No one can truly claim to be practising integrative, functional, holistic or natural medicine without dealing with hormones. Hormones are essentially chemical messenger molecules that transport a signal from one cell to another. And the hormone puzzle is puzzling indeed. Thankfully, there are major steroid hormones that give us a very wholesome picture as to how we are headed health-wise. Hormones are truly the epitome of the saying “a little goes a long way”. The concentrations of these major hormones we want to know about are typically measured in parts per trillion, requiring very sensitive analytical methods. Yet, more so than almost all other molecules in the body, these hormones need to be in very precise balance and quantities.
Therefore, even if you don’t test for anything else, you should at least test for hormones and work on them in the spirits of disease prevention, wellness optimisation, stress management, fertility and reproductive health, longevity, mood, and so much more. Oftentimes, when everything else is taken care of, it doesn’t feel like much. But the moment the hormones are well managed, everything seems to tick. You feel motivated, compassionate, and able to handle bigger tasks – it genuinely leads to not just inward healing, but also outwardly manifestation.
The million dollar question has always been “how do we test for hormones and monitor treatment protocols in a way that truly reflects the biological scenario and outcomes?”
This is where the DUTCH Test comes in. The DUTCH test, which uses dried urine, is the simplest, most elegant and informative test for anyone considering bioidentical hormone therapy, natural protocols, or suspect they may have a hormone-related challenge.
The Inevitable Challenge of Hormone Testing
If hormones are so profound in relation to health, why are so little people focusing on it? The reason is simple – it is not so simple. Regardless of whether you are a patient or practitioner, if you do some due diligence, you will be baffled by the amount of contradicting feedback on hormone testing and the protocols associated with hormone restoration.
This is because in the first place – the various forms of hormone testing available each give you an incomplete picture. Before the DUTCH Test, there wasn’t a single test that would give you sufficient information to make a precise judgment and prescribe a protocol based on that. A lot of it is really guesswork. So sometimes you hit the spot, sometimes you don’t. What’s dangerous with this is that with other underlying health issues, you run the huge risk of exacerbating those problems if you don’t hit the spot.
Blood testing is the most common, and it’s a good test for reproductive hormones like estrogen, progesterone, and testosterone, as there’s no major diurnal variation in these hormones (testosterone does have a slight drop throughout the day). The drawback is that it will not show you the metabolites of those hormones.
Metabolites can help you understand what the underlying pathology is. For example, one of the primary metabolites of testosterone is dihydrotestosterone (DHT), which is believed to be one of the primary risk factors for prostate cancer.
You want high levels of natural testosterone, but you don’t want to have too much conversion to 5a-DHT, so you don’t have excessive amounts of that metabolite. A blood, urine, or saliva test can tell you if you’re making too much testosterone. But if those levels are normal, yet you’re still experiencing symptoms of high testosterone, such as Polycystic Ovarian Syndrome (PCOS), it suggests testosterone is being metabolised into too much 5a-DHT, resulting in androgenic facial hair, thinning scalp hair, and acne.
To evaluate where the testosterone is going, you need to check the metabolites. Moreover, if metabolites are not the problem, you won’t end up treating a problem you do not have and create further imbalance. If it is indeed part of the problem causing these symptoms, then there are natural and easy ways to counteract the problem.
One of the biggest problems with hormone testing is that they fluctuate throughout the day. Cortisol, for example, rises as soon as you get out of bed and then declines as the day wears on. At least, this is what’s considered normal. But many people who feel tired in the morning and can’t seem to get going till they’ve got their coffee and cigarettes, yet feel wired at night and can’t go to bed easily – have a dysfunctional diurnal pattern. And this is very bad news if gone undetected and untreated. A 24-urine test can’t show you this pattern. The saliva test, which has to be done several times over the course of a day, is much better. However, it takes time to produce that amount of saliva and the collection method is not the easiest – making it time consuming and tedious.
Also, saliva testing only measures free cortisol, which is around 1% of your total production. The DUTCH test will measure both free and total cortisol for a better look at overall production. Metabolised cortisol comprises 80% of your total production and is a more accurate way of determining adrenal gland health.
This is crucial information for determining whether one truly has low cortisol.
If free cortisol is low, yet overall cortisol production is fine or even high – the diagnosis and treatment would be very different. Many people who test low for free cortisol on saliva tests are simply put on hydrocortisone supplements or cortisol increasing medications – and this would worsen their conditions considerably. We can avoid this problem with the complete information offered by the DUTCH test.
If a patient with depression has shown to have high cortisol on a saliva test, the instant reaction would be “Aha! I knew it!” as depression has a direct correlation to high “free” cortisol. However, most people would instantly look to lower the cortisol output. The DUTCH test shows the total cortisol and metabolites, and in some instances, the free cortisol is high (as shown in saliva), but the total cortisol is low. Lowering output further would be disastrous! This means that the body and liver specifically is not metabolising the free cortisol sufficiently. It also means that low thyroid might be implicated. Just by simply addressing these 2, everything would be restored. Also, obese people produce more cortisol, but may not necessarily have more free cortisol. So only with a full picture would you be able to tell whether there is an adrenal issue or sometimes more work simply has to be done on reducing weight.
Only the DUTCH test is able to provide us the diurnal pattern in the most convenient way, yet providing us the complete picture for adrenal function.
Made in the adrenal glands, dehydroepiandrosterone (DHEA) is also an integral hormone to be testing for. For those who do saliva and blood testing, they would be missing out on crucial DHEA metabolites only revealed in urine. The important metabolites to test for are DHEA sulphate (DHEAS) which forms through sulfation. However, sulfation is blocked by inflammation.
If you have low DHEAS, you may either have normal DHEA levels but inflammation is blocking the sulfation conversion, or you simply do not make DHEA. So, again, one directly implies a systemic inflammation and indirect liver pathway issue, whilst the other an adrenal issue. With both levels tested, you can tell where the problem lies.
And, if we know there is inflammation, we also know it will cause more estrogen to be produced from androgens that they would normally would. And from the DUTCH test, you will get not just estrogen and androgen levels, but their metabolites. Similarly, it will give you an idea of whether you are producing enough, or if you are not clearing them sufficiently e.g. liver methylation.
Inflammation also affects cortisol, so we are really getting a very good picture over here on what we need to precisely work on.
The DUTCH test gives you a total picture of DHEA production by combining the 3 most abundant metabolites namely DHEA-S, etiocholanolone and androsterone. We need sufficient DHEA to balance cortisol and it is clear from here we can get an accurate picture of one’s adrenal function.
This is the big, big one. More than ever before, we are seeing an incredulous rise of sexual-organ related diseases and cancers. We are talking about breast, ovarian, uterine, prostate and more. Estrogen dominance is a dominant problem today and by itself it is a strong cancer risk. The DUTCH test gives you levels of 2, 4 and 16-hydroxy estrone which should be in very precise proportions i.e. 70%, 10%, and 20% respectively. It also shows levels of 2-methoxy estrone, which shows how well you are methylating. This is crucial information as methylation is a fundamental process that has to take place optimally in the body for proper health.
Yes. The DUTCH test even gives you the biomarker 8-hydroxy-2-deoxyguanosine (8-OHdG), which measures the effect of endogenous oxidative damage to the DNA. This is critical information and is closely tied up to the hormone picture. We can pick up direct regarding inflammation, oxidative damage, methylation, hydroxylation and sulfation in the body.
We have given you some very solid examples of how treatment cannot proceed without a proper diagnosis and the DUTCH test is the solution to that. There are so many more metabolites and hormones tested that will require further study of attached materials and training. For example, epi-testosterone helps to give a complete insight to the crucial testosterone hormone picture. Then there is melatonin, and much, much more.
There are also caveats and ways to monitor the efficacy of treatments such as bioidentical hormones, supplements, and herbals. These will all be covered in the support materials and training.