In this article, I am going to explain why you need to do the DUTCH hormone test if you are testing adrenal function and sex hormone imbalances.
We will look at the different types of adrenal dysfunction that can occur and what you need to do to improve your hormonal health.
Dr. Mercola describes the DUTCH test as “the most informative hormone test out there” and the DUTCH test is used and recommended by practitioners such as Chris Kresser and Sara Gottfried.
For a long time, conventional medicine has only recognized two types of adrenal problems, these are Addison’s Disease and Cushing’s Syndrome, which are either extremely low cortisol or extremely high cortisol production. Both of these conditions are very serious and potentially life-threatening if left untreated, but if you don’t have these conditions does that mean your adrenal function is “perfect”?
That is like saying that if your car has not crashed, or the engine has not “blown up” then it is working perfectly fine, but we know that there can be many issues with a car that is affecting its performance, like old oil, flat tires, leaking radiator or a broken light …. all of these could affect your car’s performance or safety.
While conventional medicine has disregarded “Adrenal Fatigue”, the latest research shows that the third type of adrenal problem can occur, this is called Hypothalamus Pituitary Adrenal Axis Dysfunction or HPA-D for short.
HPA-D is essentially the same as “adrenal fatigue” except that the name adrenal fatigue is a bit misleading, your adrenal glands do not become tired and stop producing cortisol, instead it is the messages from the hypothalamus and pituitary glands in the brain that either get upregulated or down-regulated that causes changes in cortisol production by the adrenal glands.
Essentially HPA-D or Adrenal Fatigue can cause the following symptoms
- Constant fatigue – always tired and feel unrested
- Unquenched craving for sweets and carbohydrates
- Frequent depression and anxiety
- Difficulty in losing weight no matter what you do
- Frequent insomnia – trouble going to sleep or staying asleep
- Low libido
- Symptoms of PMS due to hormonal changes
- Brain fog
- Digestion problems
- Low immune function
- Poor recovery from exercise or constantly getting injured
While these symptoms may also have other causes like poor diet, digestion problems or infection, if you have a number of these symptoms there is a good chance that you have some type of HPA-D
Testing adrenal function
There are three ways to test cortisol and DHEA production by the adrenal glands, they are blood testing, saliva testing, and urine testing.
- The problem with blood testing is that it only measures total cortisol levels at one point in the day, so it does not measure the free cortisol levels or the changes in the cortisol rhythm throughout the day which is very important when measuring adrenal health. This is the test that most conventional doctors use, and it is only useful as a potential screening test to see if you may have Addison’s disease or Cushing’s syndrome, and to diagnose these you still need to do urine and saliva testing.
- The next best option is saliva hormone testing – until recently this has been the best option as it tested the free cortisol levels at 4-5 different times of the day to measure the cortisol rhythm. The downside to the saliva hormone test is that it only measures free cortisol, and while this is important it is still only around 3% of total cortisol production, and it does not measure total cortisol production or how quickly cortisol is getting metabolized into cortisone.
- A urine test known as the DUTCH hormone test which stands for Dried Urine Test for Comprehensive Hormones is my preferred way of measuring adrenal function. This test has the advantages of saliva testing in that it can measure 4-5 samples throughout the day to measure the free cortisol levels and the cortisol rhythm, but it also measures total cortisol production and your cortisone levels to give us the complete picture.
Other advantages of the DUTCH testing is that it can measure the sex hormones estrogen, progesterone, testosterone and their metabolites, which measures how well your body is detoxifying hormones, and the methylation of hormones. This is important for both men and women.
The DUTCH Hormone Test
The DUTCH hormone test kit can be shipped anywhere in the world, and because it only requires 4-5 urine samples it is easily done at home so you don’t have to go to a pathology lab. Each urine sample is collected on a special type of litmus paper which is left to dry before shipping back to the lab for analysis, the dried litmus paper fits easily into an envelope which makes it convenient for easy posting (no messy urine sample jars!)
Once the lab receives the test kit it takes about two weeks for the results to be finalized.
The DUTCH test measures these hormones and metabolites:
- Total metabolized cortisol – this shows you how much cortisol your body is making over the entire day and can be very different to the free cortisol level. The amount of cortisol you are producing will help to guide your treatment plan.
- Total cortisone – tells us how quickly your body is deactivating cortisol to cortisone
- Free cortisol – this shows you the active levels of cortisol in your body, the level and rhythm of free cortisol will help to guide your treatment plan.
- Free cortisone – plus the metabolites of cortisone to show how quickly cortisol is getting deactivated to cortisone, this will help to guide us on the best treatment strategy for you
- Tetrahyrdocortisone – this is a metabolite of cortisone
- a-tetrahydrocortisol – this is a metabolite of cortisol
- b-tetrahydrocortisol – this is a metabolite of cortisol
- DHEAs – is a precursor to testosterone and estrogen, a high level can indicate PCOS and inflammation, a low level can indicate adrenal insufficiency
- Progesterone metabolites – (a-pregnanediol, b-pregnanediol) will indicate your total progesterone levels, these are also precursors to make the neurotransmitter GABA. Low progesterone levels can lead to PMS symptoms and infertility
- Testosterone – there is an optimal range for men and women which is associated with vitality and wellbeing, low levels can affect mood, fertility, libido and athletic performance.
- Androgen metabolites of DHEAS and Testosterone – this is important to assess how well your body is processing testosterone, if it is metabolized down the 5a-DHT pathway this can cause hair loss, skin problems, aggression and even increase prostate cancer risk in men.
- Estrogens – which includes estrone, estradiol, estriol, the balance between estrogen and progesterone is important for fertility, PMS and menopausal symptoms
- Estrogen metabolites – these metabolites show how your body is detoxifying estrogen and if this is not done correctly it can increase your risk of breast cancer, prostate cancer, cysts, and fibroids.
- 6-OH-melatonin-sulfate – which assesses melatonin production, low melatonin can affect sleep quality making it difficult to fall asleep or stay asleep. Melatonin also has antioxidant effects which can help to protect the brain and improve mood.
There is not one type of HPA-dysfunction so there is no one treatment plan for this condition, this is why testing is important to know how your body is responding to stress. Equally important is identifying the underlying cause of the adrenal dysfunction, this could be emotional stress, digestion issues, sleep problems, diet, training load or many other things that we can identify through your consultation and possible further testing.
High Free Cortisol and High Total Cortisol
High free cortisol combined with high total cortisol is often associated with obesity, inflammation, insomnia and cognitive issues. Diet and lifestyle changes are going to be a big part of treatment options here and these will vary depending on the underlying cause, supplements will also be necessary to reduce the high cortisol levels.
Supplements that lower cortisol
Phosphatydlserine is great for lowering cortisol, if your cortisol is high all day I recommend taking 100mg 3 times a day, or if it is only high at night time which is quite common you can just take it in the evening. The Jarrow PS100 formula is good and is available from Amazon or www.iherb.com
Relora, Ashwagandha and Holy Basil are great for lowering cortisol and I recommend the Now Foods Super Cortisol Support which has a combination of these herbs and other nutrients to help lower cortisol. It is available from Amazon or www.iherb.com
Blood sugar support is important with high cortisol levels, usually high cortisol is going to lead to high blood sugar, nutrients to help support blood sugar include chromium, lipoic acid, bitter melon, and the herb Gymnema can reduce sugar cravings. I recommend Jarrow Formulas Glucose Optimizer which you can get from Amazon or www.iherb.com
High Free Cortisol and Low Total Cortisol
The treatment plan for someone who has high levels of free cortisol, but low levels of total cortisol production are going to be different, once again identifying the driving force behind this pattern is important. Things to consider would be low thyroid (yes you need to look at more than just TSH), chronic inflammation and even licorice supplementation, it is always important to avoid licorice with high free cortisol and a lot of adrenal supplements include it.
Supplements to consider
Inflammation can be one of the drivers of high cortisol and Curcumin is a good option to help reduce inflammation, I recommend the Life Extension Super Bio-Curcumin which you can get from Amazon or www.iherb.com
Low Free Cortisol and High Total Cortisol
This test shows low free cortisol throughout the day, and if you did a saliva cortisol test this is the only information that we would have, and most likely you would be given an “adrenal fatigue” diagnosis. However the metabolized cortisol is high normal so plenty of cortisol is still being produced, this type of pattern can occur with hyperthyroid, obesity, glucocorticoid medications, chronic stress or other chronic conditions like CFS.
Supplements to consider
You would still look at options to address inflammation, blood sugar control and other areas that are driving the chronic stress, but this type of pattern does well with Adaptogenic herbs that also include licorice. The Jarrow Formulas Adrenal Optimizer includes all of the herbs and nutrients to help improve the low cortisol levels and you can get that from Amazon or www.iherb.com
Low Free Cortisol and Low Total Cortisol
This pattern is less common than the other patterns of cortisol dysfunction, as most people have either normal or high cortisol. Low cortisol is usually seen in chronic long term health problems, extreme trauma or PTSD, and when you take the case history there is usually a particular cause that stands out.
Supplements to consider
If you have very low cortisol you will need supplements like the Jarrow Formulas Adrenal Optimizer and may even need to consider extra licorice. Adrenal glandulars may also be helpful, but the key is going to be addressing the underlying cause, optimizing sleep, diet, and exercise to improve adrenal health. It is important to work closely with your practitioner to get back on track, low adrenal function normally takes the longest to recover from and I would allow 6-12 months.
Disrupted Cortisol Rhythm
This can be one of the most debilitating types of cortisol dysfunction when free cortisol levels are very low in the day but continue to rise and are elevated at night time. This is the exact opposite of what the body’s natural diurnal rhythm is supposed to and can lead to chronic fatigue during the day, but “tired and wired” symptoms at night making it difficult to sleep.
Supplements to consider
Phosphatydlserine at night and calming adaptogens find in the Now Foods Super Cortisol Support will be helpful here to help lower night time cortisol and improve sleep, you will also need to work with your practitioner to help support morning cortisol production and address the underlying cause.
What About the Sex Hormones
I also mentioned that the DUTCH complete test takes a comprehensive look at the sex hormones and how they are metabolized, the test goes into a lot of detail and this image just shows part of the analysis of the sex hormones …. I think I will have to go into more detail about the DUTCH test and sex hormone testing in another article.
How To Order The DUTCH Test
If you would like to get started and order the DUTCH test go to the DUTCH test order page, and we can organize a test kit to be sent to you, all DUTCH test orders include a one-hour consultation to explain the results to you and help you with a treatment plan.
If your not sure where to start, or if this is the best option for you, I recommend scheduling a short consultation first so I can help to guide you on the best test options and treatment plan for you.