Testing Biomarkers

Alanine Aminotransferase (ALT) is an enzyme mainly found in your liver. ALT is used by your body to break down food into energy, with levels in the blood normally low.

Following liver damage, the levels of ALT in your blood will rise making it a useful means to indicate liver problems.

Fluctuation of ALT levels is normal over the course of the day, and can also increase in response to strenuous physical exercise.

ALT is also found in the kidney, heart, muscle but a greater concentration is found in the liver compared with other tissues of the body. 

As such ALT is more specific to liver function than Aspartate Aminotransferase, and issues can be detected in the blood many days before clinical signs appear.

What Are Normal ALT Levels?

•    Normal levels: 7 – 56 IU/L2

What Causes Abnormal Alanine Aminotransferase Levels?

High levels of ALT are seen in:

• Minor elevation:
  • Cirrhosis, Hepatitis C, and Non-Alcoholic Steatohepatitis (50 – 100 IU/L).
• Moderate elevation:
  • Alcoholic Hepatitis (100 – 300 IU/L)
• Very high levels:
  • Acute Hepatitis, Ischemic Liver Injury, Toxin-induced liver damage (300 – 1000 IU/L)

  
    Note that obese but otherwise normal individuals may have high enzyme levels.   ALT level may be normally elevated during the 2nd trimester of pregnancy in otherwise, asymptomatic normal pregnancy.

Albumin (ALB) is a protein produced by the liver and is the most abundant protein in the blood.

It transports components throughout the body, nourishes tissues & prevents blood vessel leakage.

Albumin is highly sensitive to liver damage so lower levels can indicate when the liver is damaged.

Many other factors also affect albumin levels, such as malnutrition, acute illnesses and inflammation.

Alkaline phosphatase (ALP) is an enzyme found in the human body in the kidneys, liver, bones and digestive system.

High levels of ALP typically result from liver damage or bone damage of any cause.

What Are Normal AST Levels?

•    The normal range is: 0 – 35 IU/L2

What Causes Abnormal Alkaline Phosphatase Levels?

Elevated levels are seen in:

• Moderate elevation in the level of ALP:
  • Infection of the liver (Infective hepatitis).
  • Excessive consumption of Alcohol (Alcoholic Hepatitis).
  • Cancer of Liver (Hepatocellular Carcinoma).
  • Peripheral Arterial disease
• High Levels:
  • Obstruction in the flow of Bile Juice outside the Liver (Extrahepatic obstruction, also known as Obstructive Jaundice).
  • Obstruction in the flow of Bile Juice inside the Liver (Intrahepatic Cholestasis).
• Very High Levels:
  • Bone diseases.
  • The third trimester of asymptomatic normal pregnancy (due to extra production from the placental tissue)

Low levels of ALP are less common and are seen in:

• Hypothyroidism
• Pernicious anemia
• Zinc deficiency
• Congenital hypophosphatasia

AST is a marker of hepatocellular (liver cell) damage, although it can also be released with heart, muscle, and brain disorders and is less specific to liver disease.

What Are Normal AST Levels?

•    The normal range is: 0 – 35 IU/L2

High serum levels are seen in:

• Chronic Hepatitis
• Cirrhosis
• Hepatocellular Carcinoma
• It is also found elevated in an asymptomatic pregnant patient who present with pre-eclampsia.

Bilirubin is a natural waste product formed by the breakdown of the haemoglobin in your red blood cells. The liver then processes bilirubin before its removal from your body.

High levels of bilirubin in the blood can lead to yellowing of the skin (jaundice) and can indicate that liver damage is present. However, there are a number of other medical conditions associated with a high bilirubin level including disorders of red blood cell breakdown, gallbladder or pancreatic diseases or sepsis.

What Makes Bilirubin Levels High?

High bilirubin levels are observed in:

• Mild elevation:
  • Liver Diseases
  • Physiological jaundice
  • Inherited cases of hyperbilirubinemia
• Moderate elevation:
  • Obstruction in the flow of Bile Juice outside the Liver (Extrahepatic obstruction, also known as Obstructive Jaundice).
  • Obstruction in the flow of Bile Juice inside the Liver (Intrahepatic Cholestasis).
  • Viral hepatitis
  • Inherited cases of hyperbilirubinemia

The most familiar issue of high biirubin is as the yellowish pigment observed in jaundice.

What Are The Normal Levels Of Bilirubin?

• Total Bilirubin: 0.2 – 0.8 mg/dL
• Unconjugated (Indirect): 0.2 – 0.7 mg/dL
• Conjugated (Direct): 0.1 – 0.4 mg/dL

 
What Levels of Bilirubin Are Concerning (Pathological)?

• Plasma Bilirubin level > 1 mg/dL indicates Increased Bilirubin (Hyperbilirubinemia).
• Levels between 1 and 2 mg/dL indicate Latent Jaundice.
• Level more than 2 mg/dL produces Clinical Jaundice.

The Dehydroepiandrosterone Sulfate (DHEA) test is also known as a DHEA Sulphate test.

What Is The Dehydroepiandrosterone Sulfate (DHEA) Test For?

DHEA is a hormone found in both men and women. It can be used to assess the function of your adrenal glands. It should be used with other hormone levels such as cortisol to understand the complete hormonal picture. 

What if Dehydroepiandrosterone Sulfate (DHEA) Results Are High?

Interpretation can vary by sex, age, other hormone levels, and associated symptoms.

These results are often reviewed alongside symptoms and other findings, and may be discussed with an endocrinologist as part of further evaluation.

What if Dehydroepiandrosterone Sulfate (DHEA) Results Are Low?

Interpretation can vary by sex, age, other hormone levels, and reported symptoms.

These results are often reviewed alongside symptoms and may be discussed with an endocrinologist. Further evaluation may include consideration of specialist referral.

What are the limitations of a DHEAS test?

While the DHEAS test can indicate abnormal levels of this hormone, it does not provide specific information about the exact cause of the abnormality. Also, levels of DHEAS can fluctuate throughout the day and can be affected by stress and illness. Therefore, the test should be used as a piece of the overall diagnostic puzzle rather than as a definitive diagnostic tool.

The Free Thyroxine test is also known as a FT4 test.

What Is The Free Thyroxine Test For?

Thyroxine (T4) is the most prevalent thyroid hormone produced by the thyroid gland.

It is responsible for many vital roles in the body including, metabolism, heart and muscle function, brain development and bone maintenance.

Measurement of Free Thyroxine (FT4) is used to assess thyroid health.

What if Free Thyroxine Results Are High?

High Free T4 can be associated with an overactive thyroid gland (hyperthyroidism), particularly when it occurs alongside typical clinical symptoms.

Changes in thyroid function can affect many body systems and are often reviewed further to clarify the cause.

Some medicines (including certain contraceptive birth control pills, epilepsy drugs, and large doses of aspirin) can interfere with Total T4 test results. In general, Free T4 levels are minimally affected by these medications.

What if Free Thyroxine Results Are Low?

Low free T4 can be associated with an underactive thyroid gland (hypothyroidism), particularly when it occurs alongside symptoms commonly linked to reduced thyroid function.

Can the Free Thyroxine test detect both hypothyroidism and hyperthyroidism?

Yes, the Free Thyroxine test can help diagnose both hypothyroidism and hyperthyroidism. High levels of FT4 could indicate hyperthyroidism, while low levels could suggest hypothyroidism.

The enzyme Gamma-Glutamyl Transferase (GGT) is found throughout the body, but it is most concentrated in your liver.

This makes a GGT blood test very useful helping to assess liver function and general health.

GGT levels are usually low, but can rise following liver damage. A GGT test is also particularly sensitive to detecting bile duct problems and levels can be acutely affected by alcohol consumption.

What Are Normal Levels of GGT?

• Normal Level of GGT is 9 to 85 U/L.5

What causes Increased AST Levels?

Levels of AST are elevated in:

• Infective hepatitis
• Prostate Cancer
• Alcoholics

Certain Non-hepatic causes also cause elevated GGT levels, like:

• Uncomplicated Diabetes Mellitus
• Acute Pancreatitis
• Myocardial Infarction
• Anorexia Nervosa
• Hyperthyroidism
• Obesity
• Use of drugs like Phenobarbitone, Phenytoin, Paracetamol and certain Antidepressant drugs.

GGT is also a highly sensitive indicator of alcohol abuse (where GGT levels are elevated more than 10 times).

Globulins are a group term for proteins that make up nearly half of the total protein in your blood.  Globulins have a critical role in normal liver function, fighting infection and blood clotting.

Globulins are created by the immune system and the liver. The amount of globulins in your blood helps indicate many conditions such as liver damage, kidney diseases, autoimmune conditions or nutritional problems.

Serum globulins make up the remainderr of blood proteins, and exist in several different forms, including immunoglobulins and enzymes.

Normal levels of serum globulin are 2.5 – 3.5 g/dL, with high levels seen in:

• Autoimmune Hepatitis (where autoantibodies are produced against the liver hepatocytes).
• Alcoholic Liver Disease.
• Chronic Hepatitis.
• Cirrhosis (Condition where normal liver tissue is repalced by scar tissue and indicates permanent damage).

The Oestrogen (Estradiol) test is also known as a Estrogen, Oestrone (E1), Oestradiol (E2) and Oestriol (E3) test.

What Is The Oestrogen (Estradiol) Test For?

Oestrogens are steroid sex hormones responsible for female reproductive organ function and secondary sex characteristics.

Together with progesterone they regulate the menstrual cycle & help maintain a healthy pregnancy.

There are three main forms of oestrogen and this test measures oestradiol (E2) as a good marker for overall ovarian function.

What if Oestrogen (Estradiol) Results Are High?

Interpretation of high oestradiol levels is often cautious because levels vary throughout the menstrual cycle and can also show natural day-to-day variation.

Several metabolic conditions are associated with increased oestradiol. These can include impaired liver function, impaired kidney function, anaemia, and high blood pressure, all of which can affect oestradiol levels.

When FSH (follicle stimulating hormone) is also high (often indicative of menopause), very high oestrogen levels can occur if a follicle becomes “super-stimulated”. This is described as increased FSH reactivating an ovary.

Very high results can also occur with topical hormonal treatments (gels, creams, sprays) used within 72 hours before sample collection, as hormone can be transferred into the blood sample during finger lancing.

After a high oestradiol result, results are sometimes looked at over time to understand the trend, and further investigation may be used to clarify the cause. Interpretation of elevated or low oestrogen levels is complex and can depend on factors such as use of other drugs, timing within the menstrual cycle, age, and sexual characteristics.

What if Oestrogen (Estradiol) Results Are Low?

Interpretation of low oestradiol levels is often cautious because levels vary throughout the menstrual cycle and can also show natural day-to-day variation.

Low oestrogen can be caused by many conditions. Anything that damages or affects the ovaries can lead to reduced oestrogen levels. Low oestrogen can also be a sign of approaching menopause; this transition period is called perimenopause and usually affects women over the age of 40.

Oestrogen levels can also decline for several other reasons including:

• excessive exercise
• premature ovarian failure
• being severely underweight, or having an eating disorder like anorexia
• a low-functioning pituitary gland
• thyroid disorders
• chemotherapy

Some women with low oestrogen levels may benefit from hormonal treatment. This can reduce the risk of bone loss, cardiovascular disease, and other hormonal imbalances. This topic is often discussed further with a GP.

Who Should Take This Test?

Measure your Oestrogen (Estradiol) levels and measure the levels of the primary female sex hormone with a Estrogen (Estradiol) nurse or clinic finger-prick bloodtest kit

You get the convenient testing with the reassurance of professional clinical analysis. Your results are delivered quickly & securely online.

This Estrogen (Estradiol) Test is advised if you:

• want the convenience of home testing without waiting for a GP appointment;
• need a high quality, clinically accredited test done in a professional clinical laboratory.

What are low estrogen symptoms?

Low estrogen levels mainly affect women, causing:

• Irregular menstrual cycles.
• Absence or complete disappearance of periods.
• Infertility (having trouble conceiving).
• Breast tenderness (which may be normal in the second half of the menstrual cycle, when oestrogen levels decrease naturally).
• Fatigue.
• Sleeping problems, such as insomnia.
• Mood swings, including depression.
• Decreased vaginal lubrication.
• Increased risk of vaginal infections.
• Increased risk of urinary tract infections.
• Hot flashes.
• Bone deterioration and increased risk of fractures.
• Headaches.
• Irregular sexual development if present during puberty.

Men can also be affected by low levels of oestrogen, resulting in:

• Sexual dysfunction.
• Decreased sexual desire.
• Sleeping problems.
• Fatigue.
• Excess fat around the belly.

When should estrogen levels be checked?

Oestradiol (E2) levels can be tested in the following situations:

• Menopause symptoms.
• Vaginal bleeding after menopause.
• Trouble conceiving (infertility).
• Menstruations are irregular or abnormal.
• Absent menstruations during childbearing age.
• Delayed puberty (girls and boys).
• Early puberty (girls).
• Female characteristics in a boy or man (gynaecomastia).
• Monitoring treatments for infertility.
• Monitoring treatments for menopause.
• Suspicion of oestrogen-producing tumours.

Sex hormone binding globulin – or SHBG for short, is a protein that binds to three sex hormones found in both men and women: testosterone, dihydrotestosterone, and estradiol.

SHBG helps by regulating the amount of these hormones that are free in the blood stream and active throughout the body. It is produced in the liver and can be measured through a simple blood test.

Abnormal levels of SHBG can be an indicator of health problems such as polycystic ovary syndrome, hyperthyroidism, and diabetes. Additionally, SHBG levels can be used to inform decisions about hormone therapy, such as the selection of an appropriate dose of testosterone replacement therapy or the use of estrogen-containing medications. It can also be used to diagnose hormone deficiencies or imbalances, particularly those related to sex hormones. 

Testosterone is a key androgen hormone involved in the development and maintenance of male physical characteristics.

In adult men, it supports sperm production, muscle and bone health, libido, energy levels, and aspects of mood and motivation.

In women, testosterone plays a role in libido, energy, mood, muscle and bone health, and overall hormonal balance, despite being present at much lower levels than in men.

What if Testosterone Results Are High?

High testosterone levels can be associated with a wide range of symptoms, including excessive body hair and acne, mood swings and aggression, low sperm count or infertility, hypertension (high blood pressure), or heart and liver problems.

It is unusual for testosterone levels to be naturally high. Abnormally high testosterone levels are often linked to anabolic steroid use.

Increased testosterone levels in males can indicate testicular or adrenal gland issues, which can be serious, and are often reviewed further to clarify the cause.

In women, increased testosterone levels can indicate polycystic ovary syndrome (PCOS) or an ovarian or adrenal gland problem, and are often reviewed further to clarify the cause.

High testosterone levels may be expected when testosterone supplements are being used, but interpretation can be complex because multiple factors can influence testosterone levels. A high result is commonly shared with the clinician who requested the blood test or a GP.

What if Testosterone Results Are Low?

Low testosterone can have a number of causes, including:

• Physical damage or other issues with the testes.
• Testosterone levels that naturally fall with age.
• Use of drugs, especially androgens and anabolic steroids.
• Significant alcohol consumption and resulting liver disease.
• Reduced production of the sex hormones LH and FSH due to hypothalamic or pituitary gland issues.

Low testosterone is sometimes treated with testosterone supplementation, including patches or injections. Understanding the underlying cause is important before treatment is considered.

Additional sex or fertility hormones are sometimes assessed as part of the wider picture, including through a male fertility hormone test.

Test results are commonly shared with a GP or the medical practitioner who requested the test.

Who Should Take This Test?

Measure your Testosterone levels and check male sex hormones and assess infertility risk with a Male Fertility (Sex Hormones) nurse or clinic finger-prick bloodtest kit

You get the convenient testing with the reassurance of professional clinical analysis. Your results are delivered quickly & securely online.

This Male Fertility (Sex Hormones) Test is advised if you:

• want the convenience of home testing without waiting for a GP appointment;
• need a high quality, clinically accredited test done in a professional clinical laboratory.

The Thyroid Stimulating Hormone test is also known as a Thyrotropin or thyrotropic hormone test.

What Is The Thyroid Stimulating Hormone Test For?

Thyroid stimulating hormone (TSH) is a crucial hormone made in the pituitary gland.

When levels of thyroid hormone in your blood are low, more TSH is made and released from the pituitary gland. Conversely, when thyroid hormone levels are high, the pituitary gland produces lower levels of TSH.

This role in thyroid gland regulation makes a thyroid stimulating hormone (TSH) test ideal for assessing overall thyroid function.

TSH is also a very useful marker of appropriate dose of thyroid replacement medication if you have an underactive thyroid.

What if Thyroid Stimulating Hormone Results Are High?

High TSH levels are often linked to an underactive thyroid gland (hypothyroidism). Interpretation is usually made alongside other thyroid hormone levels to indicate the degree of underactivity. Extremely rarely, a pituitary mass can secrete TSH even when T4/T3 levels are high.

Abnormal thyroid function can have a wide range of effects on the body and is often reviewed further to clarify the cause. Where treatment is used, it is commonly with daily hormone replacement therapy to raise abnormally low levels of natural thyroid hormones in the body.

What if Thyroid Stimulating Hormone Results Are Low?

Low TSH is most commonly linked with an overactive thyroid gland (hyperthyroidism). Low TSH can also occur after damage to the pituitary gland, such as following pituitary surgery.

Abnormal thyroid function can have a wide range of effects on the body and is sometimes reviewed further to clarify the cause.

TSH can be appropriately low when T4/T3 levels are high (hyperthyroidism). It can also be low in people using thyroid replacement therapy for an underactive thyroid. Depending on the wider context, this finding may be monitored without changes or may be discussed further.

The Total Protein test is also known as a Albumin to Globulin Ratio test.

Proteins are absorbed from foods and are vital parts of all cells and tissues. They are used to build muscles, skin, blood, bones and cartilage as well as making enzymes, hormones and other essential chemicals.

The total protein test measures the blood levels of two different classes of proteins; albumin and globulin.

High total protein can be linked to dehydration. It can also be associated with certain drugs, including androgens, growth hormone, insulin, and progesterone.

Several serious conditions can lead to a build-up of abnormal protein, so this finding is often investigated further to clarify the cause.

A high level is commonly treated as a result that is prioritised for routine review by a GP.

Low total protein can be linked to liver or kidney disorders, or to conditions where protein is not digested or absorbed from food properly.

This result is often reviewed further to clarify the underlying cause.

Low total protein is generally treated as clinically significant and is often prioritised for routine review.

The Triiodothyronine test is also known as a FT3, Free T3 or T3 test.

What Is The Triiodothyronine Test For?

Triiodothyronine (T3) is the one of the two main hormones released by the thyroid gland. It’s primary role is to regulate your body’s metabolism as part of your endocrine hormone system.

This test measures the biologically active unbound form in the blood – Free T3 (FT3).

Increased or decreased levels indicate an imbalance and should be interpreted alongside other thyroid markers.

What if Triiodothyronine Results Are High?

High free T3 can be associated with an overactive thyroid gland (hyperthyroidism).

Many medications, including certain contraceptive birth control pills and large doses of aspirin, can interfere with total T3 test results. In general, free T3 concentrations are affected much less by these medications.

A high T3 level is often interpreted alongside other thyroid function results such as thyroid stimulating hormone (TSH) and thyroxine. Taking thyroxine (thyroid hormone replacement) can influence T3 levels.

What if Triiodothyronine Results Are Low?

A low free T3 result can be linked to an underactive thyroid gland (hypothyroidism).

Many medicines, including certain contraceptive birth control pills and large doses of aspirin, can interfere with total T3 test results. Free T3 concentrations are generally affected much less by these medicines.

A low T3 level is sometimes associated with hypothyroidism, but interpretation is usually made alongside other thyroid function results such as thyroid stimulating hormone (TSH) and thyroxine. Thyroxine (thyroid hormone replacement) can also influence T3 levels.