Expert Add-on: Stress & HPA Axis Regulation Panel (Quest)

What this panel includes

This panel should be paired with the full Women’s Fertility Expert Panel and adds additional markers that evaluate stress physiology and HPA axis signaling.

Expert hormonal and metabolic assessment

• Reproductive and ovarian health: Estradiol, progesterone, total testosterone, free testosterone, DHEA S, FSH, LH, SHBG, prolactin, and Anti Müllerian hormone (AMH). Evaluates ovulation, ovarian reserve, androgen balance, hormone availability, and brain to ovary signaling.

• Thyroid function and immune regulation: TSH, free T4, free T3, TPO antibodies, thyroglobulin antibodies, and ANA panel. Assesses thyroid performance and screens for autoimmune patterns that may influence hormonal balance, metabolism, and fertility.

• Metabolic and cardiometabolic health: Comprehensive Metabolic Panel, fasting glucose, fasting insulin, hemoglobin A1c, leptin, lipid panel with ratios, lipoprotein(a), high sensitivity CRP, uric acid, and homocysteine. Provides insight into insulin sensitivity, metabolic regulation, inflammation, and cardiovascular risk factors that intersect with hormonal health.

• Blood health and systemic function: CBC with differential. Evaluates red and white blood cells and overall hematologic status.

• Nutrient and micronutrient status: Vitamin D, vitamin B12, folate, iron with TIBC, ferritin, magnesium (RBC), zinc, and selenium. Assesses nutrient levels essential for hormone production, thyroid conversion, ovulation, immune balance, and energy metabolism.

Additional markers for stress and HPA axis regulation

• Morning serum cortisol: Evaluates adrenal cortisol output and overall HPA axis activity.

• ACTH (adrenocorticotropic hormone): Assesses pituitary signaling to the adrenal glands and helps differentiate patterns of adrenal regulation.

• Reverse T3 (rT3): Evaluates stress related thyroid hormone shunting and patterns that may influence metabolic energy regulation.

Biomarkers tested

Why patients choose this

• A deeper draw that adds specialized markers for adrenal output and cortisol-related thyroid signaling on top of the Women's Fertility Expert Panel.
• Provides deeper insight into how stress physiology may be shaping hormonal patterns.
• Evaluates HPA axis activity, pituitary-to-adrenal signaling, and stress-related thyroid conversion together.
• Especially useful for women with persistent fatigue, irregular cycles, unexplained hormonal symptoms, or patterns that may suggest stress-related disruption of hormone regulation.
• Schedule your lab test seamlessly and complete it at a lab near you.

Before your test

This panel should be paired with the full Women's Fertility Expert Panel.

Cycle timing matters more for this panel than most. It is recommended that you schedule your lab draw on day 2 or 3 of a standard 28-day cycle.

Cycle timing is not always predictable. You may reschedule your lab appointment if needed, though same-week availability may be limited.

It is recommended to fast for at least 8 hours before your draw.

Important information

Why it matters: the HPA axis coordinates the body's response to physical and psychological stress, and chronic activation can affect reproductive hormone signaling, ovarian steroid production, thyroid hormone conversion, and overall energy metabolism.

Who it's for: especially useful for women with persistent fatigue, irregular cycles, unexplained hormonal symptoms, or patterns that may suggest stress-related disruption of hormone regulation.

This panel should be paired with the full Women's Fertility Expert Panel.

It is recommended to fast for at least 8 hours before your draw.