The DUTCH Test Basics

Hormones are little chemical messengers in our bodies that have big jobs. They tell our different organs what to do and when to do it. Heart rate, blood sugar, digestion, growth, mood, the menstrual cycle, energy use, sleep, appetite, and so much more are influenced by hormones. Basically, if your body does it, hormones are probably helping orchestrate it in the background, and in order for our bodies to function at peak levels, we these messengers need to be produced and excreted at right times and in the right amounts or else things go awry. 

The many hormones of the human body. 

Image from News Medical

While hormones do control everything, they are also heavily influenced by our habits and our surroundings: sleep, stress, exercise, environment, health, and diet all influence hormone levels. Because of this, hormone imbalance can present with seemingly vague or random, yet also debilitating symptoms that significantly affect quality of life.

Clearly, hormones are important and dynamic, so the fluctuations in these levels cannot be captured by a single blood sample, which only provides a snapshot in time of a hormone level. Historically, practitioners used 24-hour urine samples to measure hormone levels and their metabolites, which was cumbersome to collect and did not offer a complete view of the cortisol awakening response.  Enter the DUTCH Test, or Dried Urine Test for Comprehensive Hormones, a relatively easy, at-home test that measures the fluctuation and breakdown of these hormones over the course of the day, helping to pinpoint the root cause of your symptoms.

In this blog post, I will be discussing what the DUTCH Test is, who may benefit from it, and reviewing the basics of how to read DUTCH Test results so that you can decide whether this test is worth it for you.

What Is the DUTCH Test and How Do I Do It?

While we have been able to monitor hormone levels for a long time through 24-hour urine samples, saliva, and blood, each has their own strengths and limitations in their collection process and the information they can provide. The DUTCH test combines the best of both worlds, making it easier to use and complete, while offering a comprehensive picture of information regarding sex and adrenal hormone levels and their metabolites throughout the day AND doing so with relative ease (as compared to peeing in a jug for 24 hours).

Precision analytics offers different types of tests depending on exactly what you want to measure. If you are not sure, you can ask your provider which test makes the most sense to obtain based on your symptoms.

• DUTCH Complete: Uses only dried urine samples to measure 35 different hormone levels and their metabolites¹

• DUTCH Plus: Uses dried urine and saliva testing to test 35 different hormones, their metabolites, and your cortisol awakening response to measure how your body responds to the stress of waking up²

• DUTCH Cycle Mapping: Requires daily dried urine samples for roughly 25 days to pinpoint ovulation issues, PMS symptoms, PMOS, irregular cycles, and guide hormone replacement therapy (HRT) in peri-menopause³

For our purposes, I will mostly refer to the DUTCH Plus test, as this one requires a few extra steps but provides more information about cortisol. The DUTCH Plus requires both urine and saliva samples at specified times throughout the day. More specifically, you have to collect urine and saliva 5 minutes after waking, additional saliva 30 and 60 minutes after waking, urine 2-3 hours after waking, and additional urine and saliva samples at 4-5 pm before your evening meal and between 10pm and midnight before bed. Of note, Precision analytics has specific guidelines on limiting fluid, food, and activity on the day of collection, which should be reviewed prior to testing in order to get the most accurate results.⁴

In order to collect the urine, you can either pee into a cup and dip the filter paper in the cup or pee directly on the filter paper. After the filter paper is saturated, it needs to dry for at least 24 hours before packing them up and shipping them out.⁴

For saliva testing, you lightly chew on the provided cotton swab for no longer than 5 minutes to saturate the swab. After spitting it out, you can put the swab into the test tube and freeze it. Once your samples are frozen, you can pack them up and ship them off with your urine samples for analysis. Much easier (and less mess) than peeing in a jug for 24 hours!⁴

Guidelines and instructions for taking a DUTCH Plus Test

Image from Precision Analytical

Who Should Get a DUTCH Test?

At SkimWellness, we are a practice rooted in foundations, meaning that whenever a client comes to us, we perform a thorough assessment to make sure sleep, personal stress, exercise, environment, and diet are optimized before we order testing that can be expensive, unrevealing, OR may not actually change the intervention. If a client seemingly has the foundations in check but is having persistent symptoms, such as irregular periods, heavy or painful periods, infertility, digestive issues, acne, hair loss or hair growth in abnormal places based on your assigned gender, fatigue, sleep disturbances, depression or anxiety (especially on wakening), and/or loss of resiliency, the DUTCH test may be useful. The DUTCH Test may also be useful for women in peri-menopause or those navigating hormone replacement therapy. 

Getting more information about how your hormones fluctuate throughout the day (especially cortisol) can help us fine-tune nutrient intake and timing to adjust these imbalances and help you feel better, however it is certainly not always indicated.

What Does a DUTCH Test Specifically Tell You?

The DUTCH test is measuring production and excretion of your hormones. The first few pages provide graphical and written values of each level broken into hormone testing summary, sex hormones and metabolites, adrenal hormones and metabolites, and organic acid tests. Following the listed and graphical values, the “About Your Results” provides individualized feedback based on your reported symptoms. This section is broken down into 4 parts: 

1. Estrogen and Progesterone: Highlights how these hormones balance each other to impact mood, estrogen-related cancer risk, autoimmunity, PMS, infertility, and HRT.

2. Androgens: Can highlight the causes of baldness, cystic acne, and prostate issues, hirsutism, and PMOS.⁵

3. Cortisol: Highlights potential issues in the circadian rhythm and can answer questions about fatigue and sleep disturbances. Cortisol metabolite levels indicate how conditions like hypo/hyperthyroidism, obesity, inflammation, insulin resistance, infection, poor liver function, anorexia, and critical illness affect the circadian rhythm.⁵ 

4. Advanced Insights: Offers additional, but complex recommendations that may be applicable to some patients.⁵ 

Even if you cannot understand 100% of the recommendations in the “About Your Results” section, your dietitian or practitioner will help you break down each abnormality and recommendation to find which will be most impactful for you. Some issues we see and solutions we use at SkimWellness include:

1. Estrogen dominance → increase intake of fiber from cruciferous veggies, beans, and grains to help with excretion of estrogen

2. Androgen dominance → increase intake of soy product and flax seeds to increase estrogen production; increase intake of fiber, cruciferous veggies, beans, fruits and grains to promote excretion of testosterone; eat consistent amounts of complex carbs throughout the day to balance blood sugar

3. Low progesterone → Eat progesterone boosting nutrients like vitamin C, magnesium, zinc, vitamin B6, and healthy fats; manage stress, and provide consistent nourishment throughout the day to regulate blood sugar

4. Altered Cortisol Awakening Response → provide consistent nourishment throughout the day to regulate blood sugar and limit stress on the body; incorporate anti-inflammatory nutrients like vitamin C, magnesium, and omega-3 fatty acids; eat meals balanced with protein, carbs, fat, and fiber

These are just a few examples of how the DUTCH test can give an RD necessary information to provide specific and actionable recommendations. As with anything though, it is important to measure the pros with the cons, one con being the cost. Pricing ranges between $300 for only the Cortisol Awakening Response test and $650 for the Dutch Plus, which is a lot of money to spend only to possibly validate that the healthy habits you were already building with your RD are exactly what you should be doing. 

If you feel like you’re doing everything right and not getting results, a DUTCH test can be a valuable resource to understand how your hormones may be impacting your quality of life. At SkimWellness, our dietitians can navigate this oftentimes confusing wellness space to determine what steps are right for you!

References

1. Precision Analytical, Inc. (n.d.). DUTCH Complete™. DUTCH Test. https://dutchtest.com/dutch-complete

2. Precision Analytical, Inc. (n.d.). DUTCH Plus™. DUTCH Test. https://dutchtest.com/dutch-complete

3. Precision Analytical, Inc. (n.d.). Cycle Mapping. DUTCH Test. https://dutchtest.com/dutch-complete

4. Precision Analytical, Inc. (n.d.). Introduction to DUTCH Plus | The DUTCH Test. DUTCH Test. https://dutchtest.com/video-instructions/dutch-plus-collection-instructions/introduction-to-dutch-plus-the-dutch-test