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A true undermethylation test requires measuring: Methionine SAM (S-adenosylmethionine) SAH (S-adenosylhomocysteine) Homocysteine Cystathionine Cysteine The SAM:SAH ratio (a key indicator of methylation efficiency) This methylation blood test reveals where the pathway is blocked: Low SAM + low methionine true undermethylation High homocysteine + high SAH methylation congestion Low cystathionine impaired conversion of homocysteine to glutathione SAM:SAH ratio below 6.3 inefficient methylation even when normal by standard labs This clarity is what people searching for how to test for undermethylation are really looking for