DUTCH Hormone Test Review

DUTCH Hormone Test for Sex Hormones

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.

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 Hormone Test and Adrenal Function

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)

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.

The Neurotransmitter Metabolites

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 (HVA)

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 (VMA)

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.

Organic Acids for B Vitamins

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 (MMA)

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

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

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.

Organic Acid Markers for Glutathione and Oxidative Damage

Pyroglutamate

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)

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.

DUTCH Hormone Test Melatonin

Melatonin (measured as 6-OHMS)

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.