The DUTCH hormone test is a urine test that measures your adrenal and sex hormones as well as the hormone metabolites in a urine sample.
DUTCH stands for Dried Urine Test for Comprehensive Hormones, the DUTCH test is the most advanced way to test your hormones and can give us a lot more information compared to blood and saliva tests.
I have found the DUTCH test to be a valuable tool to understand the underlying cause of many different health issues, and I have used this test with 100’s of clients.
It is an easy test that can even be performed in the comfort of your own home, and from anywhere in the world.
The Precision Analytics DUTCH test is analyzed in the U.S.A but because the hormone samples are collected with a urine sample on special strips of litmus paper, it is easy to ship the samples back to the lab.
It is a better option than saliva testing as it measures your free cortisol levels as well as total cortisol production and cortisone, total cortisol and cortisone are not measured in a saliva or blood test.
The DUTCH hormone test is ideal for both men and women to assess their hormones.
The DUTCH hormone test can help you understand the cause of your health issues, it helps to take out the guesswork of why you are suffering from a wide variety of symptoms.
Once we have your DUTCH test results it will help us to help you implement a treatment plan.
The DUTCH test can help if you are experiencing the following symptoms:
The original DUTCH test was the DUTCH Complete, this is still my favorite test as it is easier to do requiring only urine collection, it is $75 cheaper, and most importantly it gives us the overnight cortisol levels which are great for people waking in the night.
The DUTCH Complete test measures all of the same markers as the DUTCH Plus in regards to the sex hormones and the Organic Acid markers, the only difference being in the way it collects the free cortisol levels.
For most people, I would recommend the DUTCH complete test.
The DUTCH Plus test was introduced to measure the “cortisol awakening response” in greater detail than the DUTCH complete test.
The cortisol awakening response (CAR) is the rise of cortisol in the first 60 minutes after waking, and the DUTCH Plus test measures this using saliva collection at short intervals after waking to measure the rise in cortisol. In total, you do 5 saliva cortisol samples throughout the day plus the urine strips to measure the hormones and their metabolites.
The DUTCH Plus maybe better for people with chronic fatigue, PTSD, anxiety or chronic depression - though, the DUTCH complete will still give an indication of the CAR.
The DUTCH Cycle mapping test is for women who want to track their cycle for the entire month.
For most women doing the DUTCH Complete or DUTCH Plus test on one day of the month will be enough, but if you are struggling with hormonal symptoms at various times of the month then it might be a good option to do the DUTCH cycle mapping test as an add-on to the DUTCH complete test.
If you have infertility problems, menstrual irregularities, and hormonal imbalances, the DUTCH Cycle Mapping test is the right decision.
With your sex hormones, the DUTCH hormone test not only measures your total hormone levels but also shows how your body is metabolizing the hormones, this is important for assessing the risk of breast cancer, prostate cancer, and other hormone dominant conditions.
Assessing the metabolism of your estrogen and testosterone cannot be done with a blood test which only measures total estrogen, progesterone, and testosterone.
In the table below there is a list of all the different sex hormone markers assessed in the DUTCH hormone test, while this comprehensive list may look confusing when you first see it, this gives us valuable information about your sex hormones.
PROGESTERONE METABOLITES: b-Pregnanediol, a-Pregnanediol.
ESTROGEN METABOLITES: Estrone, Estradiol, Estriol, 2-OH-E1, 4-OH-E1, 16-OH-E1,
2-Methoxy-E1, 2-Methoxy-E2, 2-OH-E2, 4-OH-E2.
ANDROGEN METABOLITES: DHEA-S, Androsterone, Etiocholanolone, Testosterone,
5a-DHT, 5a-Androstanediol, 5b-Androstanediol.
If you are taking bio-identical hormones then the DUTCH test is a great option for assessing if you are taking the right amount of hormones. Too little or too much progesterone, estrogen or testosterone could cause unwanted side effects.
The instructions that come with the DUTCH hormone test kit helps you to work out the best time to take the test depending on which form of HRT you are taking.
If you are taking the oral contraceptive pill it is going to influence the estrogen and progesterone levels and won’t give you a true reading of your natural levels. It can still be a good option for assessing testosterone, detoxification of hormones and the adrenal function - but if you are considering stopping the OCP then it might be a good idea to wait until you have done this.
The DUTCH test measures total cortisol production as the rhythm of free cortisol throughout the day, as well as how quickly your body is metabolizing cortisol into cortisone.
A blood test cannot measure the rhythm of cortisol and a saliva hormone test cannot measure total cortisol production or cortisone levels.
Free cortisol only makes up around 3% of total cortisol levels so it is important to assess total cortisol production, and for this reason saliva cortisol tests can be misleading if they don’t also assess this (like the DUTCH Plus test)
CREATINE: Creatine A (Waking), Creatine B (Morning), Creatine C (Afternoon), Creatine, D (Night)
DAILY FREE CORTISOL AND CORTISONE: Cortisol A (Waking), Cortisol B (Morning), Cortisol C (Afternoon), Cortisol D (Night), Cortisone A (Waking), Cortisone B (Morning), Cortisone C (Afternoon), Cortisone D (Night), 24hr Free Cortisol, 24hr Free Cortisone.
CORTISOL METABOLITIES AND DHEA-S: b-Tetrahydrocortisol, a-Tetrahydrocortisol,
b-Tetrahydrocortisone, Metabolized Cortisol, DHEA-S.
In January 2018 Precision Analytical added 8 Organic Acid markers to the DUTCH test.
The new markers included on the DUTCH hormone test are Organic Acid markers to assess neurotransmitters, B12, B6 and glutathione, this is in addition to the oxidative stress Organic Acid marker added last year.
In case you are not familiar with the Organic Acids Test (commonly known as OAT) which is one of my favorite tests to assess metabolism, the Organic Acids are urinary metabolites that can measure specific aspects of metabolism.
The 8 Organic Acid markers on the DUTCH hormone test don’t replace doing the complete Organic Acids Test which contains over 40 different Organic Acid markers, but the new markers on the DUTCH hormone test do add some valuable information to an already great test.
It is not just the brain that uses the neurotransmitters dopamine and noradrenaline, but the whole autonomic nervous system. The Organic Acid markers reflect your body’s production of neurotransmitters, and not specifically levels in the brain (there is no perfect test for that), but research shows that these levels are a good reflection of what is happening in the brain also.
Homovanillate (also known as HVA) is the primary metabolite of dopamine, a brain and adrenal neurotransmitter that comes from tyrosine and other co-factors, and goes on to create norepinephrine and epinephrine (adrenaline).
Low levels of HVA can be due to low levels of dopamine and the associated symptoms include addictions, cravings, and pleasure-seeking (to boost levels) in addition to sleepiness, impulsivity, tremors, less motivation, fatigue, and low mood.
Low circulating dopamine may be due to insuﬃcient BH4, iron or tyrosine, SAM-e, Magnesium, FAD, and NAD which are needed to metabolize dopamine. It may also be seen when adrenal function is generally low and the DUTCH test is the best way to assess this.
Elevated HVA may be caused by generally increased adrenal hormone output, elevated levels of the clostridia bacteria, or because of a copper or vitamin C deﬁciency. Elevated dopamine may be associated with loss of memory, insomnia, agitation, hyperactivity, mania, hyper-focus, high stress, and anxiety as well as addictions, cravings, and pleasure-seeking (to maintain high levels).
Vanilmandelate (also known as VMA) is the primary metabolite of norepinephrine and epinephrine (adrenaline). The adrenal gland makes cortisol and DHEA as well as norepinephrine and epinephrine. When adrenal hormone output is generally low, VMA levels may be low.
Norepinephrine is your “fight or flight” neurotransmitter.
Low levels of norepinephrine and epinephrine may be associated with addictions, cravings, fatigue, low blood pressure, low muscle tone, intolerance to exercise, depression, loss of alertness. When the body is under physical or psychological stress, VMA levels may increase.
Elevated levels may be associated with feeling stressed, aggression, violence, impatience, anxiety, panic, worry, insomnia, paranoia, increased tingling/burning, loss of memory, pain sensitivity, high blood pressure, and heart palpitations.
If HVA levels are signiﬁcantly higher than VMA, there may be a conversion problem from dopamine to norepinephrine. This case can be caused by a copper or vitamin C deﬁciency.
The enzymes COMT (methylation) and MAOA are needed to make VMA from norepinephrine. If these enzymes are not working properly, VMA may be low when circulating norepinephrine and/or epinephrine are not low.
Testing the Organic Acid metabolites for B vitamins is more accurate than assessing blood levels of B12 and B6, a blood test represents the amount of a vitamin in the blood while the Organic Acid marker represents how the cells are using B12 and B6. It is possible due to genetic SNPs to have high levels of B12 in the blood but have low B12 at the cellular level.
Methylmalonate (also known as methylmalonic acid or MMA) is a functional marker of vitamin B12 deﬁciency. When cellular levels of B12 are low either from deﬁciency or due to a B12 transporter gene mutation, levels of MMA increase.
This marker is considered superior to measuring serum B12 levels directly. A 2012 publication by Miller showed that 20% of those tested had a genetic defect in the protein that transports B12 to cells. These patients may have a functional B12 deﬁciency even if serum levels of B12 are normal.
Symptoms of a vitamin B12 deﬁciency include fatigue, brain fog, memory problems, muscle weakness, unsteady gait, numbness, tingling, depression, migraines/headaches, and low blood pressure.
If levels of MMA are elevated, it may be advisable to increase B12 consumption. Common foods high in B12 include beef liver, sardines, lamb, wild-caught salmon, grass-fed beef, nutritional yeast, and eggs.
Vitamin B12 levels can also be increased through supplementation of active B12 (taken as methylcobalamin, hydroxycobalamin, or adenosylcobalamin), many B12 supplements contain cyanocobalamin which is a poorly absorbed form of B12 and should be avoided, I prefer a B12 lozenge if low in B12.
Xanthurenate (also known as xanthurenic acid) is a functional marker of vitamin B6 deficiency. Vitamin B6 is a critical co-factor to over 100 important reactions that occur in the human body and is stored in the highest concentrations in muscle tissue.
Not only is xanthurenate an indicator of a lack of B6, it is also harmful to the human body. It competes with insulin and decreases insulin sensitivity. In fact, rats fed xanthurenate will actually develop diabetes because of the eﬀects on insulin.
If xanthurenate levels are elevated, B6 supplementation may be considered. Food high in B6 include turkey breast, grass-fed beef, pinto beans, avocado, pistachios, chicken, sesame and sunﬂower seeds.
While there is always some tryptophan going down the kynurenine pathway towards NAD (and possibly xanthurenate), this process is up-regulated by inﬂammation, estrogen, and cortisol. If levels of estrogen or cortisol are high, it may exacerbate xanthurenate elevations and increase the need for B6.
Xanthurenate can also bind to iron and create a complex that increases DNA oxidative damage resulting in higher 8-OHdG levels. If both markers are elevated, there is likely an antioxidant insuﬃciency.
Kynurenate, also known as Kynurenic acid, is an organic acid marker that also indicates a B6 deficiency. High levels will lead to high levels of Quinolinic acid which is a neuroinflammation marker.
Pyroglutamate (also known as pyroglutamic acid) is a functional marker of glutathione deﬁciency. Pyroglutamate is a step in the production/recycling of glutathione. If the body cannot convert pyroglutamate forward, it will show up elevated in the urine. Alternatively, if there is little glutathione available to be recycled, pyroglutamate will be low, so when levels of pyroglutamate are high or low, there may be insuﬃcient glutathione levels.
Glutathione is one of the most potent antioxidants in the human body. It is especially important in getting rid of toxins, including the harmful metabolites of estrogen detoxification 4-OH-E1 and 4-OH-E2. These markers are assessed in the DUTCH test and if elevated can damage DNA if not detoxiﬁed by either methylation or glutathione, this is an increased risk of cancer.
8-OHdG (8-hydroxy-2-deoxyguanosine) is a marker for estimating DNA damage due to oxidative stress (ROS creation). 8-OHdG is considered pro-mutagenic as it is a biomarker for various cancer and degenerative disease initiation and promotion.
It can be increased by chronic inﬂammation, increased cell turnover, chronic stress, hypertension, hyperglycemia/pre-diabetes/diabetes, kidney disease, IBD, chronic skin conditions (psoriasis/eczema), depression, atherosclerosis, chronic liver disease, Parkinson’s (increasing levels with worsening stages), Diabetic neuropathy, COPD, bladder cancer, or insomnia.
Studies have shown higher levels in patients with breast and prostate cancers.
Elevated levels of this oxidative stress marker mean that you need to address the underlying cause, other markers on the DUTCH test can help to identify this.
Melatonin is not technically an adrenal or sex hormone however it is highly involved in the entire endocrine system. It is made in small amounts in the pineal gland in response to darkness and stimulated by Melanocyte Stimulating Hormone (MSH).
Low melatonin is associated with insomnia, an increased perception of pain, and mold exposure. Pineal melatonin (melatonin is also made in signiﬁcant quantities in the gut) is associated with the circadian rhythm of all hormones (including female hormone release). It is also made in small amounts in the bone marrow, lymphocytes, epithelial cells, and mast cells.
Studies have shown that a urine sample collected upon waking has levels of 6-Hydroxymelatonin-sulfate (6-OHMS) that correlate well to the total levels of melatonin in blood samples taken continuously throughout the night.
The DUTCH test uses the waking sample only to test levels of melatonin production - this is because the first-morning sample is assessing the overnight melatonin levels.
Low melatonin levels may be associated with insomnia, poor immune response, constipation, weight gain or increased appetite. Elevated melatonin is usually caused by the ingestion of melatonin through melatonin supplementation or eating melatonin-containing foods.
The DUTCH Complete hormone test is simple to do and just requires you to take 4-5 urine samples (the 5th one is only if you wake up in the middle of the night which is good for checking night time cortisol levels).
For men and menopausal women they can do the DUTCH test at any time, but for women with a regular menstrual cycle then it is optimal to do the test around day 19 to 21 of your menstrual cycle.
If you don’t have a regular menstrual cycle (and this is why a lot of women are doing the test), then the instructions give you clear guidelines on how to proceed and when the best time for you is to collect the samples.
The urine samples are collected on special strips of litmus paper and then left to dry.
The next day they are shipped back to Precision Analytical in the U.S for analysis. Once the lab gets the samples it takes 10 working days for the results to be ready.
Once your results are ready you will be sent a copy via email, and we can schedule a consultation to go through your test results and help you with a treatment plan.
I know there is a lot of information on the DUTCH hormone test so this is a quick summary of the key advantages of the DUTCH test over doing other types of tests.
If you have fertility problems or hormonal imbalances and want to track your cycle for the entire month, this is the option for you.
If you just want to order the DUTCH hormone test, this is the option for you.
If you want to measure hormones, their metabolites and cortisol awakening response (CAR), this is the option for you.
Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions. As Seen