How Does DUTCH Compare to Other Spot Urine Tests?
by Mark Newman, MS
Since the launch of the DUTCH (dried urine test for comprehensive hormones) Test more than ten years ago, we’ve had the opportunity to help providers profoundly change the lives of thousands of patients. It comes as no surprise that tests similar to the DUTCH Test are starting to pop up on the market.
Naturally, many providers are curious about what sets the DUTCH four-spot urine test apart from the other tests available. Comprehensive patient reports, clinical support and education, and peer-reviewed and validated research make the DUTCH Test stand out as the ultimate tool for evaluating sex and adrenal hormones and their metabolites.
DUTCH Testing Methodology
Most labs that test hormone metabolites in urine use either LC-MS/MS or GC-MS/MS assays for their analysis. Each has its benefits and drawbacks. LC-MS/MS assays usually work better for polar compounds like cortisol and its metabolites. GC-MS/MS assays separate very similar compounds much better than LC options, and androgen and estrogen metabolites are measured more effectively with the GC option.
DUTCH uses both GC-MS/MS (for estrogen, androgen, and progesterone metabolites) and multiple LC-MS/MS assays (for each of the four free cortisol measurements, as well as separate tests for melatonin and cortisol metabolites).
While utilizing both of these assay methods is more difficult than typical analysis strategy, it’s optimal for achieving the highest level of precision and accuracy for all of the available DUTCH Test markers. Providers and patients can be assured that the DUTCH Test is reliable and a dependable tool for evaluating hormones.
Assessing Patients Taking Vaginal Hormones
There are other ways in which DUTCH methodology stands apart from the other hormone tests available. DUTCH uses a unique method to accurately assess patients taking vaginal hormones. Vaginal hormones may contaminate urine samples. Using a sophisticated extraction method, DUTCH is able to separate contaminating hormones from the conjugated forms that are naturally seen in urine.
Every sample from a patient taking vaginal hormones is run through this special method. Additionally, these samples are also run by yet another method to confirm that the extraction step successfully removed all the contaminating hormones. This is truly advanced hormone testing.
Weighted Averages of Urine Samples
The DUTCH Test uses a unique, weighted average of the four individual urine samples to produce each DUTCH report. The easiest way to combine four samples is to take an equal volume of each and mix them. This means the analysis of those samples weighs the most concentrated sample more than the others.
The DUTCH process is more sophisticated. Our analysis uses a volume of each sample that is inversely proportional to creatinine (which tells you how concentrated or dilute each sample is) to extract the same amount of hormone from each of the four samples. This results in a more accurate representation of hormone production with less bias from the patient’s hydration status. This is most important when patients are on hormone replacement therapy (HRT) and their hormone levels may rise and fall throughout the day.
Creatinine Adjustments Based on Age, Height, and Weight
Creatinine levels are evaluated to correct for hydration status, but creatinine is dependent on age, sex, height, and weight. This can introduce some bias. The DUTCH Test adjusts results based on creatinine’s known relationship with these variables. No other labs are known to correct for this bias. These adjustments improve the correlation of the DUTCH Test to 24-hour urine tests.
Comprehensive Patient Reports
Just like the name implies, the DUTCH Test is truly a comprehensive look into a patient’s hormone health. Each DUTCH report gives providers actionable results so they can develop more effective treatment plans and solve their patients’ complex hormone problems. We can accomplish this by offering the most extensive profile of sex and adrenal hormones along with their metabolites.
More Comprehensive Progesterone Metabolites
The DUTCH Test measures both the alpha and beta metabolites of progesterone. Measuring both progesterone metabolites yields a more accurate reflection of overall progesterone status. This is especially helpful when monitoring patients taking oral progesterone, as the DUTCH Test can assess how much progesterone is pushed down the a-pregnanolone pathway.
Month-Long Hormone Monitoring with DUTCH Cycle Mapping™
When patients have had partial hysterectomies or ablations or are looking for more complete fertility information, a one-time test is not enough. DUTCH Cycle Mapping allows for serial testing throughout the month. This is a one-of-a-kind test that can be combined with either the DUTCH Complete™ or DUTCH Plus® to provide the ultimate test for premenopausal female patients.
Extensive Androgen Metabolite Testing
Most labs value estrogens enough to offer 2-OH, 4-OH, 16-OH, and methylated estrogen analytes. Less value is placed on androgen metabolites. We particularly value the DHEA and androstenedione metabolites (etiocholanolone, androsterone). Here’s why:
- Etiocholanolone and androsterone are the most abundant androgen metabolites, and they offer insight into total production.
- Etiocholanolone and androsterone, as well as 5a/5b-androstanediol (the testosterone metabolites) give information about any potential 5a-reductase preference leading to DHT production.
The DUTCH Test also measures epi-testosterone. This analyte can be used to evaluate testosterone supplementation and potential phase II metabolism issues with testosterone.
Clinical Support and Education
Hormone testing and interpretation are not always utilized in traditional medicine. Some providers might feel they need a re-education about all things hormones and hormone metabolism to better serve their patients with hormone-related issues. That’s where DUTCH truly shines.
At Precision Analytical, we know providers are yearning to profoundly change their patients’ lives. And with some additional support from the expert clinical educators at DUTCH and exclusive educational resources, we believe we can help providers offer transformative care to their patients.
Our team of clinical educators is available to answer questions about individual DUTCH Test results and offer additional support through one-on-one and group mentorship sessions. DUTCH clinical educators are all integrative medicine practitioners themselves and have worked with patients with a variety of hormone-related symptoms.
Providers can further deepen their knowledge about hormones through any of our DUTCH Education offerings. Each month, providers have access to free webinars and newsletters full of educational materials. Plus, registered DUTCH providers have exclusive access to our Mastering Functional Hormone Testing course and the DUTCH Interpretive Guide. Providers who actively engage with these educational resources will build confidence in using the DUTCH Test in their practice.
Peer-Reviewed and Validated Research
Our rigorous pursuit of the truth in hormone testing has resulted in several publications proving the efficacy of dried urine testing as an alternative to serum or saliva for monitoring patients on HRT. We pride ourselves on relentlessly pursuing the most accurate and precise hormone testing techniques. This quest for excellence in hormone testing resulted in Precision Analytical being the first specialty lab to present research on dried urine testing to the North American Menopause Society (NAMS).
We encourage all those interested in learning more about our commitment to industry-leading research to visit our research page. There you can view recently published studies and read summaries of our research endeavors.
For more than ten years, DUTCH has been a leader in sex and adrenal hormone testing. Our comprehensive patient reports, clinical support and education, and peer-reviewed and validated research set DUTCH apart from other four-spot urine tests. Providers and patients can rely on DUTCH to deliver precise and accurate results that pave the way for healing.