Both men and women can experience hormonal changes. For women, the menstrual cycle and hormones play a significant role; some experts suggest considering the menstrual cycle as an important health indicator for women. For both men and women, hormone levels can influence cognitive functioning, energy levels, sexual characteristics, mood, and more. Thus, when hormone levels are imbalanced, various symptoms and issues may arise. Hormone tests offered by Precision Analytical, called DUTCH tests, can be valuable in understanding these issues. This article will discuss what DUTCH tests are, signs that someone may benefit from a DUTCH test, and three different types of DUTCH tests that may be appropriate for your patients.
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What is a DUTCH Test?
DUTCH is an acronym standing for Dried Urine Test for Comprehensive Hormones. As its name implies, DUTCH tests by Precision Analytic use dried urine samples to evaluate hormone metabolites. The laboratory offers tests for both men and women, although some tests are only appropriate for women. These tests can be convenient for the patient, as they do not require a lab visit and can be done at home. They are also an excellent choice for those who prefer to avoid blood draws.
Precision Analytic is a CLIA-certified laboratory, meaning it adheres to quality and safety standards set by the Centers for Medicare and Medicaid Services. Precision Analytical has published papers in peer-reviewed journals such as Steroid, BMC Chemistry, Journal of Clinical and Translational Chemistry, and more. The lab uses LC-MS/MS and GC-MS/MS, considered accurate testing methodologies.
What Does a DUTCH Test Tell You?
A DUTCH test provides information on various hormone metabolites measured in the urine. From these metabolites, the lab can also estimate levels of the actual hormones that relate to blood levels.
Signs Your Patient Could Benefit From DUTCH Testing
As the DUTCH test assesses hormones, individuals experiencing hormonal symptoms may find it helpful. These symptoms can include irregular periods, painful and heavy periods, low libido, weight changes, hormonal acne, mood swings, perimenopause, and menopause symptoms, like hot flashes and night sweats. For men, symptoms such as low libido, trouble with erections, mood swings, fatigue, and weight changes can indicate hormonal issues.
Which DUTCH Test Is Best For Your Patients?
When a patient presents with hormonal symptoms, choosing the right test can sometimes be overwhelming. The following section will discuss the DUTCH Complete, DUTCH Plus, and DUTCH Cycle Mapping to help clarify which test may be appropriate for various patients.
Dutch Complete
The DUTCH Complete assesses 35 different hormones and is divided into three categories: sex hormones, adrenal hormones, and the organic acids test and additional markers. The sex hormone section includes the three estrogens (estradiol, estrone, and estriol), progesterone, the androgens DHEA and testosterone, and their metabolites. This is especially important for estrogens, as the test examines the first two phases of estrogen metabolism. Challenges in estrogen metabolism can lead to an accumulation of estrogen in the system, contributing to hormonal imbalance.
The adrenal section provides insight into how the Hypothalamic Pituitary Adrenal Axis, commonly referred to as the HPA axis, is functioning. The HPA axis is activated under stress and can offer insights into how stress may influence sex hormones. Activation of the HPA axis leads to the release of cortisol, a primary stress hormone. This test provides cortisol levels and its inactive form, cortisone, and another adrenal hormone, DHEA. As mentioned above, DHEA is an androgen and sex hormone, but it is made in the adrenal glands and functions as a stress hormone. While not made in the adrenal glands, melatonin levels are also included in this section due to melatonin's relationship with cortisol.
Lastly, the organic acid section provides metabolites for vitamins B12 and B6, biotin, glutathione, the neurotransmitters dopamine, norepinephrine, and epinephrine, and oxidative stress. This test may be helpful for women experiencing the following conditions/symptoms:
- Heavy periods
- Painful periods
- Hormonal acne
- Hair loss
- Hormonal mood swings
- Premenstrual syndrome (PMS)
- Menopausal night sweats and hot flashes
The DUTCH Complete is also available for men and may be useful for men who experience the following signs and symptoms:
- Low libido
- Poor concentration
- Erectile dysfunction
- Loss of muscle mass
- Fatigue
- Growth of breast tissue
- Decline in memory
- Acne
- Mood swings
- Headaches
The DUTCH Complete can also be used to monitor certain types of Bioidentical hormones.
Dutch Plus
The DUTCH Plus is the DUTCH Complete with the Cortisol Awakening Response (CAR) test added on. The CAR test provides insight into the body's circadian rhythm, the 24-hour sleep-wake cycle. The CAR is a phenomenon that occurs within 30 minutes after waking. During this time, cortisol levels should be at their highest point of the day, setting the rhythm for the rest of the day. The DUTCH Plus, and thus the CAR, may be helpful for men and women who have hormonal symptoms as well as
- Chronic stress
- Chronic fatigue
- Poor sleep, including sleep apnea
- Depression
- Seasonal affective disorder (SAD)
- Migraines
- High blood pressure
- Autoimmune conditions
- Blood sugar dysregulation
- Gut problems
Dutch Cycle Map
The DUTCH Cycle Map is a test for women only. This test tracks nine hormone metabolites of estradiol, estrone, and progesterone over one menstrual cycle. Collecting around 25 urine samples, as the test's name implies, will map out a woman's menstrual cycle in terms of hormones. Women's menstrual cycles can vary greatly; one woman may ovulate on day 14 of their cycle, while another may not ovulate until day 20 or later. If doing a one-day test, such as the DUTCH Complete, ovulation may be missed. This can be a significant issue since progesterone is only made after ovulation, and for most women with hormonal symptoms, seeing the level of progesterone can be important. Additionally, retaining a one-day reading of progesterone may be enough for some women; however, for other women, it may give a false sense of progesterone production, as some women can make a large amount of progesterone one day and then have a significant drop in the levels the next day and vice versa. The daily hormone production variability is why the DUTCH Cycle Mapping can be useful for some women. This is why this test may be considered for the following women:
- Women with irregular menstrual cycles, including those with Polycystic Ovarian Syndrome (PCOS), infertility, and perimenopausal women
- Women cycling without a period: women who have had their uterus removed but still have their ovaries (partial hysterectomy) and those who have had an ablation can still be cycling but will not have a period, making the timing of one-day tests challenging to determine
Is DUTCH Testing Covered By Insurance?
The DUTCH tests are not currently covered by insurance. Patients are always welcome to submit bills for potential reimbursement from their insurance companies, although this is not guaranteed.
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Summary
The various tests offered by Precision Analytical, including the DUTCH Complete, DUTCH Plus, and the DUTCH Cycle Mapping tests, can be a helpful tool offered by providers to understand a person's hormonal issues. The variability in testing allows for the assessment of many different symptoms, offering insights for numerous men and women experiencing hormonal changes.
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