How To Collect Samples

I’m taking a blood spot test, how do I collect a sample?

Using the lancet included in the test kit, prick your finger and apply a few drops to the collection card.  Do this in the morning, within 30 minutes of waking.  Allow at least 30 minutes for the collection card to dry before packaging and shipping to our partner lab.

What precautions should I take before collecting a bloodspot sample?

Do not apply topical hormone creams or lotions with fingers or hands at least 2 days prior to test collection.  Do continue to take these medications as directed.

What can I do to make blood spot collection easier?

Increase blood circulation in the body by swinging arms, or doing jumping jacks.  Rub your hands together as well.  Tape the edge of the collection card to a low table near your seated location.  Once you prick your finger with the lancet, allow blood drops to fall onto the collection card.  If bleeding is slow, gently palpitate the finger towards the fingertip to increase blood flow.

How do I take a saliva sample for testing?

Within 30 minutes of waking and before any morning activity including eating, drinking, brushing, flossing, or exercise, you will fill a small tube (included in the kit) with saliva.

Does it matter how much saliva I collect?

Yes.  The small enclosed tube should be filled at least half way (preferably ¾’s) to provide an adequate testing sample for the laboratory.

Why does my test come with both large and small collection tubes?

The large collection tube is used to test specific hormones.  These include estradiol, estriol, estrone, progesterone, testosterone, DHEA-S, and morning cortisol levels.

The small collection tubes are used for multiple saliva samples collected throughout the day and are included in test kits for adrenal function where cortisol levels are taken morning, noon, evening, and at bedtime.

How can I produce more saliva for testing?

Allow the saliva to pool inside the mouth before spitting into the collection tube.

Shake the tube down if there are too many bubbles in the saliva sample.

Drink plenty of water the day or night before testing.

Smell foods such as lemon to create more saliva production.

You may fill saliva tubes over the course of 3 consecutive days as long as you refrigerate or freeze test samples in between.

Do I need to re-collect my saliva sample if I already brushed my teeth or ate breakfast?

Yes.  Wash out the tube with the current saliva sample and collect saliva the next day within 30 minutes of waking.  

Should I refrain from strenuous exercise the day prior to saliva collection for cortisol testing?

No.  While exercise does affect cortisol levels you should engage in normal daily activity.  If that includes strenuous exercise, you should not alter your routine.   

I am a diabetic and need to eat immediately after waking. How should I handle this before saliva collection?

You should discuss this with your doctor and follow any instructions for eating before saliva collection.  You should also rinse your mouth out thoroughly and not brush your teeth when preparing to take a test sample.

How do I collect a dried urine sample for testing?

Your test kit contains a collection card, which must be saturated with urine and left to dry before shipping.  Dried urine samples are viable up to 30 days past collection.

How will the lab collect my blood, urine, or saliva sample for testing?

All test kits include a sterile collection receptacle or card that must be placed in an enclosed plastic box before shipping.  Test kits include prepaid packaging to be dropped off at a designated carrier (either US Postal Service or UPS) for return shipping.

When To Collect Samples, Associated Precautions

Is there a specific time of month to collect my sample?

If you are male, you can collect a sample anytime throughout the month.

Women who do not menstruate or (no longer menstruate) can collect a test sample any day throughout the month.  

Women who have a normal menstrual cycle should collect samples on days 19, 20, or 21 by counting the first day of menstruation as day 1.

Women who have irregular menstrual cycles can collect samples any day of the month they are not menstruating.

Women who have longer menstrual cycles should collect samples on day 19-21 or anytime from day 19 up until 5 days prior to menstruation.

Women who have shorter menstrual cycles should collect test samples 2 days before menstruation begins.

Will vitamins or natural supplements affect my hormone levels when testing?

In general, neither vitamins nor herbal supplements affect test outcomes. It is important to list all medications and natural products on the test requisition form provided in the kit.

The following over-the-counter products may affect the test result:

  • Progesterone, pregnenolone, DHEA, 7-Keto-DHEA, hydrocortisone (cortisol). Do not use sublingual 7-Keto-DHEAS for the 3 days before testing. Follow oral collection instructions if taking in pill format.
  • Use topical hormones as directed, however do not apply to the neck and face the 3 days before testing. Do not use fingers to apply topical hormones the 2 days prior to testing.
  • Do not use anti-aging creams that could contain hormone compounds, prior to testing.
If I am taking hormones, when should I test?

Continue hormone therapy as directed by your physician.

Collect test sample 12-24 hours after the last dose if taking pills, gels, creams or sprays.  This includes oral, topical or vaginal therapies.

Sublinguals and Troches, test 36 hours after last dose.

Patches, collect 1-2 days after applying.

Injections and pellets, collect midway between injection/pellet inserts.

The following medications are also considered hormones and could affect test outcomes if collected outside of recommended testing window:

Oral contraceptives, melatonin, hydrocortisone, steroid injections, Flonase, prednisone, pregnenolone cream, derivatives of placenta or stem cells. 

Topical Hormone Application

Do not apply with bare hands within 2 days prior to saliva testing.  Use latex gloves or provided applicator.  Do not apply to the neck or face area.  Wash hands before and after application.  False saliva results can result from transfer from hormone contaminated surfaces and towels.

If I am taking oral contraceptives, when should I take my test?

Testing is not generally affected by oral contraceptives, but if discontinuing altogether, collect the sample on day 19-21 of your next menstrual cycle. 

Should I discontinue use of over-the-counter anti-aging cream before collecting my sample?

Yes, it is important to stop using these products for 3 days prior to collection.  Moisturizing cream can be used.

What if I am sick? Should I wait to collect my test sample?

Yes, you must wait until you are over an illness before collecting your test sample.

Should I stop eating certain foods before collecting my test sample?

No.  It is important to maintain your normal daily diet before test collection to ensure accurate results.

About the Tests

If I’m taking oral contraceptives, what tests should I take?

Saliva tests for DHEA-S and cortisol levels may benefit women who take birth control pills.  Blood spot testing for thyroid function and vitamin D are also recommended when using oral contraceptives.  These should be taken on the 20th day of your menstrual cycle unless you have been advised to discontinue pill use.  If this is the case, you should wait until your next menstrual period before collecting a test sample.

What types of at-home lab tests are available?

We offer a wide range of lab tests for a number of patient concerns including hormone, neurotransmitter, and heavy metals testing.

What are the different testing methodologies and when are they used?

Our partner laboratory conducts a number of tests through saliva, blood spot, serum, or urine sampling.  Each method is designed to collect specific information for the utmost accuracy.

Saliva Testing

When evaluating hormone levels what do saliva tests measure?

In saliva testing, free or bioavailable hormones are measured.

What hormones are tested using a saliva test kit?

Saliva tests can analyze:

  • 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)
Is saliva testing as accurate as blood and urine testing?

For several decades, saliva testing has proven to be a highly accurate testing method for free and bioavailable hormones acting at the cellular level.  Saliva tests for steroid hormones strongly correlate with hormone levels found in the blood.

Saliva tests are the most accurate for measuring the efficacy of hormone therapies delivered through the skin such as patches, gels, and creams.  

Which saliva test kit should I choose to get an overall picture of my hormone levels?

The Female/Male Saliva Profile I is designed to test hormone levels for either women or men.  The basic panel evaluates hormones estradiol, progesterone, testosterone, DHEA-S and cortisol and helps determine whether hormones are balanced overall as they work in synergy with each other. 

The Female/Male Saliva Profile II test kit is meant to evaluate hormone levels further, providing a more complete picture of the interaction between specific hormones.  Intended for those who report mild to moderate symptoms of a hormonal imbalance including stress and fatigue, insomnia, allergies or food cravings, the Saliva Profile II contains one large collection tube for the basic saliva profile and one smaller tube for collecting cortisol at bedtime. 

The Female/Male Saliva Profile III test kit is the best choice for those individuals with more severe symptoms that may be tied to a hormonal imbalance.  This test kit measures adrenal function by testing cortisol levels at different points throughout the day.  Four collection tubes are included in the kit with one large collection tube to test all of the hormones included in the basic test panel and cortisol levels at noon, evening, and bedtime collection of cortisol levels. 

Is it better to test Estriol or Estrone?

Estrogens include the three; estradiol, estrone, and estriol.  Estradiol is the strongest of each of the estrogens and the one tested most frequently.  Estriol and estrone are generally only tested to determine the efficacy of hormone therapy that includes the two endogenous estrogens.


How will I get the results of my lab test?

Test results are made available online through a secure access portal and can be accessed 24 hours a day on any personal device.

How long do I have to wait before receiving my test results?

Test results will be electronically delivered to your secure access account within 5-7 business days of receiving the test sample.

What format will my test results be in?

Test reports will provide individual assessment and evaluation of your health through detailed, easy to understand graphs, graphics, clinically significant comments and interpretation of symptoms.  Results let you track ongoing progress as well.

Am I required to share the results of my lab test with my doctor?

While it is always advisable to share health information with your medical practitioner, including any test results obtained outside of the scope of the doctor’s office, it is not required.  At-home tests are completely private and confidential.

*We cannot process orders to NY or MD at this time.  (CA consumers, some   restrictions may apply).

Prescription, Payment and Shipping

Can I order a hormone test without a doctor’s prescription?

This depends on the regulatory laws in your state.  Some states require a written or electronic prescription from a physician, while others allow for Direct Access Testing (DAT) that does not require prior permission from a healthcare practitioner.  To find out your state’s rules for testing without a prescription, contact Optimal Health at hrt.org for more information.

How should I return my test sample to the laboratory for analysis?

Test kits contain prepaid return labels with instructions for drop off at a UPS or USPS location. Can the laboratory bill my insurance company for the cost of testing?

As a courtesy, our partner lab can bill the following insurance companies for out-of-network testing costs. You must contact your insurance provider prior to laboratory testing to determine eligibility for up-front coverage or reimbursement options.

  • Original Medicare Part B
  • Medicare Advantage Plans
  • CignaHealthcare
  • Humana
Can I use my Flexible Spending Account (FSA) for testing?

Yes, an FSA allows pre-tax dollars to be deposited into an account for eligible medical expenses.

What paperwork must I submit with my laboratory sample for possible billing?

You will need to include:

  • Lab order with diagnosis code(s)
  • Date of Birth
  • Name, address, and NPI number of physician
  • Copy of insurance card (front and back)
  • Insurance Authorization Form (included)
What if I have an insurance company not listed?

While we cannot bill your insurance provider directly we will provide an itemized receipt upon request.  You may use this for possible reimbursement for up-front payment of test kit and processing.

What if I have Medicare part B as my secondary insurance, but my primary insurance is not on the list?

Send prepayment as necessary and request an itemized receipt.  Submit the receipt to your primary insurance company for claims processing.  After you receive the Explanation of Benefits (EOB), forward this to us so we can bill Medicare for you.

How can I pay for my test kit and processing myself?

You can pay by VISA, Master Card, American Express, personal check, or US. Money order.  (Internet transactions credit card only, US. currency only.)

I am healthcare professional and wish to set up an account with the lab. Who should I contact?

Either complete our Become a Provider form or call us at (866) 600-1636 or (503) 466-2445, Monday-Friday, 6am-5pm PST.

What if I need to send my test sample over a weekend or holiday?

All sample types will remain stable and viable if sent over a weekend or holiday.

What if I can’t send my sample right away?

All samples should be sent the day of collection if possible.  If this is not possible:

Saliva should be stored in the freezer and date should be noted in Section 5 of the test requisition.

Dried Blood Spot/Dried Urine must be kept at room temperature before shipping.

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.

Can I send my test samples to the laboratory if it is hot outside?

Yes, samples will remain stable if sent the same day as collection.  Saliva should be frozen if not sent immediately upon collection.  Sample will remain stable in hot conditions during shipping.  Dried Blood Spot/Dried Urine must be kept at room temperature prior to shipping and will remain stable if it is hot outside.

What if I misplaced my return shipping label, or one has not been provided with my test kit?

If you are an international shipper you must mail your sample to us at your cost.  If you ordered the test directly from our partner lab you may call customer service at (866) 600-1636 to request a replacement.  If you received our test kit from your healthcare provider, you must contact them directly for a replacement label.

How do I confirm whether the laboratory received my test sample?

If your kit contained a UPS prepaid shipping label you can enter the tracking number online to confirm receipt. If you did not send your test sample via UPS you may contact the lab’s customer service department at (866) 600-1636 for confirmation.

Shipping Policies include the following:

  • Cannot ship to PO Boxes
  • Orders generally ship within 2 business days
  • Overnight delivery requests must be received no later than 11am PST, not including weekends or holidays. Overnight delivery is not available to all areas.
  • International receivers must pay any and all sales/country taxes, import fees or duties required by customs.
  • Test kits cannot be shipped to New York or Maryland residents.
  • California residents need prior authorization from a licensed healthcare professional to order testing.
  • Delivery times for test kit receipt do not include weekends or holidays.

Return Policies include the following:

  • Fees for shipping cannot be refunded.
  • A refund can only be issued upon receipt of the original test requisition.
  • Refunds to a credit card may take up to 30 days to process.
  • Refunds are made by check for requests 120 days or more after the order date.
Can the laboratory bill my insurance company for the cost of testing?

As a courtesy, our partner lab can bill the following insurance companies for out-of-network testing costs. You must contact your insurance provider prior to laboratory testing to determine eligibility for up-front coverage or reimbursement options.

  • Original Medicare Part B
  • Medicare Advantage Plans
  • CignaHealthcare
  • Humana
Will my health insurance company cover at-home lab tests?

Most health insurance companies will not cover the cost of at-home testing without a doctor’s written prescription.

Do I have to ask my doctor for permission before taking an at-home lab test?

In states that allow *Direct Access Testing patients can order a variety of at-home tests without their doctor’s permission, consent, or knowledge.  

Blood Spot Testing

Is blood spot testing recommended over saliva testing, or blood serum testing?

Blood spot tests work well with blood serum testing in terms of accuracy and correlation of results.  This method offers convenience and reduced cost of a conventional blood draw.  

Why would I choose blood spot testing over saliva or blood serum testing?
  • Blood spot testing is useful for cardio metabolic testing and morning cortisol levels especially after a previous night’s fast. Blood spot is used for vitamin D testing as well.
  • Blood spot testing is the preferred method for individuals who take sublingual hormones (under the tongue) or troches since saliva can retain hormones for several days following usage. Blood spot testing allows individuals to continue to take hormones during the testing period.
  • Blood spot is recommended for individuals who have a medical condition causing dry mouth, or for those who may have difficulty producing enough saliva for test purposes.
Is there a difference between finger-stick dried blood spot and venipuncture blood serum?

Yes. Dried blood spot testing uses only whole blood, which is collected from the capillary blood at the end of the finger, necessary to feed tissues. This contains hormones, nutrients, and oxygen. Blood taken from a vein in the arm no longer contains the elements needed for specific tests and will circulate through the heart, lungs, and intestines for an oxygen and nutrient reload.

Dried blood spots contain blood cells and blood serum is the watery substance left behind once blood cells and venipuncture blood is separated.  Capillary blood reflects accurate hormone levels in the tissues of the body.

Do hormone level results differ when testing with blood spot rather than conventional venipuncture serum?

When evaluating hormone levels to test the efficacy of treatment with transdermal patches or pellets, results are nearly identical using both collection methods.  If testing the use of topical or sublingual hormone treatments, capillary blood levels for hormones are much higher than venous blood serum.  Blood spot testing should be used to measure hormones that reach the tissues of the body.

Can the lab use whole blood taken from a serum venipuncture on a test that normally uses dried blood spot?

When analyzing certain peptide hormones such as insulin, LH (luteinizing hormone), and FSH (follicle stimulating hormone) both venipuncture whole blood and serum and capillary whole blood from a finger-stick collection can be used to get the same result.

Certain hormones levels including estradiol, progesterone, testosterone, DHEA-S and cortisol can be accurately tested if hormones are produced from endogenous means including patches or pellets.  If however, hormones are supplemented through topical treatments or sublingually (under the tongue) blood spot testing is the most accurate.  Capillary blood once returned to venous blood no longer contains an adequate level of bioavailable hormone.

How does blood spot testing measure hormone levels in the body?

Bioavailable hormone levels are determined by measuring the total amount of hormone available to tissues, divided by the amount of Sex Hormone Binding Globulin (SHBG) present. Sex Hormone Binding Globulin is included in both the male and female hormone profiles for blood spot testing. Blood Spot available tests include:

  • AM Cortisol (C1)
  • Cholesterol, 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

Dried Urine Testing

What is dried urine testing?

Dried urine testing can be done in the privacy of your own home and is highly accurate in the assessment of certain biochemicals within the brain and body. Individuals collect urine and place it on a filter strip to dry. Dried urine test samples remain stable under storage and shipping conditions and offer accurate results regardless of age, menstrual cycle, or hormone supplementation.

A dried urine test can measure:

  • Elements
  • Metabolites
  • Neurotransmitters
How is urine testing useful?

Urine testing is an excellent way to assess hormone by-products from adrenal and sex steroid hormones as well as hormone metabolism.  Urine is used to test for heavy metals such as arsenic and cadmium, and is also the best method of testing for neurotransmitter levels.

Should I change my diet or stop taking medication or supplements before dried urine testing?

No.  It is important to continue to eat your normal diet and take any prescription medications or supplements as directed.  This will provide the most accurate picture of your normal, day-to-day health. 

How will I (or my doctor) obtain test results once I provide the lab with samples?

If you ordered the test yourself you will receive your results within 5-7 business days of receipt of sample.  If your doctor or other medical practitioner orders testing, he or she will receive your test results within 5-7 business days of receiving your sample.  In this case you can obtain results directly from your doctor.

What will my test results include?

Your test results will include one graph that identifies where your levels fall and normal reference ranges for your type of test.

Another graph will detail your self-reported symptoms, their categories, and how they correlate with your lab testing results.

You will also receive an individual analysis and review of your hormone status.

Serum Testing

What Is Tested

Serum testing is suitable for measuring steroid hormones, thyroid hormones, and peptide hormones (luteinizing hormone and follicle stimulating hormone).

Why It’s Done

Serum testing is extremely accurate for measuring levels of hormones created solely by the body, without supplementation.  Serum testing can be used to measure a wider variety of analytes than blood spot testing.  It is not accurate for measuring hormones if taking oral, topical or vaginal hormone supplements, however.

How It’s Done:

Blood is drawn from an individual and placed in a centrifuge and spun down to separate the cellular material in the blood from the liquid serum.