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Hormone Testing using the DUTCH test: including oestrogen, progesterone, cortisol and melatonin

Updated: Apr 28


Middle aged woman

Many women come into my naturopathic clinic wondering whether their symptoms are related to hormonal imbalances.


Our body's hormonal systems are very complex and there are many factors that come into play which we need to consider when we are looking to support our hormonal health and reduce symptoms.


For example we need to look at the menstrual cycle in detail:

from when menstruation first started, the length of the cycle, the intensity of the flow, the impact of any hormonal contraception, related moods, whether the breast tissue is tender, to the number of pregnancies and more. We will also discuss menopause and peri- menopause symptoms such as hot flushes, anxiety, fatigue and vaginal dryness where relevant. Other body systems need to be checked - such as digestion (are we absorbing what we are eating, are we eating enough protein and healthy fats), are the bowels regular, are there signs of liver toxicity, are we getting enough sleep to name a few.


Generally, I will start with a detailed questionnaire to assess whether there are hormonal issues that are contributing to the symptoms. There are many Apps available which are a helpful way to begin to record your cycle, and to develop awareness of what is going on in your body.

Some women have already had the basic blood hormone testing done from the doctor, however there are more complex testing options available. This article focuses on the DUTCH test.


If you suspect you are perimenopausal or menopausal this test is suitable for you. (Or even if you are feeling that your hormones are just not right). Some examples of what it can determine are: whether you have low or high oestrogen, how your oestrogen is being metabolised (whether it is inflammatory or not) as well as whether your progesterone is out of balance, as well as showing us what the underlying drivers may be. DHEA is measured, as is cortisol and its metabolites. It is a very comprehensive test.




Page one of sample DUTCH test
Page one of sample DUTCH test

Why have the DUTCH hormone test?

The DUTCH test stands for: Dried Urine Test for Comprehensive Hormones.

This very thorough test covers your reproductive and adrenal hormones as well as melatonin, some neurotransmitters and other hormones.

Why would I use a urine test rather than saliva or blood?

Simple answer is that the DUTCH test is far more comprehensive in what it collects than you can possibly collect in blood or saliva.

What will it test? And why is that favoured over saliva or blood?

Cortisol

When testing for adrenal issues using saliva you are able to get what’s called a “diurnal” pattern of cortisol (blood will not give this measurement). Diurnal meaning an every day pattern. So we can see the production of cortisol upon waking, in the middle of the day, in the evening and before bed. This is great – it’s what’s needed when analyzing HPA axis dysfunction.

However, where saliva falls short when it comes to assessing the health of our adrenals is that it doesn’t give us the metabolites of cortisol.

The DUTCH test allows us to measure this same diurnal pattern of free cortisol but it also allows us to measure cortisol metabolites, and this gives us a much more accurate picture of how much cortisol your adrenal glands are actually producing.

Metabolized cortisol (only measured in the DUTCH test, not in saliva or blood) accounts for about 80% of total cortisol output from your adrenal glands. The free cortisol – the only cortisol saliva and blood test for – only accounts for about 1 – 3% of total cortisol production


So to recap:

  • Blood only gives you the free cortisol but no metabolites or diurnal pattern

  • Saliva gives you the free cortisol and diurnal pattern but no metabolites

  • The DUTCH test gives you everything: free cortisol, diurnal pattern and metabolites

About 40% of people who have low free cortisol (the only kind tested in saliva and blood) actually present with elevated levels of cortisol metabolites (as tested only in the DUTCH test). This means they are potentially being put on protocols for low cortisol when they really have high cortisol production. For example, people who are obese typically make less free cortisol and more cortisol metabolites. So if they do a saliva test they’re going to likely be under the impression they are not making enough cortisol and their practitioner may put them on a protocol aimed to increase cortisol when really it’s high and the opposite protocol might be required

Sex Hormones: androgens, oestrogen(s) and progesterone

The DUTCH test shows the metabolites of sex hormones as well, which again we are unable to do with a saliva or blood test. This is important for understanding how we’re clearing oestrogens from the body (to avoid such states as oestrogen dominance) and in terms of the various types of oestrogen we are making. The types of oestrogen you are making will tell us how at risk you are for certain oestrogen-dependant cancers such as breast, ovarian and uterine. We can also see the methylation pathway of oestrogen when doing the DUTCH test, which can tell you if there are nutrient deficiencies or an MTHFR gene mutation, (which is relatively common) which would then need to be addressed in order to maximize health.

Additionally, another downfall of saliva is that it struggles to accurately measure and decipher between low, normal and elevated levels of oestrogen – sometimes they even co-mingle together. It’s simply not sensitive enough to see the various different levels of oestrogen therefore lacking in accuracy, which is an issue for women when it comes to trying to figure out their oestrogen state, which can impact overall health.



If you would like to know more about either the DUTCH test, or how I can work with you to support your hormones, book in a FREE 15 minute discovery call.


We can discuss what options I can offer you.



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