Hormone Testing 101: Inside the DUTCH Plus by Precision Analytical
by Kate Daugherty, MS, CNS, Functional Nutritionist and Dr. Mitchell Rasmussen, DC, Certified Functional Medicine Practitioner
When it comes to Hormone Testing, the DUTCH Plus Test by Precision Analytical is our go-to. The DUTCH Plus is an at-home hormone test using urine and saliva samples over the course of one day.
Before we jump into the specific test, let’s evaluate hormone testing. Traditional hormone tests (those ordered by your PCP or OB/GYN) are using serum (blood) collections. This gives you a specific level of a single hormone at one point in time. The limitation in this is that we get a very zoomed in picture without much context.
DUTCH stands for Dried Urine Test for Comprehensive Hormones. Dried urine testing has been clinically validated against serum and liquid urine results. Using urine metabolites, we not only see baseline levels of hormones, but also get a picture of how they are being used (metabolized) in the body. The hormone cascade is especially complicated, but when we can look at levels in context as they transform we get a much better understanding of YOUR limitations. It's like we're laying out the whole story in front of us.
For women struggling with infertility, irregular periods, PCOS, PMS, or other hormone-related issues, a DUTCH Test can show us actionable data to correct the dysfunction.
What Does the DUTCH Plus Measure?
Broadly, when we look at the DUTCH Plus there are three big categories of information collected: Sex Hormones, Stress Hormones, & Vitamin/Neurotransmitter/Antioxidant Markers.
Sex Hormones that the test will look at include:
Estrogens (Estradiol, Estrone, Estriol) and Metabolites
Androgens (Testosterone, DHEA-s) and Metabolites
Progesterone Metabolites (b-Pregnanediol, a-Pregnanediol)
Big Takeaways from this information: The pathways of these hormones are important, and often missed in conventional tests. With the DUTCH Plus, we are able to see not only overall level of hormones, but also understand detoxification pathways within your body. We can pinpoint limitations in clearance (methylation defects, enzyme issues, or nutrient deficiencies) to help speed up (or slow down) metabolism of specific hormones.
When we look at the full picture, we can correlate symptoms to hormonal patterns. This means more targeted treatment to address imbalances in hormones.
<< A full picture of the WHY behind hormone imbalance.>>
Stress Hormones that the test will look at include:
Free Cortisol and Cortisone (Saliva)
Cortisol Metabolites (Urine)
Uniquely, the DUTCH Plus includes both urine and saliva markers for cortisol. Similar to hormones, in urine we can see the distribution of cortisol metabolites giving us better understanding of both active and inactive hormone.
The Cortisol Awakening Response (CAR) is a ‘mini stress test’, looking at the rise and fall of salivary cortisol upon waking, and twice more at 30 minutes after waking and 60 minutes after waking. In HPA-axis dysfunction (sometimes mis-referred to as ‘Adrenal Fatigue’), it’s important to establish whether you have an underactive HPA axis or an overactive HPA Axis, as treatment varies greatly even though symptoms may be similar!
While not exactly a ‘stress hormone’, the DUTCH Plus also measures melatonin levels. Melatonin works somewhat in opposition to cortisol, helping us to relax and fall asleep. Assessing melatonin and
cortisol/cortisone together tells us a little about the brain input of the HPA Axis.
<<We cannot ignore the impact of stress on hormone dysfunction>>
Bonus Vitamin/Neurotransmitter/Antioxidant Markers:
This is a ‘bonus’ section of the test. Generally, we’d lean on more complete panels like the NutrEval or Metabolomix+ from Genova Diagnostics. Nonetheless, the DUTCH Plus includes Organic Acids to assess Vitamin B12, Vitamin B6, Dopamine, Glutathione, Epinephrine/Norepinephrine, and Oxidative Stress. These markers are useful in that they tell us about other areas that need further support.
You May Also Like: Stool Testing 101 - GI Effects by Genova Diagnostics
UNBOXING THE DUTCH PLUS : What to Expect
The DUTCH Plus Test requires four urine samples and five saliva samples. These are collected over the course of one day, from waking to bed time. For women, the test should be completed between days 19 and 22 of a 28-day cycle. The test kit provides clear direction on collection times and methods- but setting phone alarms/timers on test day can be helpful.
What’s In the DUTCH Plus Box?
5 Saliva Collection Tubes (with Salivette cotton swabs)
4 Urine Cards
Complete Instructions / FAQs
Prepaid Return Shipping Label
How to Collect Urine Samples
The DUTCH Plus uses dried urine, so don’t worry about carrying around cups of your pee! Here’s how it works: you’ll find four folded collection cards, clearly marked on when to use. At the appropriate time, you’ll pee directly on the card. Then, allow it to dry for up to 24 hours. It’s so easy you can even do it away from home! At the end of the day, you’ll fold them back up and return in the box.
How to Collect Saliva Samples
Each saliva tube has a cotton swab inside. It is essentially an elongated cotton ball, which you will remove from the tube and put in your mouth to saturate with saliva. Once it is fully saturated, you place it back in the tube. Then, keep the saliva samples in the freezer until ready to ship.
TIMING of the first three saliva samples is especially important, as we want to assess what happens in response to waking! The first swab should be in your mouth within 5 minutes of waking. Plan to avoid strenuous activities, eating, and drinking in the first hour of test day.
When you have completed all collections, you’ll pack them back into the box along with the requisition form. Put the entire kit in the prepaid shipping label, and drop it off at a UPS location for return. Turnaround time for results is typically 2-3 weeks. We'll schedule an appointment to review everything IN DETAIL and explain how it fits in to your symptom picture.
A 45-Second Overview of Hormone Sample Collection:
Spotlight on Hormone Testing: DUTCH Plus by Precision Analytical
For helping us scientifically diagnose hormone problems, we like the DUTCH Plus by Precision Analytical. It's an at-home urine and saliva test that gives us a complete picture of your hormones. The DUTCH Plus includes metabolites of your hormones (what does your hormone cascade look like?) + stress hormone markers (how well do you handle stress?) + nutrient, neurotransmitter, and oxidation markers (what other areas need support?).
With these results, we can help you deal with infertility, amenorrhea, PCOS, PMS, menopause, and other hormone imbalance.
First, We discover the WHAT ; then we address the WHY .
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