Genova one day hormone test instructions

The One Day Hormone Check™ is a convenient salivary hormone test that evaluates unbound, bioavailable hormone levels. Specimens collected over 24 hours are examined for levels of estradiol, estrone, estriol, progesterone, testosterone, cortisol, DHEA, and melatonin. Hormone testing can help clinicians customize and monitor therapies.

Which patients might benefit from salivary hormone testing?

The One Day Hormone Check provides information about the impact that shifting hormone levels can have in men (andropause or male menopause) and women (perimenopause and menopause). Menstruating females can also run this profile, although the Rhythm Plus is Genova’s comprehensive salivary profile that tracks the menstrual cycle over a full month.

Patients with hormone imbalance may present with:[1,2,3,4,5,6,7,8,9,10,11,12,13]

• Fatigue
• Weight loss or gain
• Breast tenderness
• Menstrual irregularities
• Loss of libido
• Insomnia
• Changes in hair and skin
• Hot flashes and night sweats
• Depression
• Anxiety
• Cognitive decline
• Decreased muscle mass/strength
• Vaginal dryness
• Osteoporosis
• Cardiovascular disease

Genova does not offer hormone testing for pediatric populations (under 18 years old).

About the One Day Hormone Check

The One Day Hormone Check results are organized into three main areas:

• Sex Hormones
  • Estrone (E1), Estradiol (E2), Estriol (E3)
  • Progesterone
  • Testosterone
  • P/E2 Ratio
  • Melatonin x 3 specimens to assess diurnal rhythm
  • Cortisol x 4 specimens to assess diurnal rhythm
  • DHEA
  • DHEA:Cortisol Ratio
  • Optional Add-on Cortisol Awakening Response (CAR)
    • Two awakening samples to evaluate CAR
    • CAR is a transient, immediate rise in cortisol upon awakening and is distinct from the diurnal rhythm. CAR reflects a person's ability to cope with anticipated challenges and their perception of control around chronic stress, providing insight into HPA axis resiliency.[14,15]

    To enhance clinical utility, a therapeutic cohort results cover page is provided for the clinician to quickly see where patient results fall in comparison to a cohort of peri/menopausal women treated with bioidentical hormone therapy.

    Patient Information

    The One Day Hormone Check is ideal for males and females who want to understand if hormone imbalances are causing their symptoms.

    These symptoms include:

    • Fatigue
    • Weight loss or gain
    • Menstrual irregularities
    • Loss of sex drive
    • Sleep issues
    • Changes in hair and skin
    • Hot flashes and night sweats
    • Depression
    • Anxiety
    • Memory issues and brain fog
    • Osteoporosis
    • Cardiovascular disease

    Knowing the levels of your hormones and how they relate to each other can open up a wide range of solutions for you and your provider. These include nutritional therapies, lifestyle changes, and potentially hormone replacement therapy to keep you in balance. Patients are often surprised at how easy it is to improve their symptoms and how great they feel once their hormones are back in balance.

    The One Day Hormone Check requires saliva samples collected over 24 hours to assess important hormonal rhythms. Saliva collection is very simple and can be completed in the comfort of your own home. We have many resources to help make your testing experience a success. Review the Test Preparation tab to learn more about the collection process.

    Test Preparation

    Preparing for this Test

    The Adrenocortex Stress Profile test preparation contains information on cortisol and DHEA collection considerations, impact of glucocorticoids, and altered sleep-wake schedules.

    Medications and Supplements May Impact Results

    Should a patient discontinue a medication or supplement prior to testing?

    Genova never recommends that patients discontinue medically necessary medications or supplements in order to complete testing.

    There may be times when a patient may stay on a medication or dietary supplement during testing in order to evaluate its effectiveness, especially if a long-term medication. Discontinuing a substance is intended to establish a baseline finding. If you choose to discontinue a medication, a good rule of thumb is to take the biological half-life of the drug times 5 to allow for 'clearance' before testing. With certain medications, the drug itself may have cleared the body, but the effect of the medication may be longer lasting.

    How will a medication or supplement impact hormone levels?

    In many instances, it is unknown what potential impact a medication or supplement may have on test results.

    Any questions regarding a medication or supplement impact on biomarker results can be researched by contacting the manufacturer, pharmacist, and/or searching the literature (PubMed, Google Scholar) for relevant information. Drug databases such as drugs.com, rxlist.com, Epocrates, and pdr.net, or laboratory textbooks such as Fischbach's A Manual of Laboratory and Diagnostic Tests may provide additional information.

    Medication Interferents

    The medications listed below are direct interferants to hormone assays resulting in falsely low or falsely elevated findings. Testing may not be appropriate for patients who cannot discontinue these medications.

    Immunotherapy or diagnostic procedures utilizing immunoglobulins or immunoglobulin fragments may produce antibodies that interfere with immunoassays. Such interfering antibodies may cause erroneous results. 1

    For additional information, visit the section on 'Immunoassay Interferents' below.

    Different steroids have differing effects on hormone levels, with some being direct assay interferents. 2,3 See Adrenocortex Stress Profile test preparation for more info.

    Immunoassay Interferents

    For all assays utilizing antibodies (i.e., immunoassays), the possibility exists for interference by heterophile antibodies in the patient sample. Patients who have regularly been exposed to animals or have received immunotherapy or diagnostic procedures utilizing immunoglobulins or immunoglobulin fragments may produce antibodies, e.g. HAMA, that interfere with immunoassays. Such interfering antibodies may cause erroneous results. Additionally, rheumatoid factor, endogenous alkaline phosphatase, fibrin and proteins capable of binding to alkaline phosphatase can act as interferants. 1 The following article thoroughly discusses hormone immunoassay interference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368230/

    • Profiles using immunoassays include:
      • Salivary hormones E1, E2, E3, P, T, cortisol, DHEA, melatonin
      • Serum hormones E1, E2, E3, P, T, DHEAs, SHBG
      • Thyroid Panel

      Medication Influencers

      The medications listed below will not interfere with Genova's ability to run the assays but may influence biomarker levels.

      These are examples of medications that are generally prescribed for non-hormone related conditions that can alter hormone levels and/or metabolism. 2-19 This list is not exhaustive.

      There is no recommendation to discontinue.

      These are examples of medications that are generally prescribed to intentionally alter hormone levels and/or metabolism. 2,3,17,20-28 This list is not exhaustive.

      There is no recommendation to discontinue.

      Genova's assays detect bio-identical hormones, but not synthetic or non-bioidentical hormones. Synthetic hormones, such as those from oral contraceptives, are generally not recommended for any of Genova's sex steroid hormone testing platforms - blood, urine, or saliva. Synthetic hormones may create unpredictable results that often do not reflect the patient's physiologic levels.

      For additional information, visit the section on 'Hormone Therapy and Test Considerations' below.

      Hormone Therapy and Testing Consideration FAQs

      When should my patient take their hormones prior to testing?

      The answer depends on several factors including the hormone delivery type, dosing intervals, specimen type, what information the clinician is hoping to glean, etc. In general, many clinicians opt to test their patients 8-12 hours following their last dose of hormones. Some clinicians wait 24 hours following transdermal cream application.

      Published standardized guidelines and best practices are lacking regarding timing of supplementation with testing. The time to reach peak and trough levels, as well as time to steady state varies with each hormone and hormone delivery method. Furthermore, peak and trough levels may vary depending on the sample type evaluated (saliva, blood, urine). Pharmacokinetic studies exist for FDA-approved hormone products and provide information about half-life and time to steady state. The same kinds of studies do not exist for custom compounded hormones, making it challenging to know the best time to test. Most of the published literature utilizes serum to conduct the pharmacokinetic studies; information on half-life and timing of saliva or urine sampling is sparse. Some sources suggest that measuring the trough level is ideal.

      Can custom compounded bioidentical hormones be monitored with testing?

      Many clinicians prefer to monitor patients on custom compounded formulas so they can adjust accordingly. Hormone compounding can result in variations depending on the base ingredients as well as actual dose of the active hormone. Genova has observed erroneously elevated levels of hormones in patients particularly being prescribed custom compounded formulations. These erroneous levels are not typically observed in baseline, unsupplemented samples. It is important to work closely with your compounding pharmacist to understand the formulations, pharmacokinetics, and pharmacodynamics. Pharmacokinetic studies exist for FDA-approved bioidentical hormones and provide information about half-life and time to steady state. These studies are sparse for custom compounded hormones. Blending more than one hormone in a regimen is another variable that affects the drug's kinetics, potentially resulting in unpredictable findings.

      What impact does hormone cream have on testing?

      Hormone creams tend to be underrepresented in serum and overrepresented in salivary samples. Progesterone is very lipophilic and accumulates in subcutaneous fat cells. Red blood cells passing through the capillaries play a role in transporting progesterone to salivary glands and other tissues. 29 As such, we can see elevated progesterone in salivary samples for several months after complete cessation of transdermal therapy, before the progesterone depot is depleted. The degree of impact that transdermal hormone therapies may have on an individual's salivary hormone levels are determined by many factors: dose, route of administration, site of administration, pharmacokinetics of the preparation, patient compliance, adiposity, and patient metabolic individuality. Anecdotally, we have noticed salivary progesterone levels persisting for up to a year after discontinuation of transdermal creams in some patients.

      Additionally, creams can directly contaminate samples. For example, a vaginal hormone cream can contaminate a urine sample. Residual cream on the fingers after application can contaminate tube caps, lips, or mouth before spitting into a tube. Sublingual hormones can directly contaminate salivary collections if they haven't been fully absorbed.

      Can a patient test while taking synthetic, non-bioidentical hormones?

      Synthetic hormones, such as those from oral contraceptives, are generally not recommended for any of Genova's sex steroid hormone testing platforms - blood, urine, or saliva. The assays are not designed to detect the molecular structure of synthetic hormones, only bio-identical and endogenously produced hormones. Synthetic hormones may create unpredictable results that often do not reflect the patient's physiologic levels. Hormone therapy impacts the hypothalamic-pituitary-gonadal axis via negative feedback as well as affecting binding protein levels, which then results in altered levels of endogenous hormones. 30 Testing while on synthetic, non-bioidentical hormones may produce results that are not clinically useful.

      How long after discontinuing oral contraceptives can a patient test hormone levels?

      Prior to testing, it is preferred that there be at least two menstrual bleeds after discontinuing contraception (i.e., oral contraceptive pill, depo-medroxy-progesterone acetate, hormonal IUD like Mirena or Kyleena, etc.). 31-33 Testing sooner may not assess the natural baseline menstrual cycle as the body needs time to readjust. Recent discontinuation of oral contraceptives may delay ovulation and prolong the follicular phase and thus overall cycle length. 31 The overall duration of contraceptive use does not significantly affect the return of fertility after discontinuation. 34

      Unintentional hormone exposure can elevate levels

      Patients should be instructed to avoid skin-to-skin exposure with close friends/family members that use hormone creams to avoid unintentional exposure. Exposure can be from close contact with others using prescription or over the counter transdermals including family members or occupational (i.e., massage therapy, pharmacies, health care facilities), and exposure to items that a person using transdermals touched including gym equipment, towels, doorknobs, sheets, etc. 35,36 Anti-aging, anti-wrinkle creams, and other cosmetics and body care products may contain hormones even if not disclosed on the label. Additionally, over-the-counter products containing hormones can be purchased directly by consumers. 37,38

      Bleeding Gums and Salivary Testing

      Salivary samples visibly contaminated with blood should be recollected. This can result in a false elevation of hormones. Blood concentrations of steroid hormones are several-fold higher than saliva levels. 39,40 For this reason, brushing and flossing is discouraged for 1 hour prior to salivary collection. Additionally, if the patient has a condition that causes gums to bleed easily, such as gingivitis or periodontitis, or has dentures and other oral appliances, a plan should be in place to ensure gums do not bleed during testing.

      Pediatric Patients

      The reference ranges for all of Genova's endocrine profiles are based off a healthy cohort of patients aged greater than 18. Genova does not have pediatric reference ranges. A literature search may provide further insight into pediatric reference ranges.

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      Support Materials

      Support Materials

      Collection Instructions

      Sample Report