Quick Facts
- Sample: Saliva (cortisol, hormones) and dried blood spots (thyroid, lipids, glucose, vitamin D)
- Fasting: Not required; optional for more precise glucose and insulin results
- Turn-around: 10-14 business days from laboratory receipt, May take longer based on weather, holiday, or lab delays.
Benefits
- Comprehensive hormonal assessment without needle sticks or clinical office visits.
- Eliminates cortisol elevation from phlebotomy stress, improving accuracy for stress and mood markers.
- Results include age-, sex-, and supplementation-adjusted reference ranges for personalized interpretation.
- Convenient room-temperature shipping; samples remain stable for weeks without cold packs.
- Monitor hormone replacement therapy effectiveness without discontinuing treatment.
- Identifies hidden imbalances years before symptoms progress to clinical disease.
Who Is This Test For?
- Women navigating perimenopause, experiencing hot flashes, sleep disruption, or mood changes.
- Men in andropause seeking clarity on hormonal shifts affecting energy, muscle, or libido.
- Individuals with unexplained fatigue, weight gain, or metabolic sluggishness.
- High-stress professionals and those managing depression, anxiety, or burnout.
- Anyone with family history of cardiovascular disease, diabetes, or thyroid dysfunction.
- Health-conscious adults seeking comprehensive preventive screening before age-related disease emerges.
- Patients diagnosed with PCOS, infertility concerns, metabolic syndrome, or thyroid symptoms.
How It Works – Just 3 Steps
- Order and receive your kit at home. The kit includes labeled saliva collection tubes, blood spot lancet and collection card, and a prepaid return envelope. No physician order required.
- Collect samples in the morning at home. Provide saliva samples at waking, 30 minutes, and 60 minutes post-waking to capture your cortisol awakening response. Complete a blood spot fingerstick collection for thyroid, cardiometabolic, and vitamin D markers. No fasting or special preparation needed.
- Mail samples and receive results within two weeks. Place samples in the prepaid envelope and mail via standard post. Results arrive electronically within 10-14 business days from laboratory receipt,
FAQ
What hormones does this test measure? The kit measures seven steroid hormones: estradiol, estrone, estriol, progesterone, testosterone, DHEA-sulfate, and cortisol via LC-MS/MS, the gold standard for hormone accuracy. Cortisol is measured at four time points to assess your stress response pattern.
Can I keep taking my hormones or medications? Yes. ZRT uses reference ranges adjusted for age, sex, and supplementation status, so you do not need to stop hormone replacement therapy, oral contraceptives, or other medications. This allows monitoring of treatment effectiveness without interruption.
How accurate is home sample collection? Home-collected dried blood spot samples show 99.5% concordance with traditional laboratory venipuncture. Saliva collection is actually superior for cortisol assessment because it eliminates the cortisol spike triggered by needle sticks in clinical settings.
When is the best time to test? Ideally during a low-stress period for accurate cortisol measurement. Women should test during the follicular phase (days 3-10 of the menstrual cycle) for optimal hormone assessment, though some providers recommend testing twice for comprehensive pattern recognition.
What if my results are abnormal? Bring results to your primary care provider, functional medicine practitioner, or naturopathic doctor. ZRT reports include specific clinical interpretation ranges to guide discussion.
More Details
What is the purpose of this test?
The ZRT SB-653 provides a comprehensive snapshot of hormonal, metabolic, and cardiovascular health in a single home-based assessment. It measures seven steroid hormones, captures your cortisol awakening response as a validated marker of stress resilience and mental health, evaluates thyroid function, assesses lipid and glucose metabolism, measures inflammation, and determines vitamin D status. This multi-system approach identifies imbalances and risk factors that often precede clinical disease by years, enabling preventive intervention before symptoms emerge.
What biomarkers are measured in this test?
Saliva Component (LCMS Hormones)
- Estradiol (E2) - primary estrogen; regulates bone, cardiovascular, and cognitive health
- Estrone (E1) - secondary estrogen, predominantly produced in postmenopausal women
- Estriol (E3) - weakly estrogenic, abundant during pregnancy
- Progesterone (Pg) - essential for menstrual regulation, mood stability, and bone health
- Testosterone (T) - critical for muscle, bone, libido, and cognitive function
- DHEA-Sulfate (DHEA-S) - adrenal precursor hormone, marker of HPA axis integrity
- Cortisol (C) - stress hormone measured at waking, 30 min, 60 min, and diurnal intervals
Blood Spot Component (Thyroid Panel)
- TSH (Thyroid-Stimulating Hormone) - primary screening marker for thyroid dysfunction
- Free T3 (Triiodothyronine) - active thyroid hormone, controls metabolic rate
- Free T4 (Thyroxine) - primary thyroid hormone, substrate for T3 production
- TPO Antibodies (Thyroid Peroxidase) - screens for autoimmune thyroid disease (Hashimoto's)
Blood Spot Component (CardioMetabolic Profile)
- Total Cholesterol - predictor of cardiovascular disease risk
- HDL Cholesterol - protective cholesterol, inversely associated with CVD risk
- LDL Cholesterol (direct) - atherogenic cholesterol, primary driver of atherosclerosis
- Triglycerides - independent CVD risk factor, marker of metabolic dysfunction
- VLDL Cholesterol - very low-density lipoprotein, atherogenic remnant
- High-Sensitivity C-Reactive Protein (hs-CRP) - inflammatory marker, predictor of CVD and metabolic disease
- Fasting Insulin - marker of insulin resistance and metabolic syndrome
- Hemoglobin A1c (HbA1c) - glucose control over 2-3 months, predictor of diabetes and CVD
- Glucose - fasting blood glucose, indicator of metabolic function
Blood Spot Component (LCMS Vitamin D)
- 25-Hydroxyvitamin D2 (25OHD2) - dietary and fungal-sourced vitamin D
- 25-Hydroxyvitamin D3 (25OHD3) - endogenous and supplemental vitamin D
- Total 25-Hydroxyvitamin D (25OHD2 + 25OHD3 combined)
Who would benefit from this test?
Ideal candidates include women in perimenopause, men in andropause, individuals with unexplained fatigue or weight challenges, high-stress professionals, and anyone with family history of cardiovascular disease or diabetes. Those with diagnosed PCOS, infertility concerns, metabolic syndrome, thyroid symptoms, or depression often benefit significantly. Health-conscious adults aged 35 and older seeking comprehensive preventive screening before disease emerges are excellent candidates for this comprehensive panel.
When should I order this test?
Schedule testing during a low-stress period to ensure accurate measurement of the cortisol awakening response
Women
- Ideally test during the follicular phase (days 3–10 of the menstrual cycle) for optimal hormone assessment
- Some providers recommend twice-yearly testing (follicular and luteal phases) to capture comprehensive hormonal patterns
Men
Follow-up testing
- Repeat testing every 3–6 months when initiating or adjusting lifestyle interventions or supplementation protocols
How do I interpret the results?
ZRT report features
- Individualized clinical interpretation linked to your specific symptoms
- Age-appropriate, personalized reference ranges
- Results clearly flagged for quick review:
- HIGH (red)
- LOW (red)
- OK (green)
Cortisol patterns and implications
- Blunted cortisol awakening response → may indicate chronic stress, depression, or adrenal dysfunction
- Elevated morning cortisol → suggests anxiety or anticipatory stress
Sex hormone findings
- Low estrogen and/or progesterone → associated with hot flashes, mood dysregulation, and sleep disruption
- Elevated androgens with low estrogen → suggestive of PCOS
Cardiometabolic and inflammatory markers
- Elevated triglycerides
- Low HDL cholesterol
- High hs-CRP
- Elevated fasting insulin
→ collectively indicate increased cardiovascular and metabolic risk
Vitamin D status
- Vitamin D deficiency (< 20 ng/mL) → predicts decline in cardiovascular and bone health
Early identification of cortisol dysregulation, metabolic dysfunction, and nutrient deficiencies enables preventive intervention years before clinical disease manifests.
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
No fasting required, though fasting blood spot samples provide more precise glucose and insulin interpretation. Avoid strenuous exercise, emotional stress, and major life events for 24-48 hours before collection, as these acutely elevate cortisol and mask baseline patterns. Maintain your normal sleep-wake cycle and collect saliva samples at exactly the specified times with consistent sleep the night before. Do not stop hormone replacement therapy, oral contraceptives, or medications unless directed by your provider. Avoid eating, drinking (except water), brushing teeth, or smoking for 30 minutes before saliva collection to prevent contamination or dilution.
How often should I get tested?
For individuals initiating lifestyle or supplementation interventions:
- Every 3-6 months to track progress and enable dosage adjustments
For stable individuals with normal baseline results:
- Annually for ongoing preventive monitoring
For those monitoring hormone replacement therapy effectiveness:
- Every 6-12 months to confirm optimal dosing
After significant life changes (major stress, sleep disruption, weight loss):
- Retest to assess system recovery
Why early detection matters
Metabolic syndrome affects 41.8% of U.S. adults, yet most are unaware until disease becomes symptomatic. Vitamin D deficiency (50.8% of the population) increases cardiovascular disease risk 2.25-fold. Subclinical thyroid dysfunction affects 10-15% of adults and often progresses to overt disease without intervention. Early identification of lipid abnormalities, inflammation, and glucose dysregulation reduces cardiovascular events by approximately 30% through targeted treatment (American Heart Association 2025). This test enables preventive intervention years before clinical diagnosis, improving long-term health outcomes and reducing healthcare burden.
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