Biomarkers Tested

16α-Hydroxyestrone is a metabolite produced when estrone is metabolized through the 16α-hydroxylation pathway. This pathway represents one of the main routes of estrogen metabolism alongside the 2- and 4-hydroxylation pathways. Unlike some other metabolites, 16α-hydroxyestrone retains estrogenic activity and can interact with estrogen receptors. Measuring this marker helps provide insight into the balance between different estrogen metabolic pathways.

2-Hydroxyisobutyric Acid is a metabolite associated with exposure to methyl tert-butyl ether (MTBE), a fuel additive used in gasoline that may contribute to environmental pollution and air contamination.

2-Hydroxyestrone is produced when estrone undergoes hydroxylation at the 2-position during estrogen metabolism. It is part of the 2-hydroxylation pathway, one of the main metabolic routes for estrogen processing. This metabolite can be further converted into 2-methoxyestrone through methylation reactions. Measuring 2-hydroxyestrone provides insight into estrogen metabolism patterns and how estrone is being transformed in the body.

2-Methoxyestradiol is a methylated metabolite formed when 2-hydroxyestradiol undergoes a methylation reaction, typically involving the enzyme catechol-O-methyltransferase (COMT). This process represents a secondary step in estrogen metabolism that helps convert hydroxylated metabolites into more stable forms for elimination. Measuring 2-methoxyestradiol provides information about the efficiency of this methylation pathway.

2-Methoxyestrone is produced when 2-hydroxyestrone is methylated as part of phase II estrogen metabolism. Methylation reactions help the body further process estrogen metabolites so they can be more easily excreted. Monitoring 2-methoxyestrone can help assess how effectively the body is carrying out this secondary detoxification step within estrogen metabolism.

25-hydroxyvitamin D (25[OH]D) is the primary circulating form of vitamin D and the most reliable biomarker for assessing vitamin D status. It reflects the combined contribution from dietary intake, supplements, and skin synthesis through sun exposure. This marker is important for monitoring calcium metabolism, bone health, and immune function. Low levels are linked to reduced bone mineralization and increased risk of bone-related conditions, and in observational studies have been associated with several non-skeletal outcomes, including cardiometabolic health and certain cancers. Adequate levels support normal skeletal maintenance, immune regulation, and broader metabolic processes.

3-Hydroxykynurenine (3-OH-kynurenine) is a metabolite in the kynurenine pathway, which reflects the breakdown of the amino acid tryptophan. It serves as an intermediate compound during the conversion of tryptophan into important molecules, including the essential coenzyme NAD+ (nicotinamide adenine dinucleotide).

4-Hydroxyestradiol is a metabolite formed when estradiol is metabolized through the 4-hydroxylation pathway. This pathway represents another route by which the body processes estrogens before further modification and elimination. The metabolite can be converted into methylated forms such as 4-methoxyestradiol. Measuring 4-hydroxyestradiol helps evaluate how estradiol is being processed through different metabolic pathways.

4-Hydroxyestrone is generated when estrone undergoes hydroxylation at the 4-position during estrogen metabolism. Like other hydroxylated metabolites, it represents an intermediate step before further methylation or elimination. Monitoring 4-hydroxyestrone provides information about how estrone is metabolized and which pathways are active in estrogen breakdown.

4-Methoxyestradiol is a methylated metabolite formed when 4-hydroxyestradiol undergoes methylation. This reaction is part of the body’s process of converting reactive hydroxylated estrogen metabolites into more stable compounds that can be cleared from the body. Measuring 4-methoxyestradiol helps provide insight into how the 4-hydroxylation pathway metabolites are being further processed and eliminated.

4-Methoxyestrone is a methylated estrogen metabolite formed when 4-hydroxyestrone undergoes a methylation reaction during phase II estrogen metabolism. This step is typically catalyzed by the enzyme catechol-O-methyltransferase (COMT), which helps convert reactive hydroxylated estrogen metabolites into more stable forms that can be eliminated from the body. Measuring 4-methoxyestrone provides insight into how efficiently the body processes and detoxifies estrogen metabolites through methylation pathways.

5-Hydroxyindoleacetic Acid (5-HIAA) is the main breakdown product of serotonin, a neurotransmitter involved in mood, sleep, appetite, gut motility and other body functions. Measuring 5-HIAA in urine can give insight into serotonin turnover, meaning how serotonin is being produced, used and metabolised. Higher or lower levels may reflect changes in serotonin metabolism, but should not be interpreted as a direct measure of brain serotonin. 5-HIAA is best understood together with serotonin, tryptophan and the wider neurotransmitter profile.

Adrenaline (epinephrine) is a hormone and neurotransmitter released by the adrenal glands. It plays a critical role in the body’s fight-or-flight response, preparing the body for rapid action during stress. Adrenaline elevates heart rate, widens airways, and enhances energy availability, supporting quick and effective survival responses.

Alanine aminotransferase (ALT) is an enzyme found mainly in liver cells. When liver cells are stressed or damaged, ALT can leak into the bloodstream, which is why it’s commonly used as a marker of liver health. Elevated ALT levels may indicate liver inflammation or injury and are seen in a range of conditions affecting the liver. ALT is typically interpreted together with other liver-related markers to provide a clearer picture of liver function and potential causes of elevation.

Albumin is the most abundant protein in blood plasma and is produced by the liver. It helps maintain oncotic (osmotic) pressure, keeping fluid within the bloodstream, and it also transports many substances such as hormones, fatty acids, and certain medications. Measuring albumin can provide useful information about liver synthetic function and overall protein status. Abnormal levels may be seen in several conditions, including inflammation, fluid imbalance, and kidney-related protein loss.

Anti-Müllerian Hormone (AMH) is produced by granulosa cells in ovarian follicles in women and by Sertoli cells in the testes in men. In women, AMH is commonly used as a marker of ovarian reserve because levels generally reflect the pool of developing follicles and tend to correlate with the number of remaining eggs. AMH is often used in fertility assessments to help estimate reproductive potential and to support planning for assisted reproductive treatments by predicting how the ovaries may respond to stimulation.

Amylase is an enzyme produced mainly by the pancreas and salivary glands that helps break down carbohydrates into smaller sugars during digestion. Measuring amylase in blood or urine can provide information about pancreatic and salivary gland activity. Elevated levels may be seen when these tissues are inflamed or injured—most notably in pancreatic conditions—while results are typically interpreted alongside symptoms and other markers for clearer clinical context.

Anti-Müllerian Hormone (AMH) is a hormone produced by the ovaries that indicates a woman’s ovarian reserve, reflecting the number of eggs remaining. It is commonly used to assess fertility potential and is an important marker in reproductive medicine.

ApoA1 is the main protein component of high-density lipoprotein (HDL), often called “good” cholesterol. It supports reverse cholesterol transport by helping move excess cholesterol from tissues and blood vessel walls back to the liver for processing and excretion. ApoA1 is therefore considered a marker of HDL particle content and function, and higher levels are generally associated with a more favorable cardiovascular risk profile. ApoA1 is often interpreted together with ApoB and other lipid markers to provide a broader picture of lipoprotein-related risk.

Apolipoprotein B (ApoB) is the main structural protein found on atherogenic (“bad” cholesterol–carrying) lipoproteins, including LDL, VLDL, IDL, and lipoprotein(a) [Lp(a)]. Each of these particles typically contains one ApoB molecule, which makes ApoB a practical measure of the total number of atherogenic particles in the bloodstream. Elevated ApoB levels indicate a higher concentration of particles that can enter the arterial wall and contribute to plaque formation, and are therefore strongly associated with increased cardiovascular risk. ApoB is often interpreted alongside markers such as LDL-C, non-HDL cholesterol, and ApoA1 for a fuller lipid risk profile.

The ApoB/ApoA1 ratio compares apolipoprotein B (ApoB) to apolipoprotein A1 (ApoA1). It provides an estimate of the balance between atherogenic lipoprotein particles (ApoB-containing) and protective HDL-related particles (ApoA1-containing). A higher ratio indicates a greater proportion of atherogenic particles relative to protective ones and is associated with higher cardiovascular risk. In many studies, this ratio has shown strong predictive value and can complement traditional lipid markers when assessing cardiometabolic risk.

Arsenic is a naturally occurring element that can be highly toxic to humans. Found in soil, water, and certain industrial materials, it disrupts normal cellular processes and is classified as a carcinogen. Even at low levels, arsenic exposure can pose significant risks to health, affecting multiple organs and systems.

Aspartate aminotransferase (AST) is an enzyme found in several tissues, including the liver, heart, skeletal muscle, kidneys, and red blood cells. It is involved in amino acid metabolism and can be released into the bloodstream when cells in these tissues are stressed or damaged. Elevated AST may indicate liver injury, but because AST is not liver-specific, increased levels can also be seen with muscle damage, hemolysis, or other conditions. AST is often interpreted together with ALT and other markers to help clarify the likely source.

Bilirubin is a yellow pigment formed when red blood cells are broken down. It is transported to the liver, where it is processed (conjugated) and then excreted through bile. Measuring bilirubin helps assess how well the liver and bile flow pathways are functioning. Elevated levels may be seen with liver or bile duct problems (such as impaired bile flow) or with increased breakdown of red blood cells (hemolysis).

Bisphenol A is an industrial chemical commonly used in the production of certain plastics and resins, including polycarbonate plastics and epoxy coatings found in food containers and packaging materials. BPA is considered an endocrine-active compound because it can interact with estrogen receptors and influence hormone signaling pathways. Measuring BPA levels in urine can help assess environmental exposure to this compound and provide insight into potential interactions with hormone metabolism.

Blood urea nitrogen (BUN) measures the amount of urea nitrogen in the blood. Urea is a waste product formed in the liver when protein is broken down, and it is normally filtered by the kidneys and excreted in urine. BUN is commonly used as part of an assessment of kidney function and hydration status. Elevated BUN levels may be seen with reduced kidney filtration, dehydration, higher protein intake, or increased protein breakdown, and results are often interpreted together with creatinine and other kidney markers.

Bromine (Br) reflects exposure to bromine-containing compounds, which can be found in certain foods, medications, and environmental sources. Elevated levels may indicate increased exposure, and bromine can interact with iodine metabolism in the body. Monitoring bromine levels can provide additional context when assessing overall mineral balance and potential environmental influences.

Blood Urea Nitrogen (BUN) is a waste product filtered from the blood by the kidneys. It's important because BUN levels indicate how well your kidneys are functioning and can reflect hydration status, protein intake, and other health issues. Elevated BUN can suggest impaired kidney function, dehydration, or increased protein catabolism, while low levels are less common but can indicate severe liver disease or malnutrition.

Cadmium (Cd) is a toxic heavy metal with no beneficial role in the human body. Prolonged exposure to cadmium can cause serious health problems, including kidney damage, weakened bones, and a higher risk of cancer. Because cadmium accumulates in the body over time, even low-level exposure poses a concern for long-term health.

Calculated LDL Cholesterol, often referred to as "bad" cholesterol, is a lipoprotein that transports cholesterol from the liver to the cells. High levels of LDL cholesterol can build up in the arteries, forming plaque and increasing the risk of heart disease and stroke.

Chlamydia trachomatis is the bacterium that causes chlamydia, one of the most common sexually transmitted infections. It can affect both men and women and may be present without noticeable symptoms. Chlamydia can affect the urinary and reproductive tract. When symptoms occur, they may include burning during urination, unusual discharge, pelvic discomfort or genital irritation. Because many infections are asymptomatic, testing is important after possible exposure, unprotected sex or a new sexual partner. If left untreated, chlamydia may increase the risk of complications, particularly in the reproductive tract. Testing can help identify whether Chlamydia trachomatis may be present and support appropriate follow up, treatment and partner notification when needed.

Chlamydia trachomatis (CT) DNA refers to genetic material from Chlamydia trachomatis, a bacterium that can cause the sexually transmitted infection chlamydia. This test uses real-time PCR to detect CT DNA targets (the cryptic plasmid and the ompA gene). Detection of CT DNA indicates the presence of C. trachomatis genetic material in the sample and supports the identification of a chlamydia infection, which can be asymptomatic but may lead to complications if not addressed.

The CHOL/HDL ratio is calculated by dividing total cholesterol (CHOL) by high-density lipoprotein (HDL) cholesterol. It helps describe the balance between cholesterol carried in potentially atherogenic lipoproteins and the protective HDL fraction. A higher ratio generally reflects a less favorable lipid profile and is associated with increased cardiovascular risk, while a lower ratio is typically considered more favorable. This ratio is often used alongside other lipid markers—such as LDL cholesterol, non-HDL cholesterol, triglycerides, ApoB, and ApoA1—for a more complete cardiovascular risk assessment.

Copper is an essential trace mineral involved in many biological functions, including iron metabolism and red blood cell formation, connective tissue and bone development, and immune function. It serves as a cofactor for numerous enzymes and supports energy production as well as antioxidant defense systems. Both low and high copper levels can affect health, with potential impacts on neurological function, cardiovascular health, and immunity. Copper status is often interpreted together with related markers (such as ceruloplasmin and zinc) for a more complete picture of mineral balance.

Cortisol is a steroid hormone produced by the adrenal glands, known as the body's primary stress hormone. It plays a crucial role in regulating metabolism, immune response, and blood pressure, making its levels important for assessing stress response and adrenal function.

Creatinine is a waste product formed in muscles from the normal breakdown of creatine. It is released into the bloodstream and filtered by the kidneys, then excreted in urine. Because creatinine levels are influenced by how efficiently the kidneys filter blood, it is commonly used to assess kidney function. Elevated creatinine may indicate reduced kidney filtration or kidney disease, while low levels are less common and can be associated with lower muscle mass. Creatinine is also used—often together with age and sex—to estimate glomerular filtration rate (eGFR), a key measure of overall kidney filtering capacity.

DHEA (dehydroepiandrosterone) is a hormone produced by the adrenal glands and acts as a precursor to sex hormones. Measuring DHEA in saliva reflects the body’s active hormone levels, providing insight into immediate DHEA production. This measurement is useful for assessing adrenal health, aging, and the risk of chronic conditions.

DHEA-S is a hormone produced mainly by the adrenal glands and serves as a precursor to sex hormones, including androgens and estrogens. Compared with DHEA, DHEA-S is more stable in the bloodstream and is therefore commonly measured to evaluate adrenal androgen production. Levels typically peak in early adulthood and gradually decline with age. Elevated DHEA-S may be seen in conditions associated with increased adrenal androgen activity, such as certain adrenal disorders and, in some cases, polycystic ovary syndrome (PCOS). Low levels can be associated with reduced adrenal function, and results are interpreted alongside symptoms and other hormone markers.

3,4-Dihydroxyphenylacetic acid / DOPAC is one of the main metabolites of dopamine, formed when dopamine is broken down by enzymes such as monoamine oxidase. Because dopamine is involved in movement, motivation, attention, and reward signaling, measuring DOPAC can help indicate dopamine turnover, meaning how actively dopamine is being produced, used, and metabolized in the body.

Dopamine is a key neurotransmitter that supports the brain’s reward and motivation systems. It plays essential roles in mood regulation, pleasure, focus, memory, and movement control. Imbalances in dopamine levels can affect mental well-being and are linked to conditions such as depression, anxiety, and Parkinson’s disease.

eAG, or estimated average glucose, is a calculated value based on the HbA1c result that translates HbA1c into an estimated average blood glucose level over roughly the past 2–3 months. It helps present long-term glucose control in the same type of units used for day-to-day glucose measurements, which can make results easier to understand and compare with home glucose readings. eAG is an estimate, and the relationship between HbA1c and average glucose can vary between individuals and in certain conditions that affect red blood cells.

eGFR is an estimate of how well the kidneys are filtering waste products from the blood. It is calculated using a formula based on blood creatinine together with factors such as age and sex (and sometimes additional variables depending on the equation used). A higher eGFR generally indicates better kidney filtering capacity, while a persistently low eGFR can suggest reduced kidney function or chronic kidney disease. eGFR is an estimate and is typically interpreted alongside other kidney markers (such as urine albumin/protein and creatinine trends) and clinical context.

Estradiol is the most biologically active form of estrogen in the body. It plays a central role in reproductive health, regulating the menstrual cycle, ovulation, and fertility. Estradiol also affects bone density, cardiovascular health, brain function, and metabolism. Levels vary throughout the menstrual cycle and across different life stages such as puberty, pregnancy, and menopause. Measuring estradiol helps evaluate hormonal balance and provides insight into overall estrogen activity and endocrine function.

Estriol is a naturally occurring estrogen and the weakest of the three primary estrogens. It is produced in small amounts in non-pregnant individuals but becomes the dominant estrogen during pregnancy, as it is generated through interactions between the placenta and the fetus. Estriol reflects aspects of estrogen metabolism and hormone turnover. Measuring estriol can help provide a broader picture of estrogen dynamics alongside other estrogen markers.

Estrone is one of the three main forms of estrogen produced in the body. It is synthesized primarily from androgens in fat tissue and becomes the dominant estrogen after menopause. Estrone can be converted into estradiol or further metabolized into various estrogen metabolites. Measuring estrone helps provide insight into overall estrogen production and balance, particularly in relation to age, body composition, and hormonal changes.

Estrone-3-glucuronide is a metabolite of estrone that is formed when estrone undergoes glucuronidation, a process that prepares hormones for elimination from the body through urine. Because E1G reflects circulating estrogen levels over time, it is commonly used as a urinary marker of estrogen activity during the menstrual cycle. Measuring E1G helps track changes in estrogen production across the cycle and can provide insight into hormonal patterns related to ovulation and cycle dynamics.

Fasting insulin measures the level of insulin in the blood after an overnight fast. Insulin is a hormone produced by the pancreas that helps move glucose from the bloodstream into cells, where it can be used for energy or stored. Elevated fasting insulin can be an early sign of insulin resistance, where the body needs more insulin to keep blood glucose in a normal range. Fasting insulin is often interpreted together with fasting glucose and markers such as HbA1c (and sometimes HOMA-IR) to better assess metabolic and cardiometabolic risk.

Fecal occult blood (FOB) is a measure that detects hidden blood in the stool, which is not visible to the naked eye. The presence of FOB can be an important indicator of internal gastrointestinal bleeding, often occurring without obvious symptoms. FOB testing is a non-invasive method used to help identify potential underlying medical conditions affecting the digestive tract.

Folate (vitamin B9) is a water-soluble vitamin essential for DNA synthesis, cell division, and normal red blood cell formation. It is especially important during pregnancy because adequate folate status supports early fetal development and helps reduce the risk of neural tube defects. Folate also participates in methylation pathways and homocysteine metabolism, where low folate can contribute to elevated homocysteine levels. Deficiency may lead to megaloblastic anemia and symptoms such as fatigue, and folate is commonly measured to assess nutritional status and identify deficiency.

The Free Androgen Index (FAI) is a calculated value used to estimate the amount of biologically available (free) testosterone. It is typically derived from total testosterone and sex hormone–binding globulin (SHBG), helping provide context for androgen activity beyond total testosterone alone. FAI is commonly used in the evaluation of androgen-related conditions, particularly in women (for example, suspected androgen excess such as PCOS or hirsutism). It can also support assessment of androgen status in men, although results should be interpreted alongside symptoms and other hormone markers.