How does DUTCH compare to other “spot” urine tests?
by Mark Newman, MS
Since we created and launched our Dried Urine Test for Comprehensive Hormones (DUTCH) 4 years ago, we’ve heard from so many of you, “DUTCH makes so much sense. Everybody should be doing this!” We agree, and it’s no surprise that similar tests are starting to pop up on the market. Naturally, a lot of providers ask us what is different and unique about our “4-spot urine” test compared to others. Obviously we don’t have exhaustive knowledge of how others are doing their testing, but here is a list of things believed to be unique to the original DUTCH:
- Unique method to accurately assess when “on” vaginal hormones – vaginal hormones may contaminate urine samples. Using a sophisticated extraction method, we are able to separate the contaminating hormones from the conjugated forms that are supposed to be in your urine. Every sample from a patient on vaginal hormones is run by this special method. Additionally, the sample is also run by yet another method that confirms that this clean-up step did in fact remove all of the contaminating hormone. This is truly advanced hormone testing!
- A unique weighted average of the four individual samples – The easiest way to combine four samples is to take an equal volume of each and mix them. This makes the analysis weight the most concentrated (least dilute) sample more than the others. Our process is more sophisticated. We use a volume of each sample that is inversely proportional to creatinine (which tells you how concentrated or dilute each sample is) to essentially take the same amount of hormone from each of the four. This gives a better representation of the entire day with less bias based on the different hydration status at different times. This is most important when patients are on HRT and the results may rise and fall throughout the day.
- Adjustments made based on creatinine’s relationship to age, height and weight – Creatinine corrects for hydration, but it is dependent on age, sex, height and weight. This can introduce some bias. We actually adjust the values based on creatinine’s known relationship with these variables (no other labs are known to correct for this bias). We have shown that this improves the correlation to 24-hour urine values. if you do not make this correction, particularly large people will have results that are lower than they really should be, and the opposite is true for smaller individuals with less muscles mass. These differences can be quite significant.
- More comprehensive progesterone metabolites – By measuring the alpha and beta metabolites of progesterone, we are able to have a more accurate reflection of overall progesterone status as well as improved information when patients are on oral progesterone (affords assessment of how much progesterone pushes down the a-pregnanolone pathway).
- Cycle Mapping – The DUTCH Complete works very well in most situations. When patients have had partial hysterectomies or ablations or are looking for more complete fertility-related information, one test is not enough. Our Cycle Mapping option allows for serial testing throughout the month. This is a one-of-a-kind test that can be combined with the DUTCH Complete to provide the ultimate test for premenopausal female patients.
- Extensive androgen (DHEA, testosterone) metabolite testing – most labs value estrogens enough to offer 2-OH, 4-OH, 16-OH and methylated estrogens. Less value seems to be placed on androgen metabolites. We particularly value the DHEA and androstenedione metabolites (etiocholanolone, androsterone).
- Etiocholanolone and androsterone are the most abundant metabolites, so they offer a fuller understanding of total production (especially when there is a situation where DHEAS may be preferentially preferred or reduced. Inflammation is an example of a situation in which the sulfation process is slowed making DHEAS a poor marker for overall production without considering the more abundant metabolites
- Etiocholanolone and androsterone (as well as 5a/5b-androstanediol, the testosterone metabolites) give information about any potential 5a-reductase preference which leads to DHT production.
- Measuring epi-testosterone helps give insight into testosterone supplementation and when there may be a phase II metabolism issue with testosterone.
- The most advanced reporting – You can certainly choose what hormone reporting format you prefer. We have attempted to make our report as easy to read as possible (given the complex nature of these types of results). We have gone a step further by embedding videos directly in the reports leading to instructional tutorials to assist you in interpreting the report. We also have specific tutorials to assist with particularly difficult scenarios.
- Most labs testing urine for hormones pick either LC-MS/MS or GC-MS for their analysis. Each has its benefits and drawbacks. To be brief, LC-MS/MS usually works better for polar compounds like cortisol and its metabolites. GC assays separate very similar compounds much better than LC options, and we’ve found androgen and estrogen metabolies perform better with the GC option (having developed all tests both ways). We use both GC-MS/MS (for estrogen, androgen and progesterone metabolites) and multiple LC-MS/MS assays (four different assays for the four free cortisol measurements as well as separate tests for melatonin and cortisol metabolites). This is far more difficult (and costly if the assays are not highly efficient) than typical analysis strategy based on one instrument type, but we’ve found it optimal for achieving the highest level of precision and accuracy for all of the hormones we test.
- Cost-effective – Precision Analytical is committed to giving you the most cost-effective pricing. Patients paying us directly have the option of receiving and insurance receipt (with ICD-10 and CPT codes) and usually get about 50-75% reimbursement. This brings the total out-of-pocket cost impressively low (often less than $100).
Expertise and Focus
- Hormone testing can be challenging. DUTCH testing is particularly challenging with the limited sample size and diversity of measurements. Because of the myriad of challenges in this highly sophisticated test, our entire focus is dedicated to making DUTCH the most accurate, precise, comprehensive and coherent hormone test available! Precision Analytical also offers a customized clinical overview from our Medical Director (Dr. Carrie Jones) on every provider’s first DUTCH test. We are committed to helping you understand DUTCH results and make the best decisions for your patients.
Mark Newman, President