Hormones, Lab Tests & Other Testing Methods, Men's Health, Miscellaneous, Women's Health

Look at Your Adrenal and Sex Hormones in a Unique Way: The DUTCH Test

Full Width Featured Image With Sidebar
Brendan Evans Moorehead
Table of Contents

You probably know that how you feel has a lot to do with your levels and balance of adrenal and sex hormones. 

Adrenal and sex hormone imbalances can lead to symptoms and conditions such as the following:

  • Fatigue
  • Exercise intolerance
  • Poor mental function
  • Weight gain
  • Hair loss
  • Premenstrual syndrome (PMS)
  • Abnormal menstrual cycles
  • Infertility
  • Low libido
  • Estrogen dominance
  • Breast tenderness
  • Fibroids or cysts
  • Polycystic ovarian syndrome (PCOS)
  • Premature ovarian failure
  • Night sweats, hot flashes
  • Insomnia
  • Mood swings
  • Depression
  • Hypothyroidism
  • Benign prostate hypertrophy
  • Diabetes

If you sense that your hormones may be out of balance, what can you do get things back to normal? The first step is to figure out exactly what is going on with your hormones, and that means testing them.

In Functional Medicine, the adrenal and sex hormones are often tested in order to see how much stress the body is experiencing, how stress is affecting adrenal gland function, and levels and ratios of sex hormones and their metabolites, which can be strongly affected by stress.

Many Functional Medicine practitioners like to use a unique type of hormone test called the Dried Urine Test for Comprehensive Hormones (DUTCH) provided by Precision Analytical.

Why Use the DUTCH?

The DUTCH uses urine rather than blood to test the sex hormones because urine is superior for this purpose than blood. One simple reason for this is that a 24-hour urine collection provides a much better view of daily hormone production than a single, random blood draw. 

Urine also enables the measurement of sex hormone and cortisol metabolites that are sometimes difficult to detect in the blood but which can be extremely important indicators for certain conditions. 

DUTCH Sex Hormone Testing

One of the signature features of DUTCH sex hormone testing is the measurement of metabolites of estrogen and testosterone. 

Estrogen is metabolized in two stages, phase I and phase II of biotransformation ("detoxification"), mostly in the liver. In phase I, one of the three types of estrogen, estrone (E1), is hydroxylated to form one of three hydroxyestrones: 16-OH-E1, 4-OH-E1, and 2-OH-E1.

Two of these hydroxyestrones, 16-OH-E1 and 4-OH-E1, are generally considered more estrogenic, pro-inflammatory, and/or carcinogenic than the third, 2-OH-E1. If the more estrogenic ones (16-OH-E1 and 4-OH-E1) are higher than normal, this can explain a variety of symptoms related to excess estrogenic signaling. It can also provide an early warning of an elevated risk of developing estrogen-sensitive cancers.

The DUTCH also detects how well these hydroxyestrones are being methylated in phase II. In the image below, the degree of methylation is seen in the lower left, and the relative levels of the three hydroxyestrones appear in the middle and right side of the image.

The slim red line in the image that looks like a fuel gauge in the lower left of the image shows that this person is not methylating their hydroxyestrones well, wihch means that they will have a hard time excreting hydroxyestrones into the bile to be transported out of the body. 

When hydroxyestrones do not get methylated, they can become oxidized to form reactive molecules called quinones and semiquinones that have been hypothesized to contribute to the development of estrogen-induced cancers. And hydroxyestrones are also carcinogenic, so it is vital that they be efficiently methylated and excreted from the body before they or their oxidized quinone and semiquinone metabolites cause problems.

The upper part of the image shows how pregnenolone, the precursor to all of the other steroid hormones (including adrenal and sex hormones) is being converted to DHEA and progesterone. DHEA is converted to androstenedione, which can then be converted to testosterone or estrone. Estrone and testosterone can then be converted to estradiol, the strongest estrogen. 

The middle left side of the image shows whether the person is converting androgens into their more potent androgenic forms or their less potent forms, which has implications for women experiencing symptoms of excess testosterone signaling and men experiencing symptoms of low testosterone signaling. 

DUTCH Cycle Mapping

For women in their reproductive years, Precision Analytical offers DUTCH Cycle Mapping, which is recommended in the following situations:

  • Women struggling with infertility
  • Women with cycling hormones and no menses
  • Partial hysterectomy (ovaries intact but no uterus)
  • Ablations
  • Women with irregular cycles
  • PCOS (polycystic ovarian syndrome)
  • Luteal phase shifting from month-to-month
  • Uncertainty as  to when to test due to long or short cycles
  • Women whose hormonal symptoms tend to fluctuate throughout the cycle
  • PMS
  • Mid-cycle spotting
  • Migraines

DUTCH Adrenal Hormone Testing

When using the versions of the DUTCH that measure adrenal hormones (DUTCH Adrenal, DUTCH Complete, and DUTCH Plus), urine testing enables the measurement of total daily metabolized cortisol, which can be heavily influenced by long-term stress, hypothyroidism, hyperthyroidism, inflammation, insulin resistance, infection, poor liver function, anorexia, acute illness, and more.

DUTCH urine testing also measures other cortisol-related markers that are usually not tested in blood or saliva. One of these cortisol metabolites is cortisone, which is inactive, Some people's bodies convert a lot of their cortisol to cortisone, potentially contributing to fatigue due to low cortisol signaling.

The versions of the DUTCH that measure adrenal hormones also include a salivary test of 4 to 5 saliva samples throughout the day in order to map the daily cortisol rhythm or "curve", which can provide clues about why a person may be experiencing symptoms like fatigue, low exercise tolerance or recovery, poor mental function, immune dysfunction, and difficulty sleeping. 

Although mapping the cortisol "curve" is not unique to versions of the DUTCH that measure adrenal hormones, this is the only test to my knowledge that offers the option of 5 salivary cortisol measurements, including the "cortisol awakening response", which provides further insight into the state of the stress response. Five salivary cortisol measurements are included in the DUTCH Plus version of the test.

Mapping the stress response can reveal what stage of the "General Adaptation Syndrome" a person is experiencing. The General Adaptation Syndrome (GAS) is a sequence of three stages of adrenal response (Alarm, Resistance, and Exhaustion) to ongoing stress described in original research by Hans Selye in the early 20th century. 

In the image below, you can see that this person has low cortisol (and DHEA), providing at least one potential explanation for her fatigue. 

Fatigue is not always related to low adrenal function, but in this case, her fatigue is probably at least partly mediated by low cortisol. She also had relatively high levels of toxic metals, which impair adrenal function, and her energy substantially improved once she started removing the metals and incorporating a few other modalities.

DUTCH Organic Acids

The DUTCH Complete and DUTCH Plus also include a mini organic acids test that includes functional markers (not direct markers) of the status of several B vitamins, glutathione, neurotransmitters, gut function, and neuroinflammation. It also includes melatonin and a marker of oxidative stress. 

Summary of DUTCH Testing

DUTCH testing from Precision Analytical gives you the option to test just sex hormones (DUTCH Sex Hormones, DUTCH Cycle Mapping), just adrenal hormones (DUTCH Adrenal), or sex and adrenal hormones (DUTCH Complete, DUTCH Plus, Cycle Mapping with Dutch Complete).

DUTCH sex hormone testing enables you to see more than just the sex hormones. It also reveals how sex hormones are being metabolized, which provides more insight into a wide range of conditions related to sex hormone metabolism. 

DUTCH and salivary adrenal hormone testing provide a more detailed view of the stress response and the state of adrenal gland function than other types of adrenal hormone testing.

Is It Time to Get Tested?

I notice that people often have some resistance to spending money on lab testing. I believe that in most cases this is because they view their health challenges as an expense that they would like to minimize and wish that they didn't have in the first place. But I encourage you to turn that around entirely. 

See your health as your greatest asset and your greatest investment opportunity. And adopt the identity of a "Wellness Athlete". As a Wellness Athlete, looking for every opportunity to optimize your health and to make wise investments in your health, you want to test your hormones (or other health metrics), even if you do not have a health challenge, because you are curious about your body's function and inspired to optimize it. 

Don't make your current situation about having a health challenge that you wish you didn't have and that you wish was not costing you money to resolve. Instead, pretend  (and intend) that your health is actually fine and that as a wellness athlete, you just want to make it better, reaching new "personal best" performances in health metrics, how you feel, and all aspects of life heavily influenced by your health and how you feel, such as performance in exercise, at work, and in your relationships (very much affected by how you feel, wouldn't you agree?).

If you want to improve how you feel and perform in life, then you have to improve how your body is functioning. And if general health advice and practices have not been enough to get you to the next level of healthy function, then perhaps it's time to start testing instead of guessing at what to do to improve your health and how you feel. 

All successful athletes have coaches. If you want to be a successful Wellness Athlete, find a coach. If you would like to speak to me about coaching or consulting, schedule a free 15-minute consultation with me to discuss what you're looking to accomplish, what you've done so far, and some suggestions about testing to consider.

To learn about my approach to resolving health challenges and optimizing energy, sleep, immunity, and more, download the Bio-Individual Blueprint Roadmap and watch the walkthrough video.