The DUTCH test detects hormonal imbalances that may be associated with chronic health conditions such as PCOS, allowing your functional practitioner to help uncover root causes of hormonal dysfunction. The results of the DUTCH test allows your functional practitioner to receive a more complete picture of what’s going on in internally regarding your hormonal health in order to create a personalized functional nutrition care plan for you. Functional lab testing would be a good idea if you really wanted to hone in on the specifics of gut microbiome imbalances, hormonal imbalances, vitamin/mineral deficiencies.

What is The DUTCH Test?

The DUTCH or Dried Urine Test for Comprehensive Hormones, test is advanced functional lab testing measuring hormone levels and their metabolites using dried urine and/or saliva samples. DUTCH is a group of validated tests that provide a complete evaluation of sex and adrenal hormones, including metabolites. They offer the most extensive of sex and adrenal hormones along with their metabolites. Additionally, the daily (diurnal) pattern of fre cortisol is included, along with melatonin (6-OHMS), 8-OHdG, and nine organic acids. The results of the DUTCH test provide valuable insight into your reproductive hormones as well as your adrenal hormones essentially assessing your hormonal health. Hormone health is only one piece of the puzzle when it comes to addressing root causes of health conditions and improving overall health. There are many different organs in the human body and each organ works together in harmony to achieve optimal health and longevity.

Health Conditions Commonly Assessed with The DUTCH Test

 It is commonly used for health conditions such as:

• Polycystic Ovary Syndrome PCOS: using the DUTCH test to evaluate androgens, progesterone, estrogens, and cortisol.
• Acne
• Weight Loss
• Hormonal Imbalances: Estrogen dominance, Low Estrogen, Low/Elevated Testosterone, Low/Elevated Progesterone, low/elevated cortisol.
• Effective HRT monitoring: DUTCH testing was designed to be optimally effective for most forms of hormone replacement therapy. Unique methods are used for improved monitoring of oral progesterone and vaginal hormones.

 For females experiencing:

• Fatigue or low energy
• PMS
• Vaginal dryness
• Brain fog
• Low libido
• Weight gain
• Fertility concerns
• Hot flashes or night sweats

 For males experiencing:

• Erectile dynsfunction
• Low libido
• Decreased muscle mass
• Abdominal weight gain
• Fatigue or low energy
• Brain fog

The DUTCH Test

Below is an example of what a DUTCH Test Result would look like:

For most accurate test results: The urine and saliva samples for the DUTCH test should be collected on or around Days 19-22 of the menstrual cycle (5-7 days after ovulation) with day 1 being the first day of menstruation in order to obtain the most accurate results. This is if you have a regular cycle. If you are menopausal or male you can test at any time since there is no cycle.

*you can still run a test while on the birth control pill (your estrogen and progesterone levels will be very low meaning it is working) to test cortisol, androgens, and organic acids.*

*Above is an example of a client with perimenopause/menopause symptoms: daily hot flashes, low mood, low energy, difficulty losing weight, and irregular menstrual cycles. As well as high elevated cortisol spike in the morning due to chronic stress and low waking melatonin levels contributing to the irregular & elevated cortisol morning spike.* The waking urinary 6-OH-Melatonin-Sulfate is low. This reflects low overnight production of melatonin. This may be implicated in poor sleep and insomnia.

Free Cortisol Levels: Overall free cortisol levels are elevated, but metabolized cortisol (the best marker for overall cortisol production) is low. Cortisol clearance may be a bit sluggish, which keeps free cortisol levels elevated in spite of low overall production. Hypothyroidism and other conditions may lead to slow cortisol metabolism. (free levels high, with low metabolized levels: take into account the interplay between the adrenals and thyroid.)

Cortisol Metabolism: The Cortisol Clearance Rate is low. This indicates the level of metabolized cortisol is significantly lower than the level of free cortisol and free cortisone. Slow cortisol clearance occurs with low levels of 5a and 5b-reductase. This occurs with hypothyroidism, cholestasis, anorexia, liver cirrhosis, and critical illness. The HPA axis can adjust cortisol excretion to maintain normal levels of free cortisol, but slow clearance can result in lower ACTH and all adrenal products (such as DHEA). In some cases, slow cortisol clearance leads to high free cortisol and high cortisol symptoms.

Xanthurenate and kynurenate are both high (above range). This can indicate low vitamin B6 from not eating food sources of vitamin B6, not absorbing it, not activating it, not having the co-factors to activate it/circulate it, or from conditions like pyroluria that bind up B6, impairing absorption. B6 is important for estrogen methylation and neurotransmitter production and can help make cysteine (glutathione/pyroglutamate) in the transsulfuration pathway.

Main Sex Hormones: Estradiol (E2), Progesterone, and Testosterone

The first page of the results shows Estradiol (E2), Progesterone, and Testosterone levels. Estradiol is shown since it is the most potent form of estrogen. This is basically a snapshot or a quick summary of the three main sex hormones as well as your cortisol production (DHEA production, free cortisol, and metabolized cortisol) graphed out through the day. Ideally, you want your levels to be in between the stars which would be considered within normal ranges. Specifically, for the estradiol and progesterone to be facing around the same area – using the arrow symbol as a guided tool or for the progesterone to be a little higher than the estradiol.

Progesterone Metabolites, Estrogens, and Androgens

Above is shown your progesterone metabolites (alpha and beta progesterone), your estrogens including the phase 1 and phase 2 estrogen detox, and your androgens such as DHEA-S, androsterone, testosterone etc.

The Three Phases of Estrogen Metabolism

All of the data that is shown above is put into dials which can seem overwhelming at first but should be read as a pathway that tells the functional practitioner how your hormones are metabolizing. In the middle of the graph, you will see the three phases of estrogen metabolism or estrogen detoxification. Phase 1 metabolism is shown above as 2-OH-E1 (low) , 4-OH-E1 (in range), and 16-OH-E1 (high). Deficiency in certain nutrients will lead to insufficient phase 2 of the estrogen detox phase or insufficient methylation of the estrogen metabolites (Phase 2 Metabolism) as seen towards the bottom left of the page. (2-Methoxy-E1 + COMT enzyme)

If you would like to further evaluate Phase 3 of estrogen detoxification, looking at stool testing using the GI-MAP stool test is necessary to evaluate the gut microbiome. You would need to look specifically towards the intestinal health markers page at GI Markers: β-Glucuronidase. Your functional practitioner will recommend dietary changes as well as targeted supplementation to help modulate these three pathways. (Phase one, two, and three of estrogen detox)

Looking towards the left side of the above page, you will see your androgens and how well they are metabolizing: DHEA-S, Testosterone, Androsterone, ect. Your functional practitioner will recommend dietary and lifestyle changes as well as targeted supplementation to help modulate these hormones.

Free Cortisol and Cortisone (Saliva Testing)

Free Cortisol and Cortisone – Graph View (Saliva Testing)

CAR (cortisol awakening response)

Above is shown your melatonin level in the upper left as well as your free cortisol levels throughout the day. If you are in a chronic state of elevated cortisol or constantly in fight or flight mode, the above graph will reflect that. Your functional practitioner will recommend dietary and lifestyle changes as well as targeted supplementation to help modulate cortisol levels.

• Low afternoon cortisol
• Low waking cortisol

Vitamins, Neurotransmitter Metabolites, Melatonin, and Oxidative Stress

Intentional Healing, Root-Cause Solutions, and Long Term Nourishment

Each person is unique and this is recognized in a personalized functional nutrition assessment and intervention plan that engages and empowers the patient in this process to restore optimal function, manage symptoms and promote overall health and well-being.

Functional nutrition addresses the whole person, not just an isolated set of symptoms. We look at it from a root-cause perspective and create a focus on prevention through nutrition, therapeutic diets, targeted supplementation, interpretation of conventional and/or functional lab testing, botanicals, detoxification protocols, exercise, and stress management tools.

My storefront is linked here to order functional labs, which is signed off by a nationally-licensed physician, to assess for gut health issues, hormonal imbalances, or vitamin/mineral deficiencies. If you need help creating a personalized functional nutrition care plan based on the interpretation of any of the above functional labs, you can work with us here.