How to Use a Symptom Checklist to Choose a Hormone Test

Symptoms of hormonal imbalance can often be challenging to assess.

Is your patient exhibiting signs of estrogen dominance because her estrogen is too high or is it due to the progesterone being too low?

Is his fatigue because he’s not making enough testosterone or that his adrenal glands are working over-time?

Are her imbalanced sex steroids the cause of her depression or is it the low thyroid hormone?

The good news is that testing hormones through saliva and/or dried blood spot can help differentiate these scenarios. The question I often get asked is “which tests should I order?” My answer is always consistent, look at the symptoms to understand what might be out of balance. This process is made easier by a ZRT resource, the Symptom Checklist for Women or Men.  These handy documents include an inventory of symptoms, categorized in an easy-to-use format.  They provide an idea of where to start with testing.

Have the patient fill out their symptoms in the four different categories. Having the patient rate the severity of the symptoms (mild to severe) helps to further specify testing. Finally review the checklist. 


At the bottom of the Symptom Checklist is a “key” to explain how to go about assessing the symptoms marked.  If most of the checkmarks are in Category 2 and they seem to be the most important, I test for adrenal gland function. The minimum testing suggested is the Adrenal Stress Profile in saliva. If most of the important checkmarks are in Category 3 the minimum testing should be the Essential Thyroid Profile in blood spot. The preferred test, the Comprehensive Elements Thyroid Profile adds iodine, selenium, bromine, and arsenic tested in dried urine. When symptoms are scattered throughout all 4 categories and range from moderate to severe, I consider more comprehensive testing such as the Comprehensive Female or Male Profile I or II. I might also consider adding-on the CardioMetabolic Profile to be more thorough.

This testing “key” suggests a Minimum and a Preferred test for each category. I consider a few different factors when deciding to order a basic profile (Minimum) or a more comprehensive profile (Preferred)

Questions to take into account:

  • Is this the patient’s first test with ZRT?  With initial ZRT testing I suggest getting a baseline of all the hormones (maybe more than just the minimum). This is beneficial, particularly if considering hormone supplementation.
  • Does the patient have limitations for a certain method of testing? Saliva testing is great for testing hormones, but some patients have difficulty with their saliva production. In this scenario, consider blood spot or for diurnal free cortisol, dried urine testing is a good option. Other special patient circumstances are addressed in this table.
  • Has the patient had recent testing performed through another lab?  Depending on what tests were completed, I might choose some of the minimum tests to augment the current lab values. In other situations the tests may not be as complete as I would like. Then I order the preferred ZRT tests.
  • Have symptoms recently changed?  Patients who are moving through hormonal transitions such as perimenopause and menopause may need more frequent monitoring or a deeper workup. 
  • Has the hormone supplementation changed?  Most of the time the minimum testing is adequate. For those patients not responding to treatment I often have to rethink my assessment strategy.
  • Is stress a major factor in the patient’s life? The pressures and anxieties of our daily lives impact the adrenal glands but think thyroid hormones and sex steroids as well. The preferred test to choose is the Comprehensive Female or Male Profile I or II.

Consequently, the process of evaluating a patient’s hormonal status doesn’t have to be overwhelming or complicated. Use of the Symptom Checklist for Women or Men, and the ZRT testing they suggest, can make an assessment much easier. Keeping in mind the few questions noted, and then reviewing the symptoms, you will soon become proficient with ordering hormone testing.


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