The Complete DUTCH Test for Hormones and Metabolites

(Dried Urine Test for Comprehensive Hormones)

This is one of the newest tests for hormones available today. The DUTCH test combines the benefits of serum (blood), saliva and urine to give a complete hormone picture that includes metabolites (break-down products of hormone metabolism.)
What makes this test more informative?
While traditional testing methods provide a tremendous amount of information, measuring hormone metabolites can provide a better understanding into an underlying hormone imbalance. For example, in cases where a hormone may be too low or too high, there are several possibilities; too little or too much hormone production or, increased or decreased hormone clearance shown by metabolite levels. Treatment is different for each case. With this information, your health provider can identify the cause of your hormone imbalance and treat it more effectively.
The DUTCH test is especially effective for measuring cortisol, our stress hormone. Similar to saliva, this test measures free cortisol, a much better marker than total cortisol (as tested in serum/blood.)
By taking multiple samples throughout the day, the results provide a cortisol pattern (a cortisol curve) much like a saliva test. The major advantage with the DUTCH test over a saliva sample is the addition of cortisol metabolites that can differentiate adrenal dysregulation, adrenal fatigue or inflammatory conditions that could mimic an adrenal imbalance.

Every Month is for Breast Health Awareness
It is critical to consider all facets of breast health – hormonal, environmental, dietary, nutritional, psychological and spiritual.
Combined with a body thermography test, the DUTCH test can be used as part of a more comprehensive plan to identify how hormones play a role in cancer awareness and possible risk factors.
Evaluating Hormones and Their Metabolites
Not all breast cancers are due to high estrogen levels (estrogen-receptor positive). How the body detoxifies estrogen through phase 1 and 2 does appear to have a large influence on risk. Alternatively, an individual can develop an (estrogen-receptor negative) breast cancer while some may develop cancer even if phase 1 and 2 detoxification is healthy.
Estrogen Dominance
Baseline levels of Progesterone, Estradiol (E2) and the P to E2 ratio can identify an overproduction of Estrogen or underproduction of Progesterone providing basic information regarding estrogen dominance.
Various Pathways of Estrogen Metabolism
The 2OH-E1 pathway is a healthy direction for estrogens to be metabolized. The 4OH-E1 pathway is considered to be more carcinogenic. Gene mutations can cause higher levels of 4OHE-1 and less of the protective 2OH-E1.
As well, part of phase 2 detoxification involves methylation, a normal biological part of metabolism. Mutations can exist in a section of one’s DNA, notably the MTHFR and COMT genes, which impair methylation, therefore reducing the efficiency of healthy hormone detoxification.
If the 4OHE-1 is not methylated, other, more damaging pathways are taken, which can detrimentally effect DNA, creating a higher risk for cancer formation.
The DUTCH test will show methylation activity of the metabolites so we can investigate these risk factors.
Finally, Melatonin, a powerful cycling hormone, has been identified as a strong antioxidant and integrative medicine marker associated with possible cancer risk. Low levels have been shown to have a relationship to postmenopausal breast cancer.(1)
Collection Made Simple
The developers of the DUTCH test have made it so much easier to collect a sample. A take-home test kit includes strips of filter paper that are urinated on, then dried. The kit includes simple collection instructions and special information on water intake and oral hormone use the day of urine collection. Once the samples are mailed into the lab, results are usually reported within 2-3 weeks. Your provider will contact you when your results are complete.

To summarize, the DUTCH complete test provides unique and comprehensive hormone analysis with one of the easiest collection methods. Please ask our staff if you have more questions or would like more information.

Why is Aldosterone not measured on the DUTCH test?

The ability to measure Aldosterone would require an enzyme immunoassay (EIA), radioimmunoassay (RIA) or liquid chromatography-mass spectrometry test (LC-MS). The first 2 tests would increase cost significantly and, as this test is not often indicated for most patients, the cost isn’t warranted.  As for the LC-MS test, validation data is weak for this type of analysis, which is difficult to do.

Why are certain estrogen metabolites, 2-Methoxy-E2 and 4-Methoxy-E1, not measured in the DUTCH test?

Levels of 2-Methoxy-E2 are very low. DUTCH tests it, but doesn’t report it as the values are not reliable enough, even though their methods are very sensitive.         It’s the same story with 4-Methoxy-E1, the tests are done, but are unreliable, so they don’t report the findings.

Why aren’t both fractions of cortisol and cortisone reported in the DUTCH test?

The 2 fractions of cortisol and cortisone include ‘free’ and ‘conjugated’. Literature reports that ‘free’ cortisol is the only clinically relevant fraction (as opposed to a combination of free and conjugated, or ‘total cortisol’).  At the present time, there is no strong clinical relevance to report conjugated cortisol. The same can be said for free and conjugated fractions of cortisone.

1) Schernhammer E, Hankinson S., Urinary Melatonin Levels and Postmenopausal Breast Cancer Risk in the Nurses ealth Study Cohort. Cancer Epidemiol Biomarkers Prevention, 2009 Jan;w8 (1): 74-79, doi: 10.1158/1055-9965.EPI-08-0637