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Patient FAQ

If you have questions about hormone and neurotransmitter testing you have come to the right page. We have lots of answers for you. There are four categories, general information about testing, practical questions about collecting your sample, and information about hormone imbalance and neurotransmitter testing. Click on the buttons below for more detail on the topics you are interested in.


Labrix works directly with practitioners. If you are looking for a practitioner to help you with testing, results interpretation and treatment suggestions please contact the lab to find practitioners in your area.

Your practitioner will be able to help you with the paperwork that is required to order testing.

If you are returning a kit from within the United States, Labrix includes pre-paid shipping. Return shipping methods vary, please see your specific kit box for shipping methods.

UPS or USPS: If your kit box contains a shipping label on the bottom of the box, please note which company is listed (it will either be USPS or UPS label.) When you are done with sample collection, simply drop off your completed kit at a UPS store or UPS drop box (or US Post Office/USPS mailbox/regular mailbox if applicable). DO NOT put a kit box with a UPS label in a regular mail box – it will not reach us in enough time to do the testing. If the mailing label on your kit is a standard US Postal Service (USPS) label you can return the kit to the lab through the regular mail. Please send your kit in as soon as possible to ensure a stable sample arrives at the lab.

FedEx: If your kit contains a FedEx Clinical Pak and FedEx Billable Stamp, follow these instructions:

Ship specimens Monday through Friday. If you complete the collection on the weekend, keep the specimen in the freezer until the following Monday to ship.

Place the cardboard kit box containing the specimens and the completed test requisition form into the FedEx Clinical Pak. (see back for example)

Write your name and address in the space provided on the prepaid Billable Stamp and tear off the Customer Receipt for your records.

To schedule a pickup, call FedEx toll-free at 1-800-463-3339 (1-800-GO FEDEX). When you hear the automated greeting, say "Schedule a Pick-up." At the next prompt, say "Schedule a Pick-up using a Label or Stamp." You will then be asked if the word "Stamp" is written on the waybill; reply "Yes". You will then be prompted for your address information.

Do not use a drop box. FedEx will not accept diagnostic specimens placed into a drop box.

Shipping from outside the US: If you reside outside the US and are returning a kit, please see your provider for shipping options. If you normally reside within the United States, and you happen to return a kit from outside the US (while on vacation or working abroad) the shipping will not be covered and you will be liable for any charges incurred.

Labrix has merged with Doctor's Data, Inc, and current billing policies can be found by clicking here.

Visa, Master Card, American Express, Discover, money order or personal check.

In some cases, Labrix/Doctor’s Data provides prepaid shipping from certain countries outside the United States. If that policy pertains to your collection kit, then country specific shipping materials (including an Air Waybill and instructions) will be included in the kit contents. If there are not any shipping materials included or you choose to use a different courier or level of service than provided, you must make your own shipping arrangements at your own expense.

In either case you must include the commercial invoice with your shipping waybill.

There are many important questions that we are asked by patients about proper specimen collection. Several of the most frequently asked questions are below.

Most of the hormones traveling in the blood stream are bound to large carrier proteins that prevent the hormone from being used by the tissues of your body (interacting with its hormone receptor) and are called bound or inactive. These hormones are not used by the body thus inactive or non-bioavailable. Less than 5% of hormones are unbound to proteins. This small percentage of unbound hormone is called free, active or bioavailable hormones. When a hormone is bound to a protein it is too large to pass into the saliva gland; therefore the saliva gland acts as a natural sieve, sorting the bioavailable (free) hormones from the large, inactive protein-hormone complexes. For this reason, the hormones tested in saliva are the most accurate reflection of the amount of the hormone that is available for your tissues to use. Serum hormone levels include ALL of the hormone (“total”), the bound and unbound portions, and does not reflect what the body actually can use.

Urinary hormone levels are directly affected by liver and kidney function, and since the hormones present in urine are not the active hormones, but are actually the metabolites that the body is disposing of, this is not an ideal fluid for hormonal assessment. Furthermore, the ease of saliva collection enables multiple samples to be taken throughout the day which is essential when measuring the rhythm of cortisol (adrenal status) instead of a single data point, or the total amount produced in a 24 hour period.

Remember to read the saliva kit instructions. If not on hormone supplements, post-menopausal women and men can collect any time. A premenopausal woman should collect on ONE of the days 19 - 23 of her cycle, which is approximately mid-way between ovulation and menstruation. That’s easy to do if you have regular cycles, but if you don't, it's harder to have a good starting point. Your practitioner will have guidelines to help you set a date for collection.

Most herbal supplements and vitamins can be used without interruption when collecting saliva as long as they don’t contain any hormones in them. Watch for hormones such as DHEA that may be in many anti-aging or male health products. In addition, some topical creams and lotions may contain hormones in trace amounts without reporting so on the label. Because of this, it is best to avoid applying lotions or creams the night before and the morning of saliva collection. Use of routine cosmetics is permitted.

We encourage you to monitor the therapeutic levels of your hormones to monitor your dosage. Remember to read the saliva kit instructions. If you are using topical hormone supplementation it is important to stop using the hormones 12-24 hours before the first collection, if the hormones are dissolved under your tongue, then you should use the last dose 24-36 hours prior to collecting your saliva and if you are swallowing the hormones (on oral supplementation) you don’t need to adjust the timing at all, you can take the hormone on the day of the saliva collection. You can restart your regular supplementation AFTER you have completed all four samples. Please ask your practitioner if you have any questions specific to your hormone treatment plan.

In general, we would recommend that you try to test on a "typical day", so if possible you should wait until you are not ill. Viruses such as colds and flues as well as bacterial infections are stressful to the body and therefore may affect the adrenal glands and cortisol levels.

You can collect your samples anytime while using oral contraceptives, since they suppress some of your hormone levels and prevent cycling. When you are discontinuing the birth control pill, wait until days 19-23 of your second cycle. Remember to read the saliva kit instructions.

Oral birth control pills work by suppressing ovulation and consequently result in low estradiol and progesterone levels and often low range testosterone levels. The synthetic progestins that are found in birth control pills are NOT measured by our test because they differ significantly in molecular structure from progesterone. Adrenal assessment including DHEA and diurnal cortisols can be very useful and important if you are taking birth control pills.

It’s a good idea to stop all creams 12-24 hours before collecting your first sample. Also – make sure that all door handles and faucets and regularly used surfaces have been wiped clean, contamination of a sample from over-the-counter creams is common. Check the ingredients on the tube and add to the list of supplements you are taking if you think it may contain hormones.

Yes. Wash out the tube with water and leave to dry. Start to collect the next day instead. The timing of the morning sample is VERY important for measuring your morning cortisol. The natural peak is at 30 minutes after you wake up so watch the clock carefully so you can collect that first sample 30 minutes after you awake. Food particles in the saliva or trace amounts of blood that may result from teeth brushing can affect the hormone levels.

Rinsing your mouth helps to eliminate any food particles from the saliva sample and will remove mucus or film that may have developed in your mouth. You can still submit this sample or you can empty the saliva tube, rinse with warm water only and begin collection tomorrow.

Please continue your routine as usual; the testing will give a clear picture of how your usual hormones function. If the exercise is typical for you, then proceed as usual. If you are planning on running a marathon the day before you plan to collect – it’s probably a good idea to wait 4 - 5 days after running to do your collection.

It is preferable to collect the sample 30 minutes after awakening and before breakfast. Please contact your health care provider for specific instructions if needed. Eating before the first saliva sample could cause the morning cortisol level to be affected.

Labrix works only with health care practitioners. Please contact the practitioner who gave you the kit to get your results.

There are many important questions that we are asked by patients about proper specimen collection. Several of the most frequently asked questions are below.

Estrogen dominance occurs when there is either too great an influence of estrogen, too little influence of progesterone, or both. There are many ways to prevent estrogen dominance including avoiding xenoestrogens (estrogen-like compounds) in your environment, managing stress, monitoring your weight and supporting your endocrine system. Often this involves supplementation of bioidentical progesterone however, proper evaluation of your hormone levels should always precede any supplementation program.

Testing your hormones is the best way to identify any hormone imbalance. There are many symptom pictures that may look similar; therefore knowing what your hormone levels are will enable your practitioner to determine the correct treatment for you.

PCOS is a syndrome that includes many systems and manifests with multiple symptoms. Women with PCOS typically have an increased resistance to insulin that stimulates their bodies to produce excess amounts of testosterone and DHEA. Elevated testosterone may result in symptoms such as increased acne or facial / body hair. Additionally, the elevated testosterone levels often cause a suppression of ovulation, which manifests as irregular or absent menstrual cycles.

Uterine fibroids are non-cancerous growths in the uterine wall and their growth is stimulated by estrogen. Estrogen is a proliferative hormone that causes tissue to grow. Progesterone helps that tissue develop and mature properly. There are many situations that result in an increased influence of the estrogens relative to progesterone. This situation is often referred to as estrogen dominance and can manifest as uterine fibroids.

Just as estrogen causes growth of breast tissue during puberty and thickening of the endometrial lining during the first half of the menstrual cycle, it can cause growth of breast tissue that, when uncontrolled, can lead to breast cancer. Hormonal imbalances such as estrogen dominance, where there is a greater influence of estrogen than progesterone, can propagate this growth. Since progesterone levels decline earlier and in greater quantity than estrogen levels as women approach menopause, the peri-menopausal and post-menopausal population is at particular risk for breast cancer.

The Labrix Comprehensive Plus Panel will provide important information such as the ratio of progesterone to estradiol. Furthermore, it will be important to measure your estrogen quotient. Both of these ratios provide an important risk assessment for breast cancer. Knowing how your body metabolizes estrogens by measuring the estriol level as well as the degree of estrogen dominance can provide important information to guide an individualized treatment plan.

Because the endocrine system is all interconnected, a thorough evaluation of thyroid function should also include measuring cortisol levels and sex hormones in saliva. Estrogen dominance leads to increased thyroid binding globulin (a carrier protein for thyroid hormone) and therefore less bio-available thyroid hormone. Additionally, cortisol is a necessary hormone for proper thyroid function however, when cortisol levels are too high it can lead to thyroid dysfunction. For these reasons, measuring diurnal cortisol levels as well as estradiol and progesterone are important for a complete thyroid evaluation.

Insulin resistance is a condition that occurs when the insulin receptor becomes resistant to its hormone insulin. In order for hormones to work properly, there must first be an adequate amount of the hormone and then, the receptor must also function properly. A good analogy for this is a key and a lock. In order to get into your house, you must have a key, but the lock must also be functioning. When insulin receptors are flooded with insulin as a result of a high sugar diet the receptors will begin to resist the hormone, like the lock changing. Insulin resistance is a pre-diabetic condition and a general laboratory workup should include a fasting glucose, fasting insulin and hemoglobin A1c (HbA1c). Additional testing may include a glucose and/or insulin tolerance test. These are all done in serum and can be ordered by your physician using standard laboratories. An early salivary indicator is when women have elevated testosterone or DHEA.

Adrenal dysfunction is a condition where the adrenal glands lose their ability to respond to stress and is usually caused by an accumulation of chronic stress over time. Adrenal dysfunction is not a black and white issue of whether or not your adrenal glands produce any cortisol at all, but a function of whether they are producing enough and if they are functioning on a daily rhythm the way they should be. Cortisol should be highest first thing in the morning, approximately 30 minutes after waking, and should slowly decline throughout the day. The best way to assess adrenal function and evaluate adrenal fatigue is to look at cortisol levels at multiple times throughout the day. Not only does saliva’s ease of collection facilitate this, but the cortisol levels present in saliva are only the bioavailable fraction of the hormone. These two factors make salivary cortisol the gold standard for assessing adrenal function and diagnosing adrenal dysfunction.

Neurotransmitters are natural chemicals that regulate numerous physical and emotional processes such as mental performance, emotional state, physical energy, and pain response. These chemicals have a very important role in allowing the body to work properly and sustain good mental and physical health. Neurotransmitters help the brain balance the highs and lows of feelings, and manage the hormonal signals that are sent to other organs in the body.

Imbalances in certain neurotransmitters are associated with most of the prevalent symptoms and conditions seen in practitioners offices today.

  • Depressed mood
  • Anxiety
  • Adrenal dysfunction
  • Fatigue
  • Poor sleep
  • Loss of mental focus, or cognitive fog
  • Addiction or dependency
  • Loss of appetite control
  • Compulsive behavior
  • Cravings
  • Low libido
  • Sexual dysfunction

It is important to talk to your health care provider about these symptoms. Neurotransmitter testing is just one component of addressing your health concerns.

Adrenal hormones, sex hormones, and neurotransmitters are functionally interrelated. Changes in sex hormones and adrenal hormones can lead to neurotransmitter imbalances. In turn, neurotransmitter imbalances can affect hormone function.

For example: Estrogen is a serotonin agonist (helps to increase production of serotonin, and promotes positive serotonin receptor activity). Low estrogen combined with low serotonin can exacerbate the symptoms of poor mood and physical discomfort.

The neurotransmitters norepinephrine and epinephrine work collaboratively with cortisol to manage the physical reactions to either chronic or acute stress such as blood circulation, muscle reaction, and mental sharpness. As adrenal dysfunction develops neurotransmitter depletion usually results, along with the associated symptoms of fatigue, agitation, and stress.

Including neurotransmitters with hormone lab panels provides a more comprehensive view of the body’s functional neuroendocrine status and the associated factors that may be contributing to symptoms.

If your health care provider suspects neurotransmitter imbalances they can order a lab test from Doctor's Data/Labrix. The test is non-invasive using a urine sample. Your provider will give you a collection kit, and you can collect your sample in the privacy of your own home.

Your neurotransmitter test results can provide information to your health care provider to help them determine the best course of treatment. Most of the time neurotransmitter imbalances can be corrected with specialized nutrient blends that provide your body certain amino acids and vitamins necessary to produce and regulate neurotransmitter function. A variety of products are available to your health care provider to choose from to fit your specific needs.

It is common for health care providers to order a follow up neurotransmitter test to monitor the progress of treatment. This allows them to adjust treatment and provide more personalized care.

Eating foods, drinking fluids with alcohol, sugar, or any kind of flavoring can all increase neurotransmitter activity in a variety of ways. Exercise can have effect on the production of serotonin, dopamine, and norepinephrine. The objective for sample collection is to collect when there has been little to no influence that could increase neurotransmitter activity.

For 48 hours before and during the collection, avoid eating avocados, eggplant, tomatoes, bananas, melons, pineapple, grapefruit, plums, nuts, nut butters, wine, cheese, and chocolate.

For 24 hours before and during the collection, avoid strenuous exercise, alcohol, coffee, tea, and tobacco. It is preferable to be off medications, including those that regulate allergy, mood, sleep, pain, and inflammation NEVER discontinue prescription medications without first consulting your physician.

Do not take any supplements on the day of testing until after sample collection.

The night before collection, don’t eat anything after you’ve eaten your dinner. Collect your urine sample before you eat again in the morning.