Which DUTCH Test Is Best For Your Patients?

Both men and women can experience hormonal problems. For women, the menstrual cycle and hormones are incredibly important; it's been suggested that we should consider the menstrual cycle as the fifth vital sign for women. For both men and women, hormone levels can affect cognitive functioning, energy levels, sexual characteristics, mood, and more. Thus, when hormone levels are imbalanced or off, numerous symptoms and problems can arise. Hormone tests offered by Precision Analytical, called DUTCH tests, can be incredibly valuable in getting to the root cause of the issue. 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 extract hormone metabolites for evaluation. 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 afraid of blood and or needles, as a blood draw is not needed.

Precision Analytic is a CLIA-certified laboratory, meaning it is held to high quality and safety standards set out by the Centers for Medicare and Medicaid Services. Precision Analytical has published papers in prestigious 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 the most accurate testing methodology available.

What Does a DUTCH Test Tell You?

A DUTCH test tells you the various hormone metabolites measured in the urine. From these metabolites, the lab can also calculate levels of the actual hormones that correlate to blood levels.

Signs Your Patient Could Benefit From DUTCH Testing

As the DUTCH test assesses hormones, anyone suffering from hormonal symptoms may benefit, including irregular periods, painful and heavy periods, low libido, weight gain, hormonal acne and mood swings, perimenopause, and menopause symptoms, like hot flashes, night sweats, irritability and more. For men, symptoms such as low libido, trouble with erections, mood swings, fatigue, weight gain, and more can signify hormonal issues.

Which DUTCH Test Is Best For Your Patients?

When a patient presents with hormonal symptoms, figuring out what test to utilize can sometimes be overwhelming. The following section will discuss the DUTCH Complete, DUTCH Plus, and DUTCH Cycle Mapping and should help to clarify which test is appropriate for various patients.

Dutch Complete

The DUTCH Complete assesses 35 different hormones and is separated 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 walks through the first two phases of estrogen metabolism. Problems in estrogen metabolism can lead to a backup of estrogen in the system and, thus, a hormonal imbalance.

The adrenal section gives a glimpse into how the Hypothalamic Pituitary Adrenal Axis, commonly referred to as the HPA axis, is running. The HPA axis is activated under stress and can give great insight into how stress may affect sex hormones. Activation of the HPA axis leads to the release of cortisol, our body's primary stress hormone. This test gives 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 given in this section due to melatonin's intricate relationship with cortisol.

Lastly, the organic acid section gives metabolites for vitamins B12 and B6, biotin, glutathione, the neurotransmitters dopamine, norepinephrine, and epinephrine, and oxidative stress. This test is a great choice for women who have 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 offered for men and may be indicated 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 gives insight into the body's circadian rhythm, the 24-hour sleep-wake cycle that our bodies operate off of. The CAR is a phenomenon that happens within 30 minutes after waking. During this time, cortisol levels should be at their highest point of the day, and this peak sets the rhythm for the rest of the day. The DUTCH Plus, and thus the CAR, can 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 quite literally 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 problem since progesterone is only made after ovulation, and for most women with hormonal symptoms seeing the level of progesterone can be of clinical significance. 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 incredibly useful for some women. This is why this test is recommended 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 wonderful tool offered by providers to get to the root cause of a person's hormonal issues. The variability in testing allows for the assessment of many different ailments and symptoms, offering solutions for numerous men and women suffering from hormonal problems.