The DUTCH test stands for: Dried Urine Test for Comprehensive Hormones, and I almost always suggest my clients get one done. Why? Because it's the gold standard when it comes to hormone testing.
Most woman who come to see me are busy, burned-out mamas who've spent the last few years (at least) wrangling a young family, sometimes whilst working as well. This will do a number on your hormones, and hence hormonal imbalances are a major reason why my clients come to see me.
The DUTCH test tests your reproductive and adrenal hormones as well as melatonin and oxidative stress. But what makes this test better than blood that your doctor can order or saliva that other health practitioners order? In a nutshell, all the information you can possibly collect you can collect with a single DUTCH test. The same cannot be said for blood or saliva.
Many naturopaths use saliva for hormone testing. All GPs use blood testing primarily (unless performing a 24 hour wet ((as opposed to dry)) urine cortisol test). Saliva and blood tests however, don't give you all the information you need in order for your practitioner to create an effective protocol. Especially when it comes to cortisol, not only might the protocol you're given be ineffective but it might actually be doing you harm.
When testing for adrenal issues using saliva you are able to get what's called a “diurnal” pattern of cortisol (blood will not give this measurement). Diurnal meaning an every day pattern. So we can see the production of cortisol upon waking, in the middle of the day, in the evening and before bed. This is great – it's what's needed when analyzing HPA axis dysfunction however, where saliva falls short when it comes to assessing the health of our adrenals is that it doesn't give us our metabolites of cortisol. The DUTCH test allows us to measure this same diurnal pattern of free cortisol but it also allows us to measure cortisol metabolites, and this gives us a much more accurate picture of how much cortisol you are actually producing from your adrenal glands and how the body's using it. It's a much more complete picture than blood, saliva, or wet urine can give us.
Metabolized cortisol (only measured in the DUTCH test, not in saliva or blood) accounts for about 80% of total cortisol output from your adrenal glands. The free cortisol – the only cortisol saliva and blood test for – only accounts for about 1 – 3% of total cortisol production. So you can imagine if you only get 1 – 3% of the actual truth of the matter, your protocol will likely be inefficient or even harmful.
So to recap:
- Blood only gives you the free cortisol but no metabolites or diurnal pattern
- Saliva gives you the free cortisol and diurnal pattern but no metabolites
- The DUTCH test gives you everything: free cortisol, diurnal pattern and metabolites
About 40% of people who have low free cortisol (the only kind tested in saliva and blood) actually present with elevated levels of cortisol metabolites (as tested only in the DUTCH test). This means they are potentially being put on protocols for low cortisol when they really have high cortisol production. As a case in point, people who are obese typically make less free cortisol and more cortisol metabolites. So if they do a saliva test they're going to likely be under the impression they are not making enough cortisol and their practitioner may put them on a protocol aimed to increase cortisol when really it's high and the opposite protocol might be required. You can see where it can get very murky when you're not testing everything you need to in order to develop an effective and helpful protocol. In fact, this happened to me. I went to see an ND and got a saliva test done. She then put me on a protocol which completely backfired and left me bouncing off the walls (not in a good way). My assumption was that she put me on a low cortisol protocol when really I was in desperate need of calming my cortisol down.
Sex Hormones: androgens, estrogens and progesterone
With the DUTCH test we are able to look at the metabolites of sex hormones as well, which again we are unable to do with a saliva or blood test. This is important for understanding how we're clearing estrogens from the body (to avoid such states as estrogen dominance) and in terms of the various types of estrogen we are making. This is super important for women and one of the reasons I tell almost all my clients to get a DUTCH test done at some point. The types of estrogen you are making will tell us how at risk you are for certain estrogen-dependant cancers such as breast, ovarian and uterine. We can also see the methylation pathway of estrogen when doing the DUTCH test, which can tell you if there are nutrient deficiencies or an MTHFR gene mutation (which is quite common and something I myself have), which would then need to be addressed in order to maximize health.
Additionally, another downfall of saliva is that it struggles to accurately measure and decipher between low, normal and elevated levels of estrogen – sometimes they even co-mingle together. It's simply not sensitive enough to see the various different levels of estrogen therefore lacking in accuracy, which is an issue for women when it comes to trying to figure out their estrogen state, which can impact overall health.
I hope this was a good explanation as to why I choose the DUTCH test for my clients when it comes to hormone testing. If you have any questions, please leave them below or reach out to me. And if you'd like to book a DUTCH test with me please get in touch and we can make this happen.
In happiness and health,