DUTCH Test

Question 1

The Dried Urine Test for Comprehensive Hormones (‘DUTCH’)

Answer 1

The Dried Urine Test for Comprehensive Hormones (‘DUTCH’) is a popular urine test that covers an array of hormones and their metabolites

Question 2

When to use a DUTCH test?

Answer 2

Reproductive hormone imbalances (e.g., low libido, PMS, irregular / painful periods or any other symptoms where you suspect a hormonal imbalance — especially if stress is involved

• Tests for many different metabolites of the major hormones: oestrogen, progesterone, testosterone and cortisol.
• To read a DUTCH test you must know the patient’s menstrual history and stage (menopause, pregnancy etc.) and if they are on any hormone-altering medication = different reference ranges.

Question 3

Key points about oestrogen metabolism

Answer 3

There are 3 main oestrogens (E1 – Estrone, E2 – E E3 – Estriol), which are metabolised down 3 phase I pathways:

1. The 2-OH pathway is considered the safest because of the anti-cancer properties of 2-OH metabolites.
2. The 4-OH pathway is considered the most genotoxic as its metabolites can create reactive products (quinones) that damage DNA.
3. The 16-OH pathway creates the most oestrogenic metabolite.

• After phase I metabolism, both 4-OH and 2-OH oestrogens can be deactivated and eliminated by methylation (part of phase II).

Question 4

Analysis

Answer 4

• High oestrogen, low progesterone and testosterone. Optimise bowel function before working on speeding up oestrogen detox. If bowel function is impaired, oestrogens will likely be reabsorbed due to beta glucuronidase activity. Consider stool testing for beta glucuronidase levels.

↓ activity with sprouted mung beans, optimising the intestinal flora etc. Optimise dietary fibre and hydration

• Very high levels of E1, E2, E3. Reduce oestrogens, avoid: Dairy, excess alcohol and caffeine, non-organic meat and eggs, water from plastic bottles, anti-perspirants, hormonal contraceptives.Oestrogen metabolites are going through the CYP34A (16-OH) pathway, which is strongly oestrogenic. Increase I3C (e.g. in broccoli sprouts) to push oestrogen down the 2-OH pathway (upregulating CYP1A1).
• Metabolised cortisol is high → high stress. Daily free cortisol is low, client may be experiencing adrenal insufficiency / exhaustion.
  Work on stress reduction / management ― regular meal times, switch to restorative exercise, optimise sleep, breathing work. Support adrenals with adaptogens (ashwagandha, liquorice), nervines (e.g. passionflower), magnesium.
• ↓ methylation activity can be caused by low levels of nutrients for methylation and / or SNPs (i.e. COMT, MTHFR). COMT requires magnesium and choline, betaine, folate and B12 to support SAMe production. COMT is slowed down by caffeine (avoid).

Support methylation with methyl factors (B12 as methylcobalamin, vitamin B6 as pyridoxal-5-phosphate, vitamin B2 as riboflavin-5-phosphate, B9 as methylfolate).

• Low progesterone levels, which are likely due to oestrogen dominance and high stress. Stress reduction, optimise sleep, increase vitamin A in diet, focus on addressing oestrogen dominance. Seed cycling.

Consider Agnus castus (Vitex) tincture to increase progesterone levels.

• Low testosterone levels (→ low libido?). High 5α reductase activity — more androgenic (→ acne). Increase: Zinc (inhibits 5α reductase), optimise sleep, reduce stress, reduce alcohol consumption, maca, shatavari.
• Low glutathione levels. Increase with: NAC, selenium, milk thistle, resveratrol, brassicas, etc.
• High oxidative stress marker — ↑ antioxidant rich foods.

Reduce: Exposure to environmental toxins, refined sugar, processed foods, etc.