Hormone imbalances are epidemic in modern day, especially amongst women—from PMS to PCOS, hypothyroidism and Hashimoto’s, irregular cycles, osteoporosis, uterine fibroids, endometriosis, infertility and even diabetes, the list goes on.
It’s pretty safe to say that you’re “normal” if you experience some form of hormone imbalance in your life. Even if you are not formally diagnosed with a hormone imbalance condition, most women are no stranger to the signs and symptoms at some point, such as unwanted weight gain or weight loss, fatigue, cold hands and feet, hair loss, heavy periods, night sweats, bloating and constipation—just to name a few.
Do you have hormonal imbalance?
The DUTCH Test is a helpful test I occasionally use in clinical practice to help my patients find out.
Dutch Test 101: What is It?
The DUTCH Complete Hormone Test is a “dried urine test for comprehensive hormones” that helps you assess the following hormone markers:
- Estrogen (Estradiol, Estriol, and Estrone)
- Nutritional organic acids
- Neurotransmitter metabolites
- Hormone metabolites (the breakdown products of hormones by gut bacteria which can tell us how your body is effectively, or ineffectively using the hormone – this may be the cause of one’s hormone imbalance).
I particularly find the DUTCH test beneficial for assessing the “diurnal rhythm” of cortisol—the highs and lows of cortisol in a given day.
What You Can Learn from the DUTCH Test
The biggest takeaway from the DUTCH test is assessing your level of “HPAT Axis Dysregulation” and any other hormone imbalances on paper (adrenals, all sex hormones, and melatonin).
The DUTCH test can allow you and your clinician to customize a hormone balancing treatment plan for you and your HPAT Axis.
As a refresher, your HPAT Axis stands for your “hypothalamus-pituitary-adrenal-thyroid” gland axis that works as your body’s “stress management system.”
Stress goes far beyond just feeling stress in your head over a work deadline or rush hour traffic. Circulating hormones throughout your body—like cortisol—also play a role in how your body experiences stress and homeostasis (balance). This hormone is constantly circulating throughout your body, influencing things like the balance and production of other hormones, blood sugar levels, cell metabolism, inflammation, detoxification, digestion, neurotransmitter signaling and the “stress response”—such as the rise in blood pressure and heart rate in the face of a threat.
You can be sitting on a beach in Tahiti, seemingly no worry in the world, but your body still feel stressed—inflamed on the inside—especially if you have high amounts of cortisol pumping through your body, or you’re depleted of cortisol from chronic stress that has never been addressed. Cortisol is not a bad thing, but too much of it or too little of it causes problems in other aspects of your health—gut health and other hormone imbalances included.
If your HPAT Axis is out of whack, you can bet your bottom dollar that your cortisol levels, and consequently, your other hormones will be out of whack if stress and inflammation persist (hello mood swings, skin breakouts, bloating or insatiable cravings for Oreo’s and peanut butter).
Enter: DUTCH testing, a great lab testing tool for understanding your current physiological hormone patterns—particularly cortisol— as you continue to hack stress and optimize your gut health.
Beyond just showing you numbers, graphs and charts of your hormone levels, the DUTCH test can help you and your clinician figure out things like:
- Why you can’t sleep through the night
- The best times of day for you to eat a snack or kick coffee
- The best herbs and supplements that may help boost or mitigate your hormone levels
- Whether or not you have estrogen dominance
- Clinical indicators of conditions like PCOS and hypothyroidism
- Understanding if you are still ovulating despite not having a regular period
- Explain hair loss, weight loss difficulties or skin breakouts
- Guide you on any missing nutrients in your diet
- Help you conceptualize and visually see how stress shows up in your body
- Risks for breast cancer
- Point to possible environmental toxins and xenoestrogens affecting your hormones
(…Just to name a few things).
DUTCH Test vs. Other Hormone Tests
There are multiple ways to assess cortisol and other hormones.
- Hair Testing
- Serum (Blood) Testing
- Saliva Testing
- Urine Testing
Like all testing methods, not all tests are created equal, and some are preferred more than others—especially depending on the hormones you are testing.
For example, bloodwork is a great methodology used in research for assessing sex hormones, like estrogen, progesterone, thyroid hormones and testosterone, however, unlike the DUTCH urine and saliva test, hormone blood tests won’t assess your cortisol rhythms and estrogen metabolism, or be able to shed light on adrenal, cortisol, and sleep problems as accurately.
This is why saliva and urine sampling is preferred for cortisol and adrenal markers in particular.
Given the fact that cortisol levels fluctuate A LOT in 24 hours, a combo salivary-urine test (like the DUTCH test) is easy to do at home and can help a patient figure out what their cortisol patterns are throughout the entire day—even better than just saliva or just urine alone.
Prior to the invention of the DUTCH test, many functional medicine and holistic practitioners administered saliva-only hormone tests to assess cortisol levels; however, something most people don’t realize is that saliva only hormone testing measures “free” cortisol (the active form of cortisol, comprising only 3-5% of total cortisol in the body). The other 95%? This cortisol is measured by assessing cortisol metabolites and cortisone—the inactive format of cortisol—that can give you a better picture of how much stress your body is really under—even if not fully expressed.
Hormone Imbalance Signs & Symptoms
Aside from lab testing to assess your hormone imbalance, signs and symptoms can be very telling for you and your clinician to figure out what’s going on “under the hood.”
Some of the top signs to look out for include:
- Low libido
- Mood swings
- Cysts on breasts/breast tenderness
- “Bad” PMS
- Cravings—especially around period
- Facial hair/chin hair growth
- Hair loss
- Blood sugar imbalances/insulin resistance
- Sugar/sweet cravings
- Period irregularities/period loss
- Yeast infections
Hypothyroidism & Hashimoto’s
- Sensitivities to iodine foods (shellfish, salt, seaweed, dairy) and supplements (Hashimoto’s)
- Sensitivities to gluten
- Cold hands and feet
- Unwanted weight gain/weight loss
- Hair loss
- Insatiable cravings
- Loss of appetite in the mornings
- A boost of energy after meals
- Feeling shaky or lightheaded before meals/if meals are delayed
- Feeling hungry shortly after eating
- Insomnia/nighttime waking
- Pelvic pain
- Painful periods
- Period irregularities
- Abdominal cramping
“Adrenal Fatigue” (Low Cortisol)
- Fatigue despite sleeping
- Apathy/low mood
- Not able to do everyday activities
- Need coffee to function
- “Crashes” (susceptible to little and big stressors)
- Exercise intolerance
HPA Axis Dysregulation
- Histamine sensitivity
- Increased food sensitivities
- Heart palpitations/shortness of breath
- Salt, sweet or caffeine cravings
- Under high amounts of stress
- Increased startle response
Hormone imbalances can overlap and run into each other.
How to Do the DUTCH Test
The DUTCH test is super simple!
All you’ve got to do with either of these tests? Just follow the directions along!
You will pee on the urine strips and chew on the saliva-test chews at key times throughout the day, then packing up your kit and shipping it out via FedEx for interpretation.
As for “prepping” for the test, there’s not much to do.
Your diet will remain fairly normal as well, other than slightly lower water intake the night before and day of the test (to ensure samples are not diluted), along with avoiding a few select foods and supplements the day before the test if you’re interested in assessing the neurotransmitters and nutrient markers like serotonin, dopamine, glutathione and Vitamin B markers.
These foods and supplements include: Avocado, Bananas, Eggplant, Kiwi, Butternuts, Pecans, Walnuts, Pineapple, Plantains, Plums and nootropic supplements like 5-HTP, Tryptophan, SAMe, Tyrosine, L-Dopa, D,L-Phenylalanine (DLPA), Macuna, Quercetin and St. John’s Wort. If you happen to consume some of these foods or supplements, simply make a note of it on your requisition form.
Note: The primary difference in these two tests is that the DUTCH Plus “captures” your CAR (cortisol awakening response) within the first 30 minutes of waking for an even more detailed assessment of your cortisol patterns for the day. I prefer the DUTCH Plus for those with sleep problems!
Beyond the basic DUTCH Complete and DUTCH Plus, women also have the option to do a 28 Day Cycle Mapping DUTCH Test if they are experiencing significant period irregularities and want to figure out what is going on with their cycle.
Work with your clinician to determine the best test option for you.
What Does the DUTCH Test Cost & Does Insurance Cover It
Not surprisingly, insurance does NOT cover this test at this time because it is “investigative.” The retail price is $399 for the DUTCH Complete and $499 for the DUTCH Plus.
If you’re my patient you get a discounted price.
How to Take the DUTCH Test
You have a couple options:
You can order the DUTCH Test directly from the DUTCH test website (DUTCH Plus here or DUTCH Complete here), then book a one-time consult with me to review and interpret your lab results here, as well as share initial recommendations with you.
You can schedule an appointment as a new patient, where we will take you through my customized 2-part Initial Intake Process (virtual).
During Appointment #1, we will meet to discuss your health history, current goals and lifestyle, followed by Appointment #2, where we will meet to review the comprehensive, customized Body Blueprint plan I put together for you. Your Blueprint plan is inclusive to nutrition, supplement, lab testing and lifestyle recommendations for feeling and looking your best. The DUTCH test may be part of a more comprehensive work up (such as bloodwork, stool analysis, food intolerance testing, SIBO testing, etc.).
Which ever you decide, to hormone balance we go!