What Does DUTCH Test? 4 Groups of Hormones, Metabolites, & Other Biomarkers

edited by Hilary Miller, ND

Traditionally, hormone testing can help patients with hormone related symptoms find the right lifestyle or treatment options. But increasingly, patients and providers are finding that sometimes traditional tests are “normal”, but symptoms are clearly not normal. This is why Precision Analytical designed the DUTCH Test. The DUTCH Test is a comprehensive sex and adrenal hormone test that includes metabolites and organic acids to bring patient hormone status into focus.  

DUTCH testing makes it easier for patients and their healthcare providers to find answers to complex clinical questions through industry-leading functional hormone testing and education. In their active form, hormones act as chemical messengers to control, facilitate, or trigger various processes in the body. As active hormones complete their work and new hormones are produced, theyneed to be cleared from the body (often via the urine). The process of production and removal is how the body regulates hormone actions to optimize health. 

Steroid hormones do not pass directly into the urine in their active forms. Instead, they must first be tagged, processed, or broken down in the liver and kidneys to form smaller, water-soluble particles (known as metabolites) that can be excreted. Each hormone has a major pathway (the pathway that is most commonly used), and some minor pathways, which serve as alternative pathways, if needed. Sometimes, different pathways lead to different types of metabolites, which can be harmful if produced in excess. Understanding hormone metabolism is one important reason to use the DUTCH test. 

Metabolites are sometimes difficult to detect with traditional methods, but their levels can be important indicators or risk factors for certain conditions. Urine testing is the best method for testing reproductive hormone metabolites. Testing these metabolites can give healthcare practitioners an in-depth picture of why their patients’ overall hormones are elevated, lacking, or point toward specific symptoms. 

What does DUTCH test? 

Estrogens, Progesterone, and Androgens

Progesterone: 

• b-Pregnanediol (major pathway) 
• a-Pregnanediol (minor pathway, can influence mood) 

Estrogens: 

• Estrone (E1) (weak estrogen, abundant) 
• Estradiol (E2) (strongest estrogen) 
• Estriol (E3 aka 16OHE2) (weak, anti-inflammatory) 
• 2-Hydroxyestrone (2-OHE1) (beneficial detox pathway) 
• 4-Hydroxyestrone (4-OHE1) (genotoxic detox pathway) 
• 16-Hydroxyestrone (16-OHE1) (weak estrogenic pathway) 
• 2-Methoxyestrone (2-MeOE1) (neutral, beneficial pathway) 
• 2-Hydroxyestradiol (2-OHE2) (beneficial detox pathway) 
• 4-Hydroxyestradiol (4-OHE2) (genotoxic detox pathway) 

Androgens: 

• DHEA-S (Adrenal androgen) 
• Androsterone (5a-reductase adrenal androgen metabolite) 
• Etiocholanolone (5b-reductase adrenal androgen metabolite) 
• Testosterone (Adrenal/ovarian/testicular androgen) 
• 5a-DHT (most potent androgen, 5a-reductase metabolite of testosterone) 
• 5a-Androstanediol (metabolite of 5a-DHT, better reflects tissue 5a-DHT) 
• Epi-Testosterone (testosterone epimer, gives insight into testosterone production) 

Progesterone is reflected in urine in the two urinary metabolites alpha and beta pregnanediol. The beta pathway is the major pathway. The minor alpha pathway reflects the production of alpha metabolites which contribute to progesterone's well-known impacts on mood.  

The DUTCH test also measures the parent estrogens estrone (E1) and estradiol (E2). The downstream estrogen metabolites measured on the DUTCH Test indicate a patient’s phase 1 estrogen detoxification status (also called hydroxylation) and phase 2 estrogen detoxification (methylation) status. The 2-hydroxy pathway is the most common and healthiest pathway for detox. The 4-OHpathway creates unstable, genotoxic metabolites which have been linked to increased breast cancer risk. The 16-OH pathway metabolites have estrogenic activity which has been linked to greater estrogen-related issues.  

Progesterone is important for balancing and modulating estrogen’s actions. Understanding both estrogen and progesterone in the body can help providers understand estrogen-related cancer risk, autoimmunity, PMS, and fertility issues in their patients. Knowing these pathways can also assist the practitioner with potential suggestions for diet and lifestyle modification, supplementation, or hormone replacement therapy. 

Androgens and androgen metabolites help determine the activity of 5a- and 5b-reductase. The more androgenic 5a-pathway can be useful to understand when working with men who experience male pattern baldness, cystic acne, and prostate issues. Women might experience cystic acne, female pattern baldness, hirsutism and PCOS when their metabolism favors the 5a- pathway. 

Adrenal Metabolites and Biomarkers

DUTCH adrenal testing includes many more important markers than tested in blood or saliva. The DUTCH Test includes eight adrenal analytes so providers can evaluate the health of their patients’ HPA axis. 

 Adrenal Metabolites:

• Cortisol awakening response (CAR) 
• Diurnal pattern of free cortisol 
• Diurnal pattern of free cortisone 
• Optional extra cortisol sample 
• a-THF 
• b-THF 
• b-THE 
• Metabolized cortisol (THF+THE) 

Free cortisol is the active form of the hormone which binds to receptors and turns them on. Testing free cortisol helps understand the circadian rhythm and answers questions about a patient’s low energy and sleep trouble. Metabolized cortisol is an indication of total cortisol production and metabolized through the liver in one day. This marker is specific to urine testing and cannot be found in blood or saliva testing. 

The DUTCH Test includes metabolized cortisol because it can be greatly influenced by cases of hypothyroidism, hyperthyroidism, obesity, inflammation, insulin resistance, infection, poor liver function, anorexia, critical illness, and more. Cortisone is the inactive form of cortisol. Testing this hormone provides a secondary look at the circadian rhythm. It is also helpful to understand as some people are more prone to the deactivation of cortisol into cortisone which can further their symptoms of fatigue. 

By looking at the entire adrenal picture with DUTCH testing, healthcare practitioners have a much more comprehensive look into the health of their patient’s cortisol production and response to help them achieve their goals.

Organic Acid Tests (OATS)

Organic acid tests (OATS) make up the last portion of the DUTCH Test. They include nutritional (B6, B12, biotin) and neurotransmitter metabolites (dopamine and epinephrine/norepinephrine), as well as markers for neuroinflammation (quinolinate), oxidative stress (glutathione, 8-OHdG), gut health (indican), and melatonin. 

Some symptoms can have multiple root causes, and the organic acids are chosen to support the hormones, metabolism, and symptoms that might be of interest. For example, some patients with hair loss may suspect androgens or cortisol, but low biotin can also contribute to hair loss. In this way, OATs can round out hormone testing, providing additional information about the nutritional status, gut, and brain health of a patient. Testing organic acids gives healthcare practitioners an even more comprehensive understanding of their patients’ overall health.

Different DUTCH Test panels offer different combinations of analytes. Take a moment to read about the analytes available on each of the DUTCH panels. You can view a side-by-side comparison of the DUTCH Complete™ , the DUTCH Plus® , DUTCH OATs , DUTCH Cycle Mapping™ , and DUTCH Cycle Mapping™ Plus in the Practitioners Resource Guide available for download through the provider portal. 

Become a DUTCH Provider to gain access to comprehensive patient reports, expert clinical support, and validated and peer-reviewed research.