance. Monitoring your estrogen levels through routine hormone testing and taking appropriate steps to maintain a proper balance of estrogen to progesterone is especially important. Please note: recent information cautions against the use of progesterone for the treatment of larger fibroids. With all fibroids, hormone supplementation should be kept as low as possible. For more information, call the ZRT 24-Hour Hormone Hotline at 503-466-9166 and listen to Track 643.

What is the link between hormonal imbalance and breast cancer?

There are many factors associated with hormonal imbalance and increased risk of breast cancer including:

  • Declining levels of progesterone with age and/or with removal of the ovaries in hysterectomy
  • Environmental, “xeno”-hormones in the form of pollutants and pesticides
  • Oral contraceptives
  • Synthetic hormone replacement therapy

These factors can contribute to an excess of estrogen in the body known as “estrogen dominance.” Since estrogen stimulates cell growth, a predominance of it, especially in the absence of adequate levels of progesterone (common in the menopausal years with the waning of ovulation), presents an increased risk of cancer, particularly in the breast. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Tapes 631 and 646.

What can hormone testing tell me if I have breast cancer?

Saliva testing in women with breast cancer often reveals a unique hormone profile. If you are interested in understanding your hormone status in regard to breast cancer, we recommend our Female Saliva Profile II. This profile includes estradiol, progesterone, testosterone, DHEA-S, AM (morning) and PM (night) cortisols. For the most comprehensive assessment of hormonal imbalance, including tests for reproductive, adrenal, and thyroid hormone testing, consider ordering one of our Comprehensive Profiles.

What is the link between thyroid function and hormonal imbalance?

Hypothyroidism or low thyroid is more common in women than men and often occurs during the perimenopausal and postmenopausal years. Approximately 26% of women in or near menopause are diagnosed with hypothyroidism. When estrogen is not counterbalanced with progesterone, a predominance of estrogen can inhibit the action of thyroid hormone at the cell level. Saliva hormone testing often reveals that women who are estrogen dominant tend to have menopausal symptoms associated with symptoms typically associated with low thyroid such as: feeling cold all the time, weight gain or inability to lose weight, thinning hair, sleep disturbances and fatigue, mood swings, depression, mental confusion, hair loss and low libido. Levels of the primary thyroid hormones can be tested as part of Proactive Breast Wellness blood spot Thyroid Panel. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Tracks 640 and 655.

What can I do to prevent estrogen dominance?

First, we recommend testing your hormones using Female Saliva Profile I to determine the extent of estrogen dominance. If your progesterone/estradiol (Pg/E2) ratio is low, this indicates that progesterone levels are inadequate in relation to estrogen levels. This is a clear indication of estrogen dominance. If this is the case, it would be a good idea to talk to your health care provider about supplementing with bioidentical progesterone to balance estrogen levels. It is also helpful to monitor your symptoms and your hormone levels regularly while following a program of hormone balance. Other important steps to take include: reducing the use of pesticides, pollutants, and chemicals in your home; eating organic foods that are free of hormones and PCB sprays; maintaining an ideal weight (excess fat increases estrogen production); exercising regularly; and avoiding unnecessary stress whenever possible. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 631.

What is insulin resistance and how do you test for it?

Insulin resistance occurs when cells “resist” the action of insulin to transport glucose into the cells of the body for energy production. Excess stress and lack of exercise in combination with simple sugars and carbohydrates cause the body to produce extra insulin in an attempt to normalize blood sugar levels. This results in overly high levels of insulin in the blood. Insulin resistance is associated with obesity, increased risk for Type 2 diabetes, and cardiovascular disease.

Blood spot testing provides a simple way to measure fasting insulin levels, particularly in people at risk for the condition. The test offers insight into imbalances in individuals who have symptoms despite a normal blood glucose test. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to tape 658.

Am I a candidate for the fasting insulin test?
  • Individuals with known or suspected hypoglycemia, insulin resistance, diabetes, pre-diabetes, family history of diabetes, being overweight or obese.
  • Women with irregular periods, scalp hair loss, increased facial or body hair, or polycystic ovarian syndrome.
  • Individuals with symptoms of anxiety, palpitations, profuse sweating, fatigue, irritability, weakness, shakiness, dizziness, food or sugar cravings, excess weight around the waist, or high blood sugar levels.
What is adrenal fatigue and how is it tested?

Many people today suffer from the adrenal glands’ inability to respond to stress. This condition stems from various factors including chronic stress, sleep deprivation, excess caffeine and carbohydrates, chronic pain, extreme exercise, and a generally unbalanced lifestyle. Also known as adrenal insufficiency, the problem shows up with a set of symptoms ranging from chronic fatigue to infertility. Those with a hectic lifestyle are potentially at risk, but the problem is more prevalent among medical professionals, police officers, executives, teachers, single working parents, or anyone who has a very stressful lifestyle.

Adrenal fatigue is tested by measuring cortisol, a key stress response hormone. Cortisol is produced by the adrenal glands 24 hours a day, although output varies at different times throughout the day. Cortisol output is highest upon waking to energize us for the day ahead and declines steadily throughout the day, reaching its lowest point at night in preparation for sleep. Individuals with adrenal fatigue have a flattened cortisol profile. This means that there is no morning surge of the hormone. Cortisol can be collected once in the morning or twice a day (morning and bedtime). It may be necessary to measure cortisol four times a day if levels are out of range and symptoms indicate the need to test adrenal function throughout the day. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 636.

Menopause-related Questions
What is Bioidentical Hormone Replacement Therapy (BHRT)?

Bioidentical hormones (BHRT) are hormone supplements made from natural, plant-based substances. They are identical in structure and function to those produced in the body. Bioidentical hormones are available by a doctor’s prescription through a compounding pharmacist who can tailor hormone supplements to meet individual needs. Natural progesterone, for example, is a bioidentical hormone as opposed to progestin, which is the synthetic version (denoting the “pro” in PremPro). Progesterone is available in a topical form over the counter. Progesterone is also available by prescription when combined with natural estrogens and other hormones by compounding pharmacists. For more information about bioidentical hormones, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 649. To locate a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing.

Why do women experience vasomotor symptoms such as hot flashes and night sweats?

These symptoms typically result from an estrogen deficiency and/or an imbalance between progesterone and estrogen. This type of imbalance is common in the perimenopausal years. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Tracks 628, 632, and 633.

You were labeled postmenopausal based on the hysterectomy. Once a woman has had a hysterectomy, the surgery, regardless of her age, has forced her body into menopause. If the ovaries are also removed, hormone production from that primary source stops overnight. Regardless of whether the ovaries are removed, it is often the case that removal of the uterus significantly reduces blood flow to the ovaries, which in turn shuts down ovarian function within a few years of the surgery. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 645.

What about phyto (plant) estrogens for menopause relief?

Phytoestrogens are part of the family of plant phytochemicals. These compounds have been shown to have health-supporting effects in the body. Phytoestrogens have weak estrogen-like activity. They can bind to and turn on estrogen receptors. But, since their binding power is much weaker than more potent estrogens like estradiol, their effect is more subtle and they do not carry the risks of estrogen replacement therapy. Many women searching for safe alternatives to HRT, like Black Cohosh and Dong Quai, are successfully using the phytoestrogens found in soy products and herbs for relief from the hot flashes and night sweats of menopause. However, it is important to consult with a qualified health care provider before using these plants medicinally over a prolonged period. If the woman is taking too many phytoestrogens and when infrared images are done the breasts have become vascular and estrogen dominant. In the Proactive Breast Wellness protocol we suggest that you avoid flax and non fermented soy products. Also, many of these herbs are contraindicated during pregnancy. For more information,call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 648.

What about using soy products for menopause relief

Soy needs to be used wisely. While soy contains phytoestrogens that can help balance your hormones, soy also has other phytochemicals called “phytates” that can block the absorption of necessary nutrients like zinc and iodine. This can disable necessary enzymes. The best way to eat soy is in its fermented form such as miso, tempeh, (especially in combination with fish proteins and seaweeds rich in minerals). Fermentation reduces the nutrient blocking effect of soy.

Other ideal plant sources that aid menopause relief are cruciferous vegetables like broccoli, cauliflower, and cabbage. These foods contain a substance called indole-3 carbinol, which encourages healthy estrogen metabolism. Onions, garlic, peppers, tomatoes, and citrus fruits also have properties that promote hormone balance. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Track 648.

Saliva Testing Questions
How does saliva testing work?

We test the following seven hormones in saliva:

  • Estradiol (E2)
  • Estrone (E1)
  • Estriol (E3)
  • Progesterone (Pg)
  • Testosterone (T)
  • DHEA-S
  • Cortisol (C)

ZRT’s at-home test kits include everything you need for collection and can be ordered online or by phone (some restrictions may apply). When your sample has been collected, return the filled tube(s) with the completed paperwork in the pre-addressed, pre-paid packaging and mailer bag provided with the kit. Once ZRT has received your sample, results will be returned to you and/or your health care provider in approximately 5 to 7 business days. Please view the ZRT saliva collection video to learn more.

How accurate is saliva testing compared to blood and urine testing?

Saliva testing has been used in scientific testing for decades and has been shown to be highly accurate. It is the most reliable way to measure free, bioavailable hormone activity – those hormones actually doing their job at the cell level. Standard blood and urine tests do not measure bioavailable hormone levels. Numerous scientific studies have shown a strong correlation between the levels of steroid hormones in the blood stream and the bio-available levels of steroid hormones in saliva. The World Health Organization has used this method of hormone testing in worldwide comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. In addition, saliva hormone testing more accurately reflects tissue uptake and response of hormones delivered through the skin in creams, gels, or patches than blood or urine tests.

Which saliva tests will give me a comprehensive picture of my hormone levels?

Our basic panel, Female Saliva Profile I, includes estradiol, progesterone, testosterone, DHEA-S and cortisol. This will give you an overall sense of hormonal balance or imbalance as these five hormones work closely together.

Female Saliva Profile II provides a more comprehensive idea of hormonal interactions. Of the four tubes included in this kit, two are used: one large tube for testing all the hormones of the basic panel (Female Saliva Profile I discussed above), and a smaller tube for collecting a cortisol sample at bedtime as well. This panel is recommended for those with mild to moderate symptoms of fatigue, stress, sleep disturbance, allergies, and food cravings.

With severe symptoms, Female Saliva Profile III, the most comprehensive of our saliva panels, is recommended. This test analyzes complete adrenal function by testing cortisol levels throughout the day. The Female Saliva Profile III test kit contains four tubes, one large tube for testing all the hormones of the basic panel in the morning, and three small tubes for noon, evening, and bedtime collections of cortisol.

Should I test estriol and/or estrone?

Since estradiol is the more predominant and potent of the estrogens, this is the most commonly measured estrogen in testing. We recommend testing for estriol and/or estrone when you are supplementing with these hormones.

Sample Collection Questions
What time of month should I collect my sample?

Women who do not have menstrual cycles can collect any day. This would include women after hysterectomy, with amenorrhea (abnormal absence of menses in women of reproductive age) and/or uterine/endometrial ablation (destruction of the uterine lining).

Women who have completely irregular, unpredictable menstrual cycles can collect any day they are not bleeding.

Women who have some kind of cycle regularity but not at the typical lengths should follow these guidelines for collection: Long cycles – test at day 19-21 or from day 19 to 5 days prior to when the period is expected.  For example, if the cycle is 35 days, collection can be done anytime between day 19 to day 30. Short cycles – collection should be done a couple of days prior to when bleeding starts  For example, someone with 14 day cycles should collect on day 12.

Are there specific herbal supplements/vitamins that can affect hormone levels and if so, how long must I avoid taking them prior to collecting my hormone sample?

Please list all hormones, supplements, and vitamins that you are taking on your requisition form. However, while vitamins may improve your symptoms, they do not generally change lab results.

The following products are available over-the-counter and may affect lab results (this is not an exhaustive list): progesterone, pregnenolone, DHEA, 7-Keto-DHEA (see special notice), hydrocortisone (cortisol). Continue to use topical hormones daily as prescribed, but avoid applying them to the face and neck areas for 3 days prior to testing. Rub in topical hormones without using fingers (e.g. wrist to wrist) for at least two days prior to collection. Skip use of anti-aging creams that may contain hormone traces. NOTE: 7-Keto-DHEA is a variant form of DHEA and can create false elevations of DHEA and testosterone test results. Please discontinue use of sublingual 7-Keto-DHEAS for 3 days prior to testing. If using pill form, follow the oral collection instructions.

When can I test if I am taking hormones?

Do NOT stop current hormone therapy prior to collection. Continue to use hormones daily as usual and follow the guidelines below for optimal timing of collection.

HORMONE TYPE COLLECT SAMPLE Pills, Gels, Creams, Sprays (oral, topical*, vaginal) 12-24 hours AFTER last dose – do not apply to face or neck Sublinguals and Troches (dissolve under tongue) 36 hours after last dosage Patches 1-2 days after applying patch Injections/Pellets Midpoint between injection/pellet inserts

THE FOLLOWING ALSO QUALIFY AS HORMONES (not limited to): Birth control, melatonin, hydrocortisone, creams containing pregnenolone and/or placental derivatives. Collect as above.

If you collect outside the recommended time frame above, this may result in hormone levels lower or higher than ZRT reference ranges for hormone users.

Topical Hormone Users should follow the instructions below to avoid direct contamination of the saliva during collection.
  • Do NOT use bare hands for topical hormone application for at least two days prior to saliva collection (apply hormones using latex gloves or preferably hormone-loaded syringe or applicator).
  • Do not apply hormones to face or neck. Apply hormones to areas of the body that can be covered by clothing to avoid transfer of hormones from fingers to face, lips, or mouth.
  • Wash hands thoroughly with soap and water after each application of hormones and dry with clean towel.
  • False-high saliva results can result when hormones from contaminated surfaces (faucets, counters, door knobs) or towels are transferred inadvertently from fingers/hands and then to face, lips, or mouth.
When should I test if I am taking oral contraceptives?

Since oral contraceptives suppress ovarian hormone levels, timing of the sample collection is less important. If you are discontinuing oral contraceptives, allow for withdrawal bleeding and wait until your next spontaneous cycle to test.  Collect sample on day 19-21 of your cycle.

Should I avoid using anti-aging OTC cream before I test?

Yes, discontinue anti-wrinkle creams at least three days before collection. You may substitute moisturizing creams that are safe for infants during the three days.

Should I test if I am sick?

No, you should wait until you are healthy before collecting.

When taking birth control pills, what tests are helpful?

Saliva testing for DHEA-S and cortisol and blood spot testing for thyroid, Vitamin D, and CardioMetabolic markers is definitely beneficial for women taking oral birth control pills. Collect your sample on Day 20 of your cycle, counting your first day of bleeding as Day 1. Please note, if you and your medical professional decide to discontinue your oral contraceptives, you should wait until your next menstrual period to collect. It may take approximately 7 weeks before you are able to collect your sample after discontinuing the pill as failure to ovulate is common in many women immediately after discontinuing birth control pills.

How do I collect a blood spot sample?

Within 30 minutes of waking, a few drops of blood from a quick and nearly painless nick of the finger, using the kit enclosed lancets, are placed on a filter paper. Once collected, allow your blood spot samples to dry for half an hour and then send them back to ZRT for processing.

How do I collect my saliva?

You should collect your sample within 30 minutes of waking prior to eating, drinking, exercising, flossing or brushing your teeth, or taking hormones.

How much saliva do I need to collect?

To ensure accurate results, all tubes should be at least full (preferably  full) excluding bubbles.

How are the large and small test tubes in the kit to be used?

The large test tube, when filled full, can test the following hormones: estradiol, estriol, estrone, progesterone, testosterone, DHEA-S, and morning cortisol. The small tube is used for those testing their bedtime cortisol level. To perform a complete adrenal function test, cortisol is collected four times throughout the same day (morning, noon, evening, and at bedtime).

Note: Too many bubbles are often caused by spitting too frequently into the tube. To avoid bubbles, try pooling saliva in your mouth for several minutes before spitting. If your sample contains a large percentage of bubbles, cap the tube and tap it on a hard surface to disperse bubbles into liquid.

I am having a difficult time collecting enough saliva to fill the tube.

If you are having difficulty collecting saliva, we have a few recommendations:

  • Drink extra water the day/night before collection to encourage the production of more saliva.
  • If your mouth is dry, try pressing the tip of your tongue against your teeth or the roof of your mouth. Smelling (not eating) a lemon or other foods can also produce saliva flow.
  • Allow saliva to pool in mouth before collecting.
  • Chewing gum (even sugarless) is not advised as it may contaminate the sample.
  • If you are still unable to collect enough saliva in one day, cap the tube, place in the refrigerator or freezer, and add more saliva at the same time the next day until the tube is at least half full. You may continue collecting in this way for up to 3 days.
I ate breakfast and/or brushed my teeth and then started collecting my saliva. Should I start over again?

Yes, you should begin collection the next morning. Just rinse the tube with warm water (no soap), allow to air dry, and collect within 20-30 minutes after waking and before eating, drinking, brushing, or flossing your teeth.

I forgot to rinse my mouth before I collected my saliva. What should I do?

We suggest you rinse before collection as a film develops in your mouth at night. If you have not rinsed your mouth and have not collected the full amount of saliva, just start over by first rinsing the tube with warm water (no soap), and then rinsing your mouth before collecting.

Should vigorous exercise be avoided the day before saliva collection for cortisol (adrenal function)?

Collection should be done on a day when you are engaging in your normal, routine activity. Any exercise will affect cortisol levels. Therefore, if you routinely engage in strenuous exercise and want to see what happens to your cortisol with exercise, then testing on that day is acceptable. However, if you do not routinely exercise or do not wish to see the effect of exercise on your cortisol levels, refrain from vigorous exercise (e.g., running, biking, etc.) on the day of testing.

I have diabetes and have to eat when I get up. Can I eat before I take the test?

People with diabetes who are doing saliva testing should discuss this question with their medical professional. If you do choose to eat before collecting your sample, cortisol levels will be affected. In any case, it is always important to rinse your mouth prior to collecting your saliva. Do NOT brush your teeth prior to collecting as this may cause micro-bleeding in your mouth that could change sex hormone results.

I would like more tubes to do extra testing. Can I use a test tube from my daughter's science kit?

No. The collection tubes for hormone collection are made especially for ZRT. We cannot guarantee the quality of the sample if it arrives in anything but these tubes. Please contact ZRT Laboratory directly and they will mail you additional tubes as needed. If you wish to collect an additional sample before the tube arrives, you may do so in a glass jar and freeze until the tube arrives. Be sure to mark the date and time of collection on the glass jar.� When the tube arrives, thaw your sample, pour into the collection tube(s), and mail to ZRT. Please indicate on the requisition form that the sample had been previously frozen.

Sample Return and Payments Accepted
How are samples returned to the ZRT laboratory for testing?

Most test kits contain a UPS or US Postal Service return label for sample returns within the US. Testers may choose to purchase an alternate form of shipping at their own expense. Proactive Breast Wellness TM does not typically cover the cost of samples being returned from outside of the US.

International testers will need to purchase return shipping at their own expense because these samples are not bio-hazardous, there should not be any restrictions imposed by customs. Note: Samples should be sent as soon as possible after collection and will remain stable under average shipping conditions, including over weekends and holidays.

What forms of payment are accepted by Proactive Breast Wellness?

We accept VISA, Master Card, American Express, Discover Card and mailed US money orders. However, Internet orders must be paid by credit card only.

What if I live outside of the United States?

Prepayment in United States dollars is required. We cannot accept foreign currency outside of the United States.

Test Results and Follow-up Questions
What should I expect after I send in my test?

If your health care provider orders your test, your results are returned to them within 5 to 7 business days from the date we receive your sample. In this case, you can obtain a copy of your test results from your provider. If you order your test directly, your results are returned to you within 5 to 7 business days from the date we receive your sample. The test report includes:

  • A graph showing where your hormone levels fall within set ranges. Levels can be either within or out of normal range.
  • A second graph detailing the symptoms you listed on your self-evaluation form. Symptoms are grouped according to the indicated category of hormonal imbalance. Symptoms are also correlated with the hormone levels identified through ZRT testing.
  • A comment field providing an individualized review of your hormone evaluation.
Can I have my test results faxed to my provider if I ordered my test kit directly?

You will receive a copy of your lab report directly from the lab. You may choose to copy or fax your personal lab report and send it to your provider.

I have my test report, but I do not understand how to interpret

When you receive your Hormone Evaluation test report, you will also find instructions, Understanding Your Hormone Test Results, which contain a full explanation about how to interpret your results. However, to ensure correct interpretation of your test results, we advise you to discuss them with your health care provider.

Now that I know what my hormone levels are, where can I go for help?

We recommend that you have your results evaluated by a knowledgeable health care provider who, depending upon your test results, may take steps to correct and monitor any hormone imbalances detected during testing. To locate a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing, you may visit www.zrtlab.com and find a provider in your area.

Can you recommend any doctors who I can see for treatment?

Please refer to www.zrtlab.com to find a health care practitioner or compounding pharmacist in your area who is familiar with ZRT testing.

I want to begin using bioidentical hormones. What products do you recommend?

As ZRT is a research and testing laboratory, they do not make any recommendations for any specific products. There are many different types of creams and gels that are available over the counter but not all are reliable. We suggest researching the list of natural hormone creams approved by Dr. John Lee, MD. It is also beneficial to speak with a compounding pharmacist skilled in the formulation of bioidentical hormone supplements tailored to individual needs. Please refer to www.zrtlab.com to find a compounding pharmacist in your area who is familiar with ZRT testing and can formulate bioidentical hormone supplements for you.

If you are currently on hormone therapy, it is advisable to test your present hormone levels to identify any existing hormone imbalances before making any changes to the dosage. For more information, call the ZRT 24-hour Hormone Hotline at 503-466-9166 and listen to Tracks 648 and 649.

What if my doctor is unsure about prescribing bioidentical hormones?

If your doctor is interested but unsure about prescribing bioidentical hormones, you can put him or her in touch with a compounding pharmacist. These professionals are thoroughly trained in modern compounding methods and skilled in the use of bioidentical hormone therapy. They can provide your physician information about safe dosing guidelines for bioidentical hormone supplementation. Please refer to www.zrtlab.com to find a compounding pharmacist in your area who is familiar with ZRT testing.

Shipping Questions
How are samples returned to the laboratory for testing?

Note: Samples should be sent as soon as possible after collection but will remain stable under average shipping conditions, including over weekends and holidays.

Most test kits contain a UPS or US Postal Service return label for sample returns within the US. Testers may choose to purchase an alternate form of shipping at their own expense. ZRT does not typically cover the cost of samples being returned from outside of the US.

International testers will need to purchase return shipping at their own expense.  These samples are not bio-hazardous so as long as they are packaged according to the Collection Instructions , there should not be any restrictions imposed by customs.

Is it ok to send samples to the laboratory over a weekend or holiday?

SALIVA samples should be sent as soon as possible after collection and will remain stable under average shipping conditions, including over weekends and holidays and during hot temperatures.  If sample(s) will not be sent the day of collection, please store in the freezer and note dates in Section 5 of the Test Requisition.

DRIED BLOOD SPOT or DRIED URINE samples should be kept at room temperature and will remain stable for shipping over weekends and holidays, and during hot temperatures.

What if I can't find my return label or the kit does not contain one?amples to the laboratory over a weekend or holiday?

International testers – Due to vast differences in international postal systems, we are not usually able to provide international return mailers.

In most cases, a prepaid return label is provided by ZRT Laboratory inside the test kit(s).  If you do not have one, you may send the sample to us via any method of your choosing. (A method where you are able to track your package is recommended.) Please note that ZRT Laboratory does not reimburse shipping charges. If you received your kit from a healthcare professional, you may contact their office to see if they are able to provide a replacement label. If you received your kit directly from ZRT Laboratory, you may contact Customer Service toll free at (866)600-1636. Please be aware that having a shipping label mailed can take up to 7 business days to arrive, which may further delay the testing and validity of your sample.

Is it ok to send samples to the laboratory when it's really hot outside?

SALIVA samples should be sent as soon as possible after collection and will remain stable under average shipping conditions, including over weekends and holidays and during hot temperatures.  If sample(s) will not be sent the day of collection, please store in the freezer and note dates in Section 5 of the Test Requisition.

DRIED BLOOD SPOT or DRIED URINE samples should be kept at room temperature and will remain stable for shipping over weekends and holidays, and during hot temperatures.

What are your shipping policies for online orders?

Please see our shipping policy for more information about cost, delivery times, and restrictions for your particular state

What is your return/refund policy for Hormone Testing Kits?

Hormone Test Kits and shipping fees are non-refundable due to health regulations.