Can the DUTCH Test answer my hormonal questions?
When it comes to testing hormone levels, we’ve gotten mixed messages. Some health specialists advocate for blood-sample hormone testing, while others say a person’s hormones fluctuate throughout the day, making it hard to get a good read.
When I heard about the DUTCH Test I became curious about how it works and whether it could provide insights about my own peri- and menopausal hormonal woes.
The hot topic of “hormonal imbalance”
Hormones dominate discussions in my friend group, on social media, in mom playdate groups, and community forums. Headlines, comments, and even some research say that hormone shifts in midlife are the reason why so many women feel burned out, exhausted, and stressed.
While previous generations may have considered energy changes “normal” for a woman trying to manage her career, family, and social life, more of us now think maybe we’re not supposed to feel like a constantly sinking ship — even in the midst of postpartum, child rearing, or menopause.
I’ve learned that leaders in the menopause medical community dislike the term “hormonal imbalance” because it’s vague and lacks a specific clinical definition. While hormonal imbalances can cause various health problems related to metabolism, mood, sleep, or reproductive health, the term doesn’t pinpoint a specific hormone problem that can be easily identified and treated.
What is the DUTCH Test?
DUTCH is an acronym for Dried Urine Test for Comprehensive Hormones. Men and women can take the test, but for our purposes, I’ll refer only to a woman’s experience with the test. The instructions will change based on whether you are cycling premenopausal, meaning that you are still having menstrual cycles and are not in menopause, or postmenopausal. Not sure if you’re in perimenopause, premenopause, or postmenopause? Read this.
Dried urine is the key component of the DUTCH test. You’ll collect your pee four different times on a small sheet of filter paper over the course of two days. The paper is left out to dry after each sample, hence it’s a “dried urine test”.
Urine collection timing is believed to be imperative to test accuracy. The math is a little tricky, but starting collection 9-12 days prior to the end of a menstrual cycle is crucial. Premenopausal women with a 28-day cycle collect on days 19 and 22.
Have a shorter cycle? A woman with a 26-day cycle would collect between days 17 and 20. Alternatively, with a 30-day cycle, collect between days 21 and 24. Have an irregular cycle? The creators of the DUTCH Test have an entire video on how to handle your collection. Postmenopausal women can collect on any day.
Collection time is also important. On collection day one, you will need to collect at exactly 5 pm. Avoid drinking fluids two hours before depositing urine on the filter, and strictly avoid caffeine, alcohol, or large fluid intake after lunch.
Just a few hours after the first foray into peeing on filter paper, you get to try again at your bedtime collection, around 10pm. A glass of wine with dinner is allowed; the only stipulation is that you do not drink fluids for two hours prior to collection.For some of us insomniacs, day two begins not long after the clock strikes midnight. You’re advised to collect an extra overnight sample at your first waking sleep disturbance. Within ten minutes of fully waking up for the day, quickly collect a rising sample
With sample three out of the way, you only have one left. Unfortunately, no alcohol, caffeine, or more than one cup of fluid is allowed between your rising collection and your final sample. You’ll need to soak your last swatch of filter paper two hours after waking up.
Along with these helpfully detailed instructions, there are a variety of tips on what to do if you miss a sample or have a shy bladder come collection time. The most comprehensive version of the test, DUTCH Complete, recommends removing certain foods and supplements from your diet two days before and during the collection period.
Why complete the rigorous DUTCH Test?
Professionals can measure the hormone metabolites found in the urine collections. The measurable hormones include:
- Cortisol
- Cortisone
- DHEA
- Estradiol
- Estrone
- Estriol
- Progesterone
- Melatonin
- Testosterone
The DUTCH Test is also said to measure the rhythms and the levels of cortisol and cortisone. Estrogen metabolism pathways — how estrogen is detoxified and excreted from your body — are also reportedly discernible.
Dr. Tara Brandner, DNP, FNP-C, notes that the test can show what is “bioavailable,” which refers to a substance’s ability to be broken down and used by the body. She says that “urine is the breakdown” of what has been absorbed and excreted by your body already, instead of a glimpse of what substances are in your saliva or blood.
These hormone levels may be incredibly insightful for someone trained in reading the DUTCH Test. Especially considering that it can give an expansive overview of a woman’s hormones while blood or saliva tests primarily focus on the specific amount of a hormone, not how well your body can process the hormone as indicated by fluctuations over time.
“I prefer using [the Dutch Test] over other hormone testing methods (blood or saliva) because what is measured in the blood doesn’t necessarily reflect what is able to get into the cells,” says Jaclyn Downs, a functional nutrigenomics practitioner. “There may be cell receptor issues, which is like the hormones not being able to unlock the cell wall door to get inside. Your urine is able to show you what has been utilized by the body and now is getting cleared by the body.”
One of the more prominent DUTCH Test manufacturers notes that measuring cortisol metabolites is the major difference between the DUTCH test and other tests. Measuring free and metabolized cortisol throughout the day instead of one snapshot of a patient’s cortisol levels helps provide a broader scope of an individual’s hormone levels and how they change throughout the day.
“It is not one isolated snapshot, as there are four or five different samples taken over a period of about a day, so you can see how your levels may fluctuate,” Down says.
The DUTCH Test is supposed to be able to assist with a host of physical issues. For example, DHEA levels can indicate how you feel emotionally and mentally. Low production is thought to cause depression, fatigue, reduced mood, lower bone density, muscle mass, and immunity. The number of adrenal and reproductive hormones assessed in the test is believed to help experts recognize fertility issues, PCOS, and endometriosis. The results may indicate why a woman is experiencing painful or irregular periods, moodiness, PMS, anxiety, or menopausal issues. The test claims to provide a clearer picture of your hormonal balance and all the ways it can affect you physically, mentally, and emotionally.
That is, only if you have someone who can read the results and make informed dietary and lifestyle suggestions.
DUTCH Test drawbacks?
While there are no physical or mental drawbacks to taking the DUTCH, many conventional medical doctors are skeptical about the need for it. They don’t doubt that the test does what it says. Instead, they question how useful the test is and whether or not it would ever be medically indicated.
The DUTCH test is predominantly used by experts in the alternative medical field, like — think naturopaths, functional doctors, and holistic practitioners. My friends who have used the test didn’t do so on their own, but with the guidance of medical professionals who typically “strive to find the root cause of disease and ailments, instead of solely treating the symptoms”.
Those who question the DUTCH cite that few studies prove the usefulness of metabolites, especially estrogen, and help us understand what the specific levels mean. That doesn’t mean that conventional doctors don’t value hormone levels. However, in most cases, they typically need a valid clinical indication that a specific hormone level needs to be checked, rather than checking them all with a comprehensive test without any indication that it’s required.
In short, conventional medicine could argue there’s no medical indication that the DUTCH Test is necessary — that it’s essentially probing for problems when there might not be any. Some go so far as to say it’s only a tool for functional doctors to be able to sell you supplements, like personalized compounded hormones. Gynecologist and The Menopause Manifesto author Dr. Jen Gunter is in this camp.
“The DUTCH Test is clinically meaningless for menopause and should not be used to evaluate menopausal status or to guide menopausal hormone therapy,” says Dr. Gunter. “In fact, no hormone testing is needed to guide menopausal hormone therapy. This is not just my opinion, but the recommendation of the major medical societies.”
A few of the women I know have said that the DUTCH test has helped with their menopause, and others, their fertility. I don’t doubt their statements, and many conventional doctors likely don’t want to minimize people’s experiences with the DUTCH Test.
The only other drawback to the test is that it is not covered by insurance, and the comprehensive version will often cost a couple hundred dollars. “Cost is the biggest [limitation],” Dr. Brandner says. “Patients have to pay upfront.”
What’s a woman to do?
Conventional medicine is improving, but historically it’s been a rough place for women experiencing things like hormonal shifts, menopause, and period problems. At one point or another, we all likely felt unheard, or that our concerns had been brushed off. I completely understand the compelling need to find answers. Dr. Brandner agrees.
“Medical technology is advancing at a fast pace and new tests are being produced now more than ever,” she says. “We know from medical research these diseases exist and it’s simply a matter of different views and perspectives on approaching healthcare.”
If you’re open to learning more about hormonal conditions and solutions, the DUTCH Test could give you clarity, and suggest new dietary or lifestyle suggestions to try. Alternatively, you may feel that its lack of validation with the conventional medicine community means it isn’t worth spending the money or effort on the DUTCH.
Ultimately, it’s up to you to decide.
Can you order a DUTCH test at home?
Yes, apparently you can — we found this one. We have not tried it, but let us know if you do.
This article represents the opinion and experience of the author, Megan Moore. The Midst is a collective of independent voices.
A version of this story was originally published here on The Midst Substack in 2023.
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