Quick Facts
- Sample: Saliva
- Fasting: No fasting required
- Turn-around: 5–7 business days after lab receipt. May take longer based on weather, holiday, or lab delays.
Benefits
- See your daily stress pattern – Four cortisol time points reveal how your body responds throughout the day
- Measure bioavailable hormones – Saliva captures the free, active fraction that actually affects your cells
- Skip the needle – Collect all samples privately at home with no blood draw needed
- Track hormone therapy – Ideal for monitoring bioidentical or topical hormone replacement over time
- Comprehensive insight – Five key hormones plus cortisol curve show how stress and sex hormones interact
- Precision technology – LC-MS/MS delivers highly accurate results, especially for low hormone levels
Who Is This Test For?
- Adults experiencing persistent fatigue, poor sleep, or difficulty managing stress
- Women with perimenopausal or menopausal symptoms like hot flashes, mood swings, or low libido
- Individuals on hormone replacement therapy needing objective monitoring of treatment levels
- People with unexplained weight changes, low energy, or reduced exercise tolerance
- Those seeking a preventive health baseline before hormone imbalances cause long-term complications
- Anyone wanting to understand how adrenal and reproductive hormones affect their daily wellbeing
How It Works – Just 3 Steps
- Collect saliva at home – Fill small tubes at waking, midday, evening, and bedtime as instructed
- Ship your samples – Place tubes in the biohazard bag and mailer, send Monday–Thursday for prompt delivery
- Review your results – Receive a detailed report with age- and sex-adjusted reference ranges within about one week
FAQ
What hormones does this test measure? Estradiol, progesterone, testosterone, DHEA-S, plus cortisol at four times across the day to map your stress curve.
Is saliva testing as reliable as blood work? Yes—salivary cortisol correlates well with serum free cortisol and is validated by the Endocrine Society for adrenal screening (Endocrine Society 2015). LC-MS/MS technology ensures high accuracy for sex steroids.
Will my medications affect the results? Glucocorticoids and oral contraceptives can influence hormone levels; discuss timing with your provider but do not stop medications without medical guidance.
How soon after starting hormone therapy should I test? Establish a baseline before therapy, then retest about 6–12 weeks after dose adjustments to confirm levels are in the target range.
Can I use this test to diagnose Cushing's or adrenal insufficiency? This panel helps screen for abnormal cortisol patterns, but definitive diagnosis requires confirmatory blood tests, ACTH stimulation, or imaging ordered by your clinician (Endocrine Society 2016).
Do I need a doctor's order to purchase this test? Walk-In Lab provides physician oversight for direct-access ordering, so you can purchase online and discuss results with your own provider afterward.
More Details
What is the purpose of this test?
The S-141 panel evaluates your key sex hormones—estradiol, progesterone, testosterone, and DHEA-S—alongside a four-point cortisol curve that shows how your adrenal glands respond to stress throughout the day (ZRT Laboratory 2023). This integrated profile helps identify contributors to symptoms like fatigue, mood changes, sleep disturbance, and perimenopausal complaints, enabling you and your clinician to tailor treatment or lifestyle strategies. By measuring the free, bioavailable fraction of each hormone in saliva rather than total levels in blood, you gain insight into the hormones actively interacting with your cells.
Who would benefit from this test?
Adults experiencing persistent stress, suspected adrenal dysfunction, perimenopausal or menopausal symptoms, low libido, or unexplained fatigue may benefit from an integrated adrenal–sex hormone profile (ZRT Laboratory 2023). It is particularly helpful for individuals already on hormone or adrenal support therapy who need objective monitoring of free hormone levels, especially when using topical or transdermal formulations. People with features suggestive of Cushing's syndrome—such as unexplained weight gain and hypertension—or adrenal insufficiency—including weight loss, low blood pressure, and severe fatigue—should discuss testing and further evaluation with a clinician promptly.
When should I order this test?
It is reasonable to order when you are experiencing ongoing stress-related symptoms, menstrual or menopausal changes, or before and during hormone therapy to establish a baseline and track your response over time (ZRT Laboratory 2023). Endogenous Cushing's syndrome affects about 40–70 cases per million people in the United States, yet many cases are missed or diagnosed late, leading to increased cardiovascular and metabolic risk (Endocrine Society 2015). Primary adrenal insufficiency has a prevalence of roughly 100–140 per million in Western countries, and delayed diagnosis increases the risk of adrenal crisis and hospitalization (Endocrine Society 2016).
How do I interpret the results?
Your results are compared with reference ranges adjusted for sex, age, cycle status, and hormone use, and cortisol values are plotted across four time points to show whether your daily curve is normal, elevated, or flattened (ZRT Laboratory 2023). Interpretation should be done with a healthcare professional who can integrate your symptoms, medications, and other lab findings, as abnormal values may require confirmatory blood tests or imaging depending on the pattern.
- High morning cortisol with gradual decline: Normal diurnal pattern indicating a healthy adrenal response; maintain current lifestyle, no intervention needed
- Flat or low cortisol curve: Possible adrenal fatigue or chronic stress; implement stress management, nutritional support, and consider medical evaluation
- Elevated cortisol at night: Disrupted circadian rhythm or possible hypercortisolism; rule out Cushing’s syndrome, improve sleep hygiene, and consider targeted therapy
- Low DHEA-S: Reduced adrenal reserve or age-related decline; assess for adrenal insufficiency and consider DHEA supplementation if appropriate
- Low estradiol or progesterone: Suggestive of perimenopause, menopause, or ovarian dysfunction; consider hormone replacement and lifestyle modifications
- High testosterone (women): Possible PCOS, adrenal hyperplasia, or exogenous hormone use; pursue further endocrine evaluation and adjust therapy as needed
Abnormal diurnal cortisol patterns have been associated with higher all-cause mortality and increased cardiovascular disease risk in recent cohort studies (ZRT Laboratory 2023).
Disclaimer: Reference ranges may vary by laboratory. Listed ranges are general guidelines and may differ from those used by the performing lab. Always consult your healthcare provider for interpretation.
Pre-test preparation
Follow the kit instructions carefully; ZRT typically allows continued use of prescribed hormones but recommends timing collections relative to dosing—for example, avoiding sampling within several hours of topical application to the face or mouth (ZRT Laboratory 2023). Fasting is usually not required, but you should avoid eating, drinking anything except water, brushing teeth, or smoking for about 30 minutes before each saliva collection to prevent contamination. Certain medications such as glucocorticoids and oral contraceptives can affect hormone levels; discuss with your clinician before making any changes, as abrupt discontinuation can be unsafe for adrenal conditions.
How often should I get tested?
- Stable on hormone therapy: Every 6–12 months
- Recent treatment changes or unresolved symptoms: 6–12 weeks after dose adjustment, then as directed by your clinician
- Preventive baseline (no symptoms): Once, then repeat only if symptoms develop
- Monitoring chronic stress or adrenal support: Every 3–6 months initially, then less frequently as patterns stabilize
- Post-diagnosis of adrenal disorder: Follow your clinician’s protocol; more frequent testing may be needed during treatment titration
Why early detection matters
Up to 75 percent of women experience vasomotor symptoms during the menopause transition, and many report sleep disturbance and mood changes linked to fluctuating estradiol and progesterone levels (ZRT Laboratory 2023). Abnormal diurnal cortisol patterns, including flattened or blunted curves, have been associated with higher all-cause mortality and increased cardiovascular disease risk in cohort studies published in the last decade. Economic analyses suggest that earlier identification and management of adrenal and sex-hormone disorders can reduce downstream costs related to fractures, cardiovascular events, and hospitalizations. Identifying imbalances before they cause long-term complications supports more personalized lifestyle, supplement, or treatment decisions and helps you maintain energy, mood stability, and overall quality of life.
Related tests you may consider
Thyroid #3 Extreme Blood Test Panel – Thyroid and adrenal/sex hormones interact closely; combined assessment clarifies fatigue and weight changes (ZRT Laboratory 2023)
Wellness #2 Essential Blood Test Panel plus Hemoglobin A1c — a comprehensive assessment of metabolic, cardiovascular, thyroid, liver, kidney, and hematologic health, with HbA1c providing insight into long-term blood sugar control and cardiometabolic risk associated with insulin resistance, chronic stress, or midlife hormonal changes.
Vitamin #3 Extreme Blood Test Panel — a comprehensive micronutrient and metabolic assessment that evaluates key vitamins and minerals involved in energy production, immune support, iron status, and nutritional health, including vitamins D, B12, K1, C, folate, magnesium, and iron markers, alongside a CMP to provide broader insight into fatigue, mood changes, and overall wellness.
