The DUTCH test is an at-home urine test that provides valuable information on hormone health and can help identify root causes for pesky hormone related symptoms.
Because, let’s face it. Many women are struggling with hormonal chaos and crushing symptoms that interfere with their daily living. And not getting the answers they need to fix these issues. This includes things ranging from fatigue, painful periods, acne, and even infertility.
The DUTCH test is unique because it provides deep insight into your hormonal pathways that allow you to understand exactly where your hormones are going awry. And with this information, you can get an individualized and targeted care plan.
So, if you struggle with symptoms of a hormonal imbalance, the DUTCH test might be the perfect next step for you. In this article, we’ll cover everything you need to know before getting your own DUTCH test.
What is a DUTCH test?
The DUTCH test is an at-home hormone test created by Precision Analytical. It uses dried urine to get an in depth look at sex and adrenal hormones. And this is where the name comes from, with DUTCH standing for Dried Urine Test for Comprehensive Hormones.
There are a couple of different DUTCH tests available. We’ll walk through the available tests so you understand the differences and when various tests might be used.
DUTCH Complete
The DUTCH Complete tests sex hormones (estrogen, progesterone, testosterone, and androstenedione) and adrenal hormones (cortisol, cortisone, and DHEA). And of course, you’ll also get information on metabolites of these main hormones.
The metabolites are the real secret sauce of the DUTCH test. Hormonal metabolites allow you to see how your hormones flow through various pathways in your body. With this information, you can better understand how to optimize the ideal pathways and minimize those more harmful.
And lastly, the DUTCH Complete provides a handful of organic acids (OAT). OATs are a way to indirectly assess nutrient status by measuring byproducts of metabolic processes. Based on the results of your OAT tests, you can target which nutrients need optimizing to more efficiently run certain metabolic pathways.
The DUTCH Complete is ideal for those are looking to better understand their hormones and don’t feel that stress is playing a major role in their hormonal issues.
DUTCH Plus
The DUTCH Plus includes all the same information as the DUTCH Complete but with some additional cortisol testing parameters.
With the DUTCH Plus, you’ll also provide a series of saliva samples that will measure the cortisol awakening response (CAR) along with your overall daily cortisol pattern. This bit of information is especially useful for those dealing with stress or HPA axis dysfunction.
The CAR measures your cortisol pattern specifically in the first hour of waking and provides a picture of how your HPA axis is functioning. Your HPA axis helps to regulate stress and energy levels. Variations in your CAR and overall daily cortisol pattern indicate that your body needs more support regulating stress.
Cycle Mapping
For women struggling with menstrual issues, a more comprehensive look at the entire cycle can be helpful. This is where the DUTCH Cycle Mapping comes in handy.
With this test, you collect samples on 9 different days throughout your cycle.The results map the pattern of estrogen and progesterone throughout the entire cycle. With these results, you can see how your estrogen and progesterone levels fluctuate in various stages of your cycle.
Cycle Mapping can be combined with the DUTCH Plus or DUTCH Complete to obtain even more data on cycle health and hormonal patterns.
Cycle mapping is most helpful for women who are trying to conceive and understand specifically their sex hormones. The test does not provide information on adrenal hormones/ health (unless coupled with the DUTCH Plus or Complete).
How is it different from regular blood work?
There are several key differences between hormone testing using the DUTCH test and hormone tests using blood samples. The most obvious of which is how the sample is obtained. The DUTCH test uses urine to measure hormone levels compared to providing a blood sample at a laboratory.
Because the DUTCH test uses urine collected over a 24 hour period, the samples can also be analyzed for hormone metabolites. And as mentioned prior, the metabolites really are what provide the robust information that makes the DUTCH test so helpful for analyzing hormonal concerns.
Also, because the urine samples are taken several times over the course of the day, you will get more robust results that take into consideration hormonal fluctuations during the day. This is in comparison to a standard blood test which captures hormones at a single moment.
It is also important to point out that the convenience of testing hormones from home is a huge advantage when using the DUTCH test.
What information do you get from a DUTCH test?
The DUTCH test provides hormone information from 3 major categories: sex hormones, adrenal hormones, and organic acids (OATs). In this section, we will break down the types of information you will see on a DUTCH test. You can view a sample DUTCH test report on Precision Analytical’s website.
Sex Hormones
The main sex hormones measured with the DUTCH test are estrogen, progesterone, and several androgens.
Estrogen
Estrogen is often considered to be the queen bee of female hormones. And for good reason. Estrogen is the leading lady in the menstrual cycle, stimulating growth of the uterine lining and triggering the hormonal cascade that leads to ovulation.
Outside of reproductive health, estrogen also plays important roles in mood, cognitive function, heart health, and bone health.
In the test results, you’ll see a breakdown of the 3 main forms of estrogen and how they flow through the detox pathways.
The 2-OH pathway is the preferred pathway because it creates estrogen metabolites that are stable and non-reactive. Meaning they are unlikely to damage other cells, tissues, or DNA.
The 4-OH pathway is the most harmful of the detox pathways and is linked with increased risk of DNA damage and cancer. This is because the metabolites that form as a result of this pathway can bind with and damage DNA which increases the risk of cellular mutations.
Lastly, the 16-OH pathway is considered a “proliferative pathway”. This pathway is preferred during pregnancy. But outside of pregnancy, excessive use of this detox pathway is associated with issues of excessive uterine tissue growth such as heavy periods, fibroids, and endometriosis.
Progesterone
Healthy progesterone levels are crucial for achieving a pregnancy. But even if you aren’t trying to get pregnant, progesterone is so important for healthy and happy hormones. Progesterone and estrogen balance each other and are often described as yin vs yang.
It’s important to note that even if estrogen levels are considered to be in a normal range, low levels of progesterone can be the driver for symptoms of estrogen dominance. This is a clear example of why progesterone is so important for overall wellness even if you’re not trying to get pregnant.
The DUTCH test provides a picture of overall progesterone production by measuring the 2 main forms of progesterone, α-pregnanedoil and β-pregnanedoil.
One of the biggest benefits to assessing progesterone via DUTCH is that you take several samples throughout the day. This is helpful because progesterone fluctuates hugely during the course of the day. With more data points, the DUTCH progesterone results provide a more robust picture of overall daily progesterone production.
This is of course compared with a standard progesterone lab draw where you’ll only get a quick glimpse. But you don’t know if that measure was high or low in that individual’s normal daily progesterone cycle.
Androgens
Androgen hormones are often thought of as “male hormones” but they are also very important for women, as long as they are in the right amount. Androgens help to influence muscle growth, support a healthy libido, and keep energy levels up.
The DUTCH test measures the main five androgen hormones – DHEA, testosterone, 5α-DHT, androsterone, and etiocholanolone. Assessing these hormones and their metabolic pathways provides huge insights for women struggling with PCOS and/or androgen dominant symptoms such as acne or hair loss.
DHEA also plays a very important role in egg quality. This information can be especially useful for women who are trying to conceive, struggling with recurrent miscarriage, or are planning to try for a pregnancy after 35 years old.
Adrenal Hormones
DHEA and cortisol are the main adrenal hormones reported on the DUTCH test. We already covered DHEA under the androgen section.
Cortisol is a hormone that cycles as part of the normal sleep-wake cycle but also fluctuates with stress. The DUTCH results show the cortisol curve for the day, called a diurnal pattern. Both the DUTCH Complete and the DUTCH Plus also measure cortisol’s inactive form, called cortisone. Analyzing the daily patterns of cortisol and cortisone along with the metabolites can provide information on stress response, thyroid function, and metabolic health.
The DUTCH Plus also includes a saliva cortisol tests which provides information on the cortisol awakening response (CAR), which we discussed prior.
Organic Acids
The DUTCH test includes 6 organic acid markers which provide information on nutrient status, oxidative stress, and inflammation. Here’s a breakdown of the 6 OATs included in the DUTCH test.
- Methylmalonate (MMA): Assesses vitamin B12 status
- Xanthurenate: Assesses vitamin B6 status
- Kynurenate: Assesses inflammation, oxidative stress, and/or gut health
- Pyroglutamate: Assesses glutathione levels. Glutathione is critical for healthy detoxification
- Homovanillate: Assesses dopamine metabolism. Provides information on energy and motivation
- Vanilmandelate: Assesses norepinephrine/ epinephrine metabolism. Provides information on adrenal health and stress response.
And although not technically an organic acid, DUTCH also reports melatonin (via its metabolite 6-hydroxymelatonin sulfate) and 8-OHdG in the OATs section.
Alternations in melatonin levels can point to stress, poor sleep hygiene, or even dysfunction in the pineal gland (where melatonin is produced). And 8-OHdG is a measure of oxidative stress and cellular health.
Who would benefit from a DUTCH test?
Because the DUTCH test provides so much information, it is really helpful for many different conditions and symptoms, especially when conventional tests or providers have not been able to find answers.
Other men and women like to run a DUTCH test annually to check in on their hormones and see if there is anywhere to optimize their health before symptoms show up.
In this section, we’ll go through several scenarios that the DUTCH test may be especially helpful.
Symptoms of Hormone Imbalance
Yes, this is a broad category. But women struggling with symptoms of hormonal imbalances will definitely obtain helpful information from the DUTCH test. Symptoms of hormonal imbalances include:
- Painful and heavy periods
- Irregular periods
- Breast tenderness
- Moodiness
- Anxiety or depression associated with cycle
- PCOS
- Endometriosis
- Acne
- Brain fog/ difficulty concentrating
- Mid cycle spotting
- Short cycles
Because the DUTCH test provides information on how hormones are moving through certain metabolic pathways, it helps to identify where there is a breakdown in the hormonal system. When you know where to target your interventions, you can develop a plan that hits on those specific areas.
Chronic Stress, Fatigue, Anxiety, Poor Sleep
The adrenals section of the DUTCH test provides information on managing chronic stress, fatigue, and anxiety.
Chronically high cortisol and cortisol metabolites paint a picture of someone who is constantly wired, experiencing anxiety, and probably struggling to get good sleep. On the flip side, chronically low cortisol and cortisol metabolites point towards fatigue and low motivation.
This information coupled with the results in the OATs section will provide a picture of nutrient status and how this could relate to the symptoms of stress, poor sleep, anxiety, and fatigue.
Understanding where your cortisol, adrenal health, and OAT results land allows practitioners to make a plan to support your adrenal health and overall cortisol levels to get you feeling back to your ideal functioning.
Difficulty Losing Weight
If you are someone who has tried everything and your weight doesn’t budge, taking a look at hormone health through the DUTCH test might provide some insights.
The DUTCH test examines your hormonal health from various angles. High cortisol, slow cortisol clearance, excessive estrogen, and imbalances in DHEA all can point to causes for stubborn weight loss.
For example, when the body is slow to clear cortisol, thyroid function is also slowed. A sluggish thyroid makes weight loss near impossible. With this information, you can implement interventions aimed at supporting your thyroid. And an optimally functioning thyroid will allow for healthy weight loss.
Fertility & Reproductive Health
The DUTCH test can provide a plethora of information for those going through infertility, recurrent miscarriage, or struggling with egg quality.
Of course, the DUTCH provides an indepth look at the sex hormones to help understand if they are in goal ranges for achieving a pregnancy.
But beyond sex hormones, the DUTCH test also provides a picture of androgens and adrenal hormones including DHEA which is hugely related to egg health.
Alterations in cortisol patterns are also known to affect fertility by reducing progesterone levels and disrupting ovulation. Long term elevated cortisol can also have an impact on egg quality, the health of the uterine lining, and even the odds of implantation.
We also can’t forget that the DUTCH test includes 8-OHdG, which is a marker to oxidative stress and cellular damage. Elevations in 8-OHdG indicate the body needs more support against oxidative stress to prevent damage to cells (especially egg cells which are very prone to oxidative damage).
How does a DUTCH test help to make personalized nutrition recommendations?
Seeing how your hormones work together is pretty interesting. But the really cool thing is when you can take that information and translate it into personalized nutrition and lifestyle recommendations to improve your hormonal health.
Now, if I am totally honest – this test is confusing to look at. The first time I saw one I was like, “what am I even looking at here!”
This is why it is important to work with an experienced provider to interpret your results into diet and lifestyle recommendations. Otherwise, you’ll end up with some really expensive information that doesn’t translate to results.
In this section, it is going to be impossible for me to go through every scenario that can show up on the DUTCH test. But I will give you some broad ideas of how the results of a DUTCH test translate into diet and lifestyle recommendations.
Estrogen Dominance
Estrogen dominance is one of the most common hormonal imbalances. It occurs when the balance between estrogen and progesterone is off and results in some pretty uncomfortable symptoms including heavy bleeding, PMS, cramps, and uterine fibroids.
On the DUTCH test, estrogen dominance shows up as elevated estrogen or estrogen levels that are high relative to progesterone. In cases of estrogen dominance, detoxification often favors the least preferred pathways (4-OH or 16-OH), though that is not always the case.
Here are some examples of how a provider might use your DUTCH results to come up with a personalized nutrition and lifestyle plan based on your results.
- Evaluate preferred estrogen detox pathway. Recommend increase in cruciferous vegetables such as broccoli, cabbage, kale, and cauliflower to encourage preferred 2-OH pathway. Supplements with these extracted compounds are also sometimes used.
- Encourage increased fiber intake and gut health to encourage daily bowel movements. Regular bowel movements get excess estrogen out of the body.
- Evaluate overall estrogen burden. Reduce xenoestrogen exposure in the environment. This means reducing plastics, using caution with body care products, and making an effort to reduce pesticide/ herbicide exposure.
- Evaluate methylation efficiency in estrogen detox. Support methylation as needed to allow for complete elimination of estrogen metabolites.
- Ensure adequate calories to support progesterone production.
- Evaluate stress and cortisol; excessive cortisol can interfere with progesterone production.
An estrogen dominance diet is a very powerful tool for correcting excessive estrogen symptoms. Once you understand where the dysregulation is occurring (be it with excessive estrogen or low progesterone), you can target which interventions will be most effective at resolving your symptoms!
Cortisol Dysregulation
The DUTCH test provides a picture of your daily cortisol pattern to help you learn how to best support your stress response. There are two main cortisol pictures you can see on the DUTCH test (with many other acute subgroupings that your DUTCH provider can help to decipher!):
Chronically Low Cortisol (sometimes referred to as adrenal fatigue). In this scenario, the overall cortisol production is too low and it requires gentle support to help get it back online.
The focus would be on making the body feel safe with regular meals/ snacks to prevent spikes and drops in blood sugar. Also, avoiding strenuous exercise and rather favoring gentle movement until cortisol has normalized.
Chronically High Cortisol (often described as wired but tired). Here, we want to avoid stimulants such as coffee and alcohol and help to gently nudge the body into a normal cortisol curve by encouraging healthy sleep habits and morning light exposure.
Chronically high cortisol also can cause issues with blood sugar regulation so a big focus would be on maintaining good blood sugar balance with well balanced meals.
PCOS
PCOS is a very common metabolic condition that creates many uncomfortable symptoms for women and can contribute to infertility. The results of your DUTCH test can help your provider develop an individualized diet and lifestyle plan to overcome your PCOS symptoms naturally.
Here are some things you and your provider can review on your DUTCH test and how this information translates into your personalized diet and lifestyle plan.
- Evaluate the activity of 5α-reductase. This enzyme creates highly androgenic metabolites which contribute to some of the bothersome symptoms of PCOS including unwanted hair growth, male pattern baldness, and oily skin. Certain nutrients help to regulate this enzyme and prevent its overactivity. This includes favoring foods rich in zinc as well as increasing the polyphenols ECGC (found in green tea), quercetin, lycopene, and curcumin.
- Evaluate overall androgen levels. Excessive androgen production in PCOS is typically tied with insulin resistance. Improving blood sugar balance is central in reducing androgens and symptoms of androgen excess (such as irregular ovulation, acne, male pattern hair loss, etc).
- Evaluate or dysregulated cortisol levels. PCOS with an adrenal component needs special attention to adrenal health to balance cortisol and DHEA-S levels. Based on cortisol results, your practitioner may suggest interventions such as adaptogens, improved sleep hygiene, and morning sunlight to improve adrenal function.
- Specific supplements, including myoinositol or saw palmetto may be helpful to consider based on results and overall picture of hormone health.
What are the downsides to the DUTCH test?
Now, the DUTCH test has a lot of positive aspects that we’ve discussed in this article. But it is also important to consider the potential downsides for the test.
The first downside to mention is the cost. The DUTCH test is generally not covered by insurance and does cost several hundred dollars for the test alone. Then, because it is a nuanced test that takes a trained professional to interpret, you’ll have to pay an additional fee for interpretation.
Another downside of the DUTCH test is that it does need to be taken during a specific window in your cycle. For the DUTCH Complete and DUTCH Plus, the urine samples need to be taken during the middle of your luteal phase. This is when progesterone is at its highest.
This means you will need to be able to identify ovulation and generally know the length of your luteal phase (time between ovulation and the start of your next period) so you can sample on the right day.
Getting a sample on the right day can be especially frustrating for women with PCOS or irregular/ missing cycles. If your cycle is long and/or irregular, it means you need to be patient and wait for the right testing window. Obviously, this is frustrating when you probably wanted answers yesterday.
Lastly, There is also debate in the conventional health community about the accuracy of the test. While testing has been done to validate the DUTCH test, it was done mainly by the company that invented the test. Many will cite this as a concern.
Now, it is important to point out that countless people have reported positive outcomes from the DUTCH test and the protocols that they implemented as a result. But, there have also been plenty of people who did not experience life changing results.
For those who did not see the desired results – it is important to ask:
- Was the test interpreted by someone who knew what they were looking at?
- Were they able to implement the diet and lifestyle recommendations in order to produce the desired result? (because, let’s face it – that’s most of the battle!)
Ultimately, the choice is yours. And it does provide promise for those looking for answers that other conventional providers haven’t been able to provide.
What are the steps to get a DUTCH test?
If you are ready to get started with your own DUTCH test, the best thing to do is find a provider who will be able to work with you. The DUTCH test website has a list of providers that you can use to narrow your search.
Once you obtain your test, you will need to get your samples in the middle of your luteal phase (after ovulation). Finding the right testing window can be tricky, but Precision Analytical (the makers of the DUTCH test) have a guide to help you find your testing window. Note, you might find it helpful to have some LH test strips on hand to help you identify ovulation and accurately time your testing samples.
After submitting your test, your practitioner will be in contact with you about your results. Typically, results are available 2-3 weeks after they are received back -at the lab.
Final Thoughts
If you are dealing with symptoms related to hormonal health issues, the DUTCH test might help provide the answers you are looking for.
This test can be especially helpful for men and women who are struggling with hormonal issues that conventional medicine and tests have not been able to identify. Especially symptoms such as brain fog, PMS, irregular cycles, fatigue, and anxiety/ stress response.
The main reason the DUTCH test is unique compared to other hormone tests is that it includes hormonal metabolites. Hormonal metabolites allow you to see how your hormones flow through various pathways in your body. With this information, you can better understand how to optimize the ideal pathways and minimize those more harmful.
Further, the DUTCH test can provide individualized information that allows a skilled practitioner to develop a diet and lifestyle plan that will target the specific concerns that were identified on the test.
If you are interested in getting started with your DUTCH test, check out the find a provider page on the DUTCH test’s website to find a practitioner to get started with!