The majority of patients we see in clinic are exhausted, adrenalized, and burned-out, spending their time juggling family duties, work, and other life challenges that are thrown their way.

They are often not aware that they are suffering from a hormonal imbalance, presenting with symptoms such as  headaches, decreased sex drive, bloating, mood swings, fatigue, anxiety & depression, breast tenderness, endometriosis, fibroids, and hormonal weight gain.

We almost always recommend they complete the DUTCH Test.

Why? Because it’s the gold standard when it comes to hormone testing. The DUTCH test tests reproductive and adrenal hormones as well as melatonin and oxidative stress.

What is the DUTCH Hormone Test?  

The DUTCH test stands for Dried Urine Test for Comprehensive Hormones and involves collection of a small amount of urine on filtered paper four times a day.  The DUTCH TEST measures hormone metabolites from the dried urine samples. The hormones measured in the test include:

• 8 estrogen metabolites (E1, E2, E3, 2-OH- E1, 4-OH-E1, 16-OH-E1, 2-methoxy-E1)
• 8 androgens (including Testosterone, DHT and DHEA-S)
• Progesterone (2)
• Cortisol (3)
• Melatonin (6OHMS)
• 8-OHdG
• The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response.
  

This test also measures cortisol and cortisone rhythms and levels, and estrogen metabolism pathways.

DUTCH Test &  Women's Health

While hormone blood tests are a useful tool, they are not the same as the DUTCH test.

Blood and saliva tests don’t measure cortisol rhythms and estrogen metabolism and do not track hormone replacement as thoroughly, not being sensitive enough to see the different levels of estrogen, which can be an issue for women when it comes to trying to figure out their estrogen state, and can impact on their overall health.

What makes the DUTCH test better than blood or saliva tests is the comprehensive information that is collected with a single test. The DUTCH test is well-recognized for its ease-of-collection, coupled with comprehensive reporting that is not currently available from other tests.

• Adrenal fatigue, sleep or stress issues. Testing the adrenal hormones provides specific information about how to support stress and sleep issues, by specifically looking at the the HPA axis (hypothalamus-pituitary-adrenal) adrenal-brain communication.
  
• Fertility problems, poly-cystic ovarian syndrome (PCOS). This test is beneficial for women suffering from fibroids, PMS, irregular periods, painful periods, anxiety & moodiness, and endometriosis. It provides a comprehensive picture of how the adrenal and reproductive hormone imbalances may be contributing to these problems.
  
• Hormone replacement therapy. This test works well for oral progesterone, vaginal hormones, patches, pellets and injections. Note that this is only for hormone replacement therapy, not hormonal birth control pills.
  
• Sleep problems. By checking melatonin levels we can assess how your sleep patterns may be affected. Melatonin can be low and related to your sleep problems, or it can be normal.
  
• DHEA levels. This “feel-good” hormone produced by your adrenal glands, when low it can cause fatigue, decrease in muscle mass or bone density, depression, aching joints, loss of libido, and lowered immunity.
  
• Estrogen dominance. Estrogen dominance occurs when we have too much oestrogen in the body and is relative to the other sex hormones, such as having too little progesterone to balance it out. Estrogen dominance can be a factor in endometriosis, PMS, painful periods, fibrous breasts, fibroids, tender breasts, moodiness, and more. It can also make perimenopausal symptoms significantly worse.
  
• Metabolization of estrogen through the liver. This is important for understanding how we are clearing estrogen's from the body. If you don’t metabolize estrogen well, you risk estrogen dominance, as well as risks of estrogen-related cancers such as breast, cervical and uterine cancers. We can also see the methylation pathway of estrogen when doing the DUTCH test, which can tell if there are nutrient deficiencies or an MTHFR gene mutation, which would then need to be addressed in order to maximize health.
  

DUTCH Test & Men's Health

The DUTCH Test provides excellent information to men looking to optimize their health and wellbeing. While the media focus is often on increasing testosterone, other hormones play key roles in common symptoms such as fatigue, abdominal weight gain, gynecomastia, male pattern baldness, depression, insomnia and more.

The DUTCH Test provides insights into multiple androgens such as DHEA-S, etiocholanolone, androsterone, 5a-DHT and testosterone. It evaluates the three main estrogens including phases 1 and 2 of estrogen metabolism. While estrogen metabolism is often associated with women’s health, men need healthy clearance as well. Lastly, hormones such as cortisol and melatonin play a role in testosterone production and spermatogenesis.

How is the DUTCH Test Performed?

The test is compact, concise and user friendly. It is set-up so that patients can take it home and collect samples without disrupting their usual schedule.

The kit consists of an envelope containing instructions, a requisition form, and 5 paper strips for sample collection. 4 dried urine samples are collected throughout a 24-hour period:

• Waking
• 2 hours after waking
• Dinner time (~5:00pm)
• Bed time
• Extra overnight sample if needed
  

After collecting your samples, they are sent into the lab via air mail. Results can take approximately 2 weeks to be returned.

You will then receive a detailed and straightforward report from the lab. This will include an overview of hormone levels (total estrogens, progesterone, testosterone, total DHEA production, 24-hour free circulating cortisol, and metabolized cortisol). It also includes a breakdown of the hormones and their metabolites, as well as a list of hormones with their normal ranges.

DUTCH vs. Other Testing Methods

Dried urine testing has become a very sought after form of hormone testing as it is a good reflection of not only hormone levels, but hormone metabolites. Metabolites are the downstream breakdown products of hormones and are excreted in the urine. Some of these metabolites can be harmful, so testing their levels can be useful in determining the root cause of symptoms.

Saliva testing: Useful for testing free cortisol, but does not measure cortisol metabolites. To properly characterize a patient’s cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis.

Serum testing: Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing (especially for cortisol and estrogens).