When a woman comes to see me with concerns about her weight, energy, libido, history with breast cancer or even better, she proactively wants to optimize overall health, I almost always recommend we start with the DUTCH hormone test.
Lab tests won’t “cure” you and in fact, sometimes even the best lab tests simply point to the need for further investigative testing, but the DUTCH is a great test for all women to do because of the richness of the data it provides when you seek to uncover the hidden causes behind health concerns instead of just covering up symptoms with drugs and supplements. (As an aside, I am not against supplements, but very often they can be used as a form of “green allopathy” where you simply treat the problem with a pill, albeit a holistic pill).
Why test hormones anyway though?
Hormones are chemical compounds present so sparsely in the blood that their concentration is usually measured on the level of a few parts per trillion. Yet they are tremendously powerful in coordinating the actions of our organs and glands – and affecting our quality of life! Steroid hormone imbalance can affect EVERY OTHER BODY SYSTEM and your specific lifestyle choices play a huge role in this outcome.
While it is possible to test hormones in blood or saliva and derive some useful data, these methods have drawbacks that limit their usefulness.
DUTCH is an acronym and it stands for “dried urine total complete hormones” from Precision Analytical lab in Oregon. It’s an easy to do test that helps inform a plan of action. This test has you collecting 4 separate urine samples (using filter paper) over the course of 14 hours, to give you far more actionable data than using a salivary hormone panel.
BELOW ARE MY TOP 10 REASONS TO DO THE DUTCH TEST:
Reason 1: It gives you a comprehensive look at cortisol production by your adrenal glands. Saliva adrenal testing only measures the free fraction of cortisol, which is around 1% of your production. The DUTCH test will measure both free and total (also called metabolized) cortisol for a better look at overall production. Metabolized cortisol comprises 80% of your total production and is a more accurate way of determining adrenal gland health. For more information on this, see my blog post “You Don’t Have Adrenal Fatigue”.
Why is this important? This is crucial for determining whether you have low cortisol, or not. Far too many women have been told they’ve got low cortisol, or “adrenal fatigue” based on a saliva panel. 85% of these women have high metabolized cortisol (as seen on the DUTCH test) which means that although their free cortisol was low, overall production is just fine. Even worse, some of these women, (who were found to have low cortisol production via a saliva panel) were given hydrocortisone supplements. If they have high total cortisol and are given cortisol increasing medication or supplements, they will likely feel much worse.
Reason 2: The DUTCH test is easier to do than a saliva panel. I don’t know about you but working up a tube full of spit can be a challenge. With the DUTCH test, you just urinate on filter paper and put it aside to dry. Easy!
Reason 3: It is only slightly more expensive than a saliva test. A leading lab charges $219 for their salivary adrenal and sex hormone panel. Although the DUTCH lab lists the price as $399 to consumers, when you work with a trained practitioner as me, you can get the test for $250. For just $31 more, you get much more data that you can work with.
Reason 4: The DUTCH test can point a finger towards a concurrent thyroid problem. The DUTCH test is not a thyroid test but if you are hypothyroid, your adrenal values will likely show up as high free cortisol and low total cortisol.
Why is that?
Cortisol and thyroid hormone really interface with each other. In hypothyroidism, the body experiences sluggish clearance of cortisol because the liver is not doing a good job at getting rid of it. So, if you were to look at the free value (which is the only value you’d get if you’re doing an adrenal saliva profile) then you might think “this person is making too much cortisol” but it’s not because you’re making too much, it’s because it’s clearing the hypothyroid person’s system very slowly.
Reason 5: The DUTCH test gives you a total picture of DHEA production. The DUTCH test will show you your overall DHEA production (by combining the 3 most abundant metabolites of DHEA which are DHEA-S, etiocholanolone and androsterone). The sum of these 3 metabolites gives you a good estimation of your overall production of DHEA, which is a vitality hormone that counterbalances the effects of too much cortisol. The difference between DHEA and DHEAS is that DHEA has an extra sulfate molecule attached to it and 90% of the DHEA in the body exists as DHEA-S. However, this “sulfation” of DHEA into DHEA-S is inhibited by inflammation. Therefore, If you have high total DHEA production but low DHEA-S, it could be due to inflammation.
Reason 6: It tells you how you are processing your estrogen. Estrogen should be a “use it and lose it” hormone. For us to be healthy, the body has to get rid of spent estrogen. It does this primarily through the liver which sends it to the colon for removal. There are two phases of estrogen metabolism. The first is the 2, 4 or 16 hydroxy estrone pathway. 70% of your estrogen should break down to 2-OH because this is the more protective estrogen metabolite.
Here’s a peek at one of my client’s results, Carmen, who lives a very healthy lifestyle with lots of cruciferous vegetables and pasture raised meat. She also practices stress reduction and gets adequate sleep. Her 2-OH of over 70% (hers was 78.6%, which is awesome) is highly correlated with her healthy lifestyle. It’s pretty awesome when you put so much effort into your health to see your labs reflect that effort. I know Carmen was happy to find out these results and it influences her to stay motivated with her healthy habits for the long run.
Reason 7: Don’t forget about 4-OH and 16-OH. Those are the more proliferative (and potentially cancer-causing metabolites) of estrogen. We still need some, (they can never be zero), because the 4-OH metabolite helps maintain bone health…. but they should not be too much over 10% and 20% respectively.
Reason 8: The DUTCH test tells you how well you are “methylating” your estrogen. Methylation of estrogen is the second step in the estrogen detoxification process. It is a protective step in which you turn your 2-Hydroxy estrone into a 2-Methoxy estrone. This takes place in the liver, so this test is a somewhat indirect measurement of liver health as well. I will be honest; many people fall a little short in this area….it seems that our methylation is collectively lacking. This seems to reflect the toxic times that we live in and all that our livers have to deal with these days. I do find a few people who are “methylating” their estrogen well, but in the 100 or so tests that I’ve done, more than 60% of people show up as low methylators.
Here is an example of low methylation. The 2-Methoxy-E1 should be up around a 7 or 8, but its only a 4.3.
Reason 9: The DUTCH test tells you what type of testosterone metabolites your body favors. Testosterone can break down into 5a-DHT or 5b-DHT. 5a-DHT is more “androgenic” or potent metabolite of testosterone and is responsible for things like acne, thinning head hair, excess body hair and is correlated in PCOS. If you have these issues and have what is called high 5a reductase activity, there are specific things that can be done to reduce this metabolite of testosterone, but you need to test in urine, such as the DUTCH test, and not in saliva.
Reason 10: The DUTCH test can tell you if you are estrogen dominant. Estrogen dominance is one of the most damaging hormone imbalances that modern women face today. It means that you don’t have enough progesterone to balance out your estrogen. Symptoms of estrogen dominance include PMS, migraines, heavy periods, moodiness. Estrogen dominance can sound a little misleading because it sounds as though you have too much estrogen. This is usually the case, but not always. You can be low estrogen and estrogen dominant and all that really means is that you have low estrogen and even lower progesterone. The DUTCH test can tell you both…. what your total estrogen is and what your estrogen level relative to progesterone is. Both values are important in recovering from hormone imbalance.
Here is an example of estrogen dominance:
Science has advanced. Saliva testing has been replaced with dried urine testing. A hormone test such as the DUTCH test can help get you on the path to better health. I use this test exclusively in my Balance Your Hormones, Love Your Life online group program and with my 1:1 work with women all over the world.
If you have any questions about the test, please leave a comment below and I would be happy to answer them!
UPDATE: As of Jan 2018, the DUTCH complete test now includes markers for vitamin B6 and B12.
Related Article: The Top 3 Tests All Women Should Do (+ 2 ‘Honorable Mentions’)