You Cannot Address
What You Cannot Measure.

The most accessible entry point for mineral and toxic metal assessment. Hair reflects a 3-month window of mineral status and toxic metal accumulation. Shows calcium, magnesium, sodium, potassium ratios alongside lead, mercury, cadmium, arsenic, aluminum, and nickel. Inexpensive and does not require blood draw or urine collection.

Best for: Initial heavy metal screen, mineral dysregulation, adrenal/thyroid patterns. Limitation: Does not differentiate between recent and long-term exposure the way urine testing does.

The gold standard for mercury assessment. Differentiates between methylmercury (fish exposure) and inorganic mercury (dental amalgam exposure) — a distinction that standard mercury tests do not make. Inorganic mercury from amalgam preferentially deposits in organs and the brain and does not show clearly in blood.

Best for: Anyone with amalgam fillings, significant fish consumption, neurological symptoms, or autoimmune conditions where mercury is a suspected driver.

Screens for 11 mycotoxins produced by common indoor molds. Ochratoxin A (Aspergillus/Penicillium — the most prevalent, found in water-damaged buildings, coffee, and grains), trichothecenes Roridin E and Verrucarin A (Stachybotrys — black mold), Aflatoxin M1 (Aspergillus — food and water contamination), Gliotoxin (Aspergillus fumigatus — immune suppression), Chaetoglobosin A, Citrinin, Dihydrocitrinone, Enniatin B1, Mycophenolic Acid, and Sterigmatocystin. Mycotoxin illness is dramatically underdiagnosed — symptoms overlap with chronic fatigue, autoimmune conditions, and psychiatric presentations, and most practitioners never test for it.

Best for: Anyone who has ever lived or worked in a water-damaged building, or who has unexplained fatigue, brain fog, chemical sensitivity, recurrent infections, or unusual lab patterns that don't respond to standard treatment.

Screens for the most clinically significant toxic non-metal chemicals from everyday environmental exposures. Covers herbicides and pesticides (glyphosate, atrazine, 2,4-D), phthalates (MEHP, MEOHP, monobutyl, monoethyl, monoisobutyl, DEP, DPP), parabens (methyl, ethyl, propyl, butylparaben), bisphenols (BPA, Bisphenol S), the sunscreen chemical oxybenzone, perchlorate (thyroid disruptor in drinking water), and pyrethroid pesticide metabolites (3PBA, phenylglyoxylic acid). Most of these chemicals are not tested in any conventional medical setting — and most people carry detectable levels of nearly all of them.

Best for: Anyone with unexplained inflammation, hormone disruption, thyroid dysfunction, or neurological symptoms; those in high-exposure environments (agriculture, renovations, urban air, new construction); and anyone who wants to know their actual chemical body burden before it becomes a diagnosis.

The most comprehensive hormone panel available. Dried urine collection captures hormone metabolites — not just levels — showing how your body is actually processing and clearing estrogen, progesterone, and androgens. Key markers: estrogen metabolites (2-OH, 4-OH, 16-OH pathways — the 4-OH pathway is carcinogenic when elevated), cortisol and cortisone rhythm across the day, DHEAS, testosterone, DHT, melatonin (6-OHMS), and an organic acids add-on.

This is the hormone panel. Serum estradiol tells you the level; DUTCH tells you what your body does with it. Critical for anyone on HRT, experiencing cycle irregularities, with a history of estrogen-sensitive conditions, or navigating perimenopause.

Cortisol is not a static number — it follows a circadian rhythm that should peak sharply at waking and decline through the day, reaching its lowest point before midnight. A single serum cortisol tells you almost nothing. Four-point saliva testing captures the actual rhythm: whether the morning spike is present, whether it crashes by afternoon, whether it rises inappropriately at night. Adrenal dysfunction is a pattern, not a number.

Best for: Fatigue (especially morning or afternoon crashes), sleep disruption, anxiety, blood sugar instability, weight gain around the midsection, burnout recovery.

A full-spectrum baseline for women in a single draw — built to see what standard panels skip entirely. The hormonal axis covers estradiol (ultrasensitive LC/MS — the most accurate method), FSH, LH, testosterone (free, bioavailable, and total by LC/MS), DHT, and DHEA-S. Full thyroid includes TSH, fT3, fT4, and reverse T3 — elevated rT3 blocks active T3 at the cell level, producing hypothyroid symptoms even when TSH looks normal. Fasting insulin is included because insulin resistance is invisible on standard glucose and HbA1c for years. Cystatin C alongside eGFR catches kidney decline that creatinine alone misses until function is already significantly reduced. Ceruloplasmin and iron/TIBC/ferritin give the copper-iron picture — standard care almost never runs them together. Nutrient status: Vitamin D, Vitamin A (retinol), B12, folate, RBC magnesium, and phosphorus. Homocysteine and hs-CRP cover cardiovascular and inflammatory risk independently of the lipid panel. IGF-1 by LC/MS measures growth hormone signaling. HbA1c is included alongside fasting insulin and glucose for the full metabolic picture.

Best for: Any woman wanting a true baseline — reproductive years, perimenopause, postmenopause, unexplained fatigue, hair loss, cycle irregularities, low libido, weight changes, or anyone who has never had a comprehensive hormonal workup. This is the starting point before layering in DUTCH or specialty panels.

A full-spectrum advanced baseline for women in a single draw — built to see what standard panels skip entirely. Uses high-specificity LC/MS methods for estradiol, testosterone, and IGF-1. The hormonal axis covers ultrasensitive estradiol, progesterone, FSH, LH, testosterone (free, bioavailable, and total), DHT, DHEA-S, and SHBG — high SHBG suppresses free hormone availability and is frequently overlooked in women on oral contraceptives or with thyroid dysfunction. Prolactin is included because elevated levels cause cycle disruption and amenorrhea and can signal a pituitary issue that standard workups miss entirely. Full thyroid: TSH, fT3, fT4, and reverse T3. Fasting insulin is included because insulin resistance is invisible on standard glucose and HbA1c for years. Cystatin C alongside eGFR catches kidney decline that creatinine alone misses. Ceruloplasmin and the iron panel give the copper-iron regulatory picture standard care never runs together. Full nutrient status: Vitamin D, Vitamin A (retinol), B12, folate, RBC magnesium, and phosphorus. Homocysteine and hs-CRP cover cardiovascular and inflammatory risk independently. HbA1c alongside fasting insulin and glucose provides the complete metabolic picture. Uric acid is included — elevated in metabolic syndrome and frequently missed.

Best for: Women who want the full picture — advanced hormonal, metabolic, nutrient, kidney, and inflammatory assessment in one draw. Step up from the Comprehensive Female Panel when deeper data is needed or when symptoms haven't been explained by standard workups.

A full-body baseline for men in a single draw — built to catch what standard panels miss. The full androgen axis runs beyond total testosterone: free testosterone, bioavailable testosterone, SHBG (high SHBG binds testosterone and makes total T meaningless), DHT (the primary androgenic driver of prostate growth and BPH — more relevant than PSA for most men), and E2 (estradiol, critical in men — elevated E2 drives fat deposition, low libido, and mood disruption). PSA Free + Total included — the free PSA ratio differentiates cancer risk from benign enlargement when PSA is elevated. Full thyroid goes beyond TSH: fT3, fT4, and reverse T3 — elevated rT3 blocks active T3 at the cell level, producing hypothyroid symptoms even when TSH looks normal. Fasting insulin is included because insulin resistance is invisible on standard glucose and HbA1c for years; elevated fasting insulin with normal glucose is the earliest detectable signal. Cystatin C is added alongside creatinine-based eGFR — creatinine alone does not register kidney decline until roughly half of function is already gone, and it runs falsely high in muscular men. Nutrient status is fully covered: Vitamin D, Vitamin A (retinol), B12, folate, RBC magnesium, and phosphorus. Iron panel covers ferritin, serum iron, TIBC, and transferrin saturation. Homocysteine and hs-CRP cover cardiovascular and inflammatory risk independently of the lipid panel.

Best for: Any man wanting a true comprehensive baseline — fatigue, low libido, weight gain, mood changes, poor recovery, erectile dysfunction, prostate concerns, or anyone who has never had a full hormonal and metabolic workup. This panel covers what a standard annual physical misses entirely.

A full-body baseline for men in a single draw. Covers the complete hormonal axis — testosterone (total, free, SHBG), DHEA-S, E2 (estradiol — elevated E2 in men drives fat deposition, low libido, and mood disruption), FSH, LH, IGF-1, and full thyroid (TSH, fT3, fT4, reverse T3). Total PSA included as a prostate baseline. Full CBC with differential, complete metabolic panel, lipid panel, ferritin, and hs-CRP. Fasting insulin is included — insulin resistance is invisible on standard glucose and HbA1c for years; elevated fasting insulin with normal glucose is the earliest detectable signal. Reverse T3 is included — elevated rT3 blocks active T3 at the cell level, producing hypothyroid symptoms even when TSH looks normal. SHBG is critical — high SHBG binds free testosterone and renders total testosterone meaningless.

Best for: Any man wanting a true baseline — fatigue, low libido, weight gain, mood changes, poor recovery, erectile dysfunction, or anyone who has never had a comprehensive hormonal workup. Step up to the Advanced Male Baseline when deeper nutrient, kidney, and prostate data is needed.

76 metabolic markers from a single urine sample. Organic acids are byproducts of metabolism — from your own mitochondria, from gut microorganisms, and from neurotransmitter processing. Key areas: mitochondrial energy production (Krebs cycle intermediates), gut dysbiosis (arabinose for Candida overgrowth, HPHPA for Clostridia bacteria), oxalate burden (linked to kidney stones, joint pain, fibromyalgia), neurotransmitter metabolites (dopamine, serotonin), and B vitamin status markers.

Best for: Fatigue, brain fog, chronic pain, mood disorders, gut symptoms, autism spectrum support, and anyone who wants a comprehensive metabolic snapshot from a single non-invasive collection.

Quantitative PCR-based stool analysis — the most sensitive method for identifying gut pathogens and mapping microbiome disruption. Identifies H. pylori with virulence factors (which determines whether treatment is warranted), parasites (Giardia, Cryptosporidium, Entamoeba, Blastocystis hominis), opportunistic bacteria, Candida species, viruses, and worm markers. Also measures zonulin (the protein that controls intestinal permeability — the direct biomarker for leaky gut), calprotectin (intestinal inflammation), sIgA (immune status of gut lining), and beta-glucuronidase (estrogen recirculation enzyme).

Best for: Any gut symptom, autoimmune conditions, skin conditions (gut-skin axis), mood disorders, hormone imbalance (via the estrobolome), food intolerances that don't resolve with elimination.

Standard care runs TSH only — a pituitary signal that tells you virtually nothing about what the thyroid is actually producing or how cells are responding to it. A complete panel includes: TSH (pituitary signal) + T4 / fT4 (total and free storage hormone) + T3 / fT3 (total and free active hormone — most cells run on T3, not T4) + Reverse T3 (the brake — elevated rT3 blocks active T3 from working, even when levels look "normal") + Anti-TPO + Anti-Tg (autoimmune thyroid markers — present years before TSH shifts). Hashimoto's can be completely missed on TSH alone.

Insist on the full panel. If your practitioner only runs TSH, that is an incomplete evaluation. Many patients with clear hypothyroid symptoms are told their "thyroid is fine" because only TSH was checked.

Standard serum nutrient levels (magnesium, B12, zinc, iron) measure what's circulating in your blood — not what's actually inside your cells where nutrient function occurs. Intracellular testing measures functional nutrient status within lymphocytes over a 4-6 month window. Includes B vitamins (B1, B2, B3, B6, B12, folate, biotin, pantothenate), minerals (magnesium, zinc, copper, manganese, chromium), fat-soluble nutrients, amino acids, CoQ10, carnitine, and glutathione.

Best for: Chronic fatigue, neuropathy, cardiovascular risk, anyone on medications that deplete nutrients (PPIs, metformin, oral contraceptives, statins), and before starting supplementation so you're addressing actual deficits.

Most chronic disease, in Morley Robbins' research framework, is rooted in iron dysregulation caused by copper deficiency — not iron deficiency. Copper, through the enzyme ceruloplasmin, is the master regulator of iron: it controls whether iron is properly bound and transported, or circulating unbound and producing oxidative stress. When ceruloplasmin enzyme activity is impaired (from low retinol/vitamin A, which activates it), iron accumulates in tissue and drives inflammation regardless of what the hemoglobin looks like. Standard care almost never runs this picture together. These are standard Quest draws, ordered through our Rupa Health storefront with physician signing included.

Iron Markers

Copper Markers

Calculated — Free Copper = Serum Copper (µg/dL) − [Ceruloplasmin (mg/dL) × 3.15]. Ideal: 5–15 µg/dL. No extra test required — calculate from the two draws above. Elevated free copper indicates unbound, pro-oxidant copper circulating without enzyme activity.

Magnesium, Zinc, Retinol & Vitamin D

Uric Acid

Ideal: ~4 mg/dL. Uric acid reflects mitochondrial "exhaust" — the waste product of xanthine oxidase activity driven by unbound iron. Elevated uric acid in this framework indicates iron-driven oxidative stress, not primarily gout or diet.

Best for: Unexplained fatigue, brain fog, chronic inflammation, conditions not responding to standard treatment, anyone supplementing high-dose D3 (retinol suppression risk), hemochromatosis evaluation, and anyone wanting to understand whether their iron picture is truly healthy rather than just "in range."

The most comprehensive single cardiovascular panel available through functional medicine ordering. Goes far beyond the standard lipid panel to capture the full picture of arterial disease risk, metabolic function, fatty acid balance, and organ status in one draw. Key clinical distinctions: Cholesterol balance markers — Lathosterol and Desmosterol (synthesis) alongside Beta-sitosterol, Campesterol, and Cholestanol (absorption) answer the question standard care never asks: is this patient an overproducer or overabsorber? That distinction determines whether a statin, ezetimibe, or neither is the right conversation. OxPL-apoB (oxidized phospholipids on apoB) — the most sensitive marker for Lp(a)-driven plaque vulnerability and rupture risk. HDL subfractions (Pre-β-1, α-1 through α-4) — functional reverse cholesterol transport capacity, not just HDL-C. CoQ10 — depleted by statins; rarely checked; essential for cardiac muscle function. Full fatty acid profile including Omega-3 Index, AA/EPA ratio (direct measure of systemic inflammatory tone), Trans Fat Index, and SFA Index. Complete metabolic markers including liver function, full electrolytes, kidney function (eGFR/Creatinine), HbA1c, and Uric Acid.

Best for: Any patient with cardiovascular risk factors, family history of heart disease, anyone on statins (CoQ10 depletion), metabolic syndrome, fatty liver, poor omega-3 status, or any case where you want the full picture — arterial inflammation, fatty acid balance, cholesterol metabolism, liver, kidney, and metabolic function — from a single blood draw.

HbA1c and fasting glucose are the standard markers — but insulin resistance can be present for a decade before either shifts. Key additions: Fasting insulin (optimal range: 2–6 µIU/mL; most practitioners don't order this) + HOMA-IR (calculated index of insulin resistance from glucose + insulin) + HOMA-B (beta cell function — how hard the pancreas is working) + HOMA-S (insulin sensitivity — how well cells are responding) + Uric acid (consistently elevated in metabolic syndrome, gout risk, and cardiovascular disease; frequently missed) + Triglyceride:HDL ratio (one of the strongest predictors of insulin resistance from a standard panel — a ratio above 2.5 is a red flag). Full CMP included: liver enzymes, kidney function, electrolytes, and inflammatory marker hs-CRP.

Best for: Anyone with fatigue, weight that won't move, PCOS, fatty liver, sugar cravings, or a family history of type 2 diabetes — long before a diagnosis is on the table.