Written by Georgie France, Naturopath & Herbalist @ Urban Herbalist

Why hormone testing? 

Whether we like it or not, hormones play an important role in the body- they’re chemical messengers that travel throughout the body, which control bodily functions such as growth, metabolism, sex drive, cognitive function, mood, appetite, body temperature etc. In order for the body to function optimally, hormone balance is fundamental. However, when our hormones become unbalanced, this is when many health issues may arise.    

Let's face it - hormones can be very confusing. It can be difficult to know what is going on with your body if you are experiencing a variety of symptoms. Painful periods, acne, irregular menstrual cycles, weight gain, depression, anxiety and low libido are just some of the common symptoms of hormone imbalance. The simplest way to understand what the imbalance is is to test your hormones. This information provides both you and your practitioner with great insight into any underlying hormonal imbalances that may be impacting your health. From there, your health practitioner can make an informed treatment plan to restore hormone balance- and in turn improve your overall wellbeing.

 

What are my options?

D.U.T.C.H Testing

The DUTCH test (or Dried Urine Test for Comprehensive Hormones) is the gold standard when it comes to shedding light on your hormones and is used extensively by functional medicine practitioners throughout the world. It is a simple dried urine test that you can complete in your own home. It provides an extensive amount of information on hormones and how these are metabolised in the body. There are a range of DUTCH tests, which provide different information and are suitable for a wide range of conditions. DUTCH tests are designed to be used in conjunction with seeing a qualified practitioner in order to give you the most information out of them. 

 

 

D.U.T.C.H Complete

This test is perhaps the most popular of the range. It is comprised of five dried urine samples over a 24 hour period- waking, 2 hours after waking, dinner time, bed time and an extra overnight sample if needed. The test is usually performed on the 20th day of the menstruating women's cycle (or adjusted for longer or shorter periods)  or any day for men. It represents an entire days of reproductive hormone production and their metabolites, as well as cortisol, melatonin and organic acids (Includes markers for vitamin B12, vitamin B6, glutathione, dopamine, norepinephrine and more). 

DUTCH Complete is useful for:

For those who’s cycles follow the expected pattern (same number of days every cycle) , but experience hormonal related symptoms.

For those who want to see how their hormones are being metabolised

Post menopausal and pre menopausal women

Men (can also choose the DUTCH plus)

 

See sample report 

  

D.U.T.C.H. Plus

Equivalent test to the DUTCH complete, with added cortisol-awakening response (CAR). This test uses both Dried Urine as well as Saliva Tests to go even deeper into the stress response, which is particularly useful for those who have major issues with stress or depression. Cortisol levels naturally begin to rise as we wake up. After 30 minutes, cortisol levels will still show this sharp increase and by 60 minutes, cortisol levels will have peaked and begin to decline. By measuring this rise and fall of cortisol when waking, it can then be used as a “mini stress test”. This test provides a deeper insight into HPA-axis function, which relates to how the body responds to stress.  

DUTCH Plus or Cycle Mapping Plus is useful in (to show either a low or elevated Cortisol Awakening Response)

• Psychological burnout
• Seasonal affective disorder
• Sleep apnoea
• Poor sleep
• PTSD
• Chronic fatigue
• Chronic pain
• Ongoing job-related stress
• Glycemic dysregulation
• Pain
• Depression

 

Sample Report

 

D.U.T.C.H Cycle Mapping

For some women, testing reproductive hormones on a single day is not sufficient. In order to capture the whole clinical picture, their hormones need to be mapped out throughout their menstrual cycle. The expected pattern of hormones shows a relatively low level of estrogen early on in the cycle, which then increases around ovulation and lowers towards the last third of the cycle (the luteal phase). Progesterone levels stay relatively low until after ovulation, which ideally increase 10-fold and then drop again at the end of the cycle. Any changes to this normal cycle can then lead to infertility or hormonal imbalance. Cycle mapping plus can be chosen if CAR is needed.

DUTCH Cycle Mapping is useful for:

• When struggling with infertility
• When experiencing issues on the Mirena IUD
• For women who experience cycling hormones, but no periods
• Polycystic Ovarian Syndrome (as periods can be irregular or absent)
• Unsure when to test due to changing days of cycles
• When suffering mid-cycle spotting, migraines etc.
• When hormonal symptoms fluctuate throughout the cycle
• Partial hysterectomy (ovaries intact, but no uterus)

 

 Sample Report

 

 

EVE Complete 

The EVE Test is a new test offered by Eve Wellness, by BePure. It is also a home kit, which can be purchased online or in selected health stores and pharmacies. The EVE test will measure 18 different sex hormones. However, it does not measure stress hormones, melatonin or organic acid tests, which are all important in giving a clearer picture.

Sample report

 

Conventional Serum Lab Tests

You can ask your practitioner or Doctor to give you a form to take to Lab Tests to test your reproductive hormones such as follicle stimulating hormone (FSH), luteinising hormone (LH), progesterone, oestradiol, testosterone, sex hormone binding globulin (SHBG), prolactin and human chorionic gonadotropin (hCG). These hormone tests can provide insight into amenorrhoea (absence of a menstrual period), confirming pregnancy, menopause, PCOS, sub-fertility (in both males and females), as well as delayed puberty in males, plus more (Ogilvie, O’Sullivan, & Kyle, 2013). However, serum hormone tests do have their limitations. Cortisol cannot be tested throughout the day (this requires a 24 hour free cortisol urine test). There is also a lack of extensive metabolite testing, such as cortisol and estrogens.

Prices: Variable. Some are fully funded and some are not. You can see a list of test that are available here

What other tests are useful in conjunction with hormone tests?

Thyroid function tests

 

• An underactive thyroid can interfere with ovulation, impairing fertility. Thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) blood tests are useful to provide more information about a possible root cause for fertility problems or hormonal conditions. These can be done through your GP. 
• Tracking your basal body temperature is another way of monitoring your thyroid function- ask one of our practitioners for more info.

 

Random blood glucose

• Women with polycystic ovarian syndrome (PCOS) also tend to have high levels of insulin in their blood, or insulin resistance. A fasting blood glucose test measures your blood sugar after you haven’t eaten for at least 8 hours- this provides a valuable clue to whether or not PCOS may be a factor for you. HBA1C is another important marker which gives you an indication of how high your blood sugar levels were in over the last three months.

 

Ovulation tests

• Ovulation tests work by detecting a rise in luteinising hormone in your urine. A rise in LH signals the ovary to release the egg, therefore these tests can be used to help predict when ovulation is likely to occur. Ovulation tests can be used to help you plan to become pregnant, or as a way to see if you are in fact ovulating- providing insight to any potential hormonal imbalances (Jacobson, 2019). Ovulation can also be tested by checking basal body temperature during the cycle, as a small rise halfway through the cycle will indicate presence of increased progesterone and hence ovulation.

 

Hormone testing for men

The DUTCH test offers a comprehensive view for men’s health. A lot of the time, the focus it to only increase testosterone, however, other hormones play key roles in symptoms such as abdominal weight gain, fatigue, male pattern baldness, insomnia, depression and more. The DUTCH test provides insights into multiple androgens such as testosterone, androsterone, etiocholanolone, DHEA-S and 5a-DHT. It also looks into cortisol and melatonin levels, which both play important roles in spermatogenesis (sperm production) and testosterone production. Blood tests measuring testosterone can also be used, however, it isn’t possible to test for many of the androgens and metabolites.

 

Hormone Testing Comparison

 

Progesterone Metabolites	DUTCH Complete	DUTCH Plus	DUTCH Cycle Mapping	DUTCH Cycle Mapping Plus	The Eve Complete	Blood Tests
b-Pregnanediol	✔	✔	✔	✔	✔	✔
a-Pregnanediol	✔	✔	✔	✔	✔	✔

 

Androgen Metabolites	DUTCH Complete	DUTCH Plus	DUTCH Cycle Mapping	DUTCH Cycle Mapping Plus	The Eve Complete	Blood Tests
DHEA-S	✔	✔	✔	✔	✔ *DHEA only	✔
Androsterone	✔	✔	✔	✔	✔
Eitocholanolone	✔	✔	✔	✔	✔
Testosterone	✔	✔	✔	✔	✔	✔
5a-DHT	✔	✔	✔	✔	✔ *DHT
5a-Androstanediol	✔	✔	✔	✔	✔
5b-Androstanediol	✔	✔	✔	✔	✔
Epi-Testosterone	✔	✔	✔	✔	✔

 

Estrogen Metabolites	DUTCH Complete	DUTCH Plus	DUTCH Cycle Mapping	DUTCH Cycle Mapping Plus	The Eve Complete	Blood Tests
Estrone (E1)	✔	✔	✔	✔	✔
Estradiol (E2)	✔	✔	✔	✔	✔	✔
Estriol (E3)	✔	✔	✔	✔	✔
2-Hydroxyestrone (2-OH-E1)	✔	✔	✔	✔	✔
4- Hydroxyestrone (4-OH-E1)	✔	✔	✔	✔	✔
16-Hydroxyestrone (16-OH-E1)	✔	✔	✔	✔	✔
2-Methoxyestrone (2-Methoxy-E1)	✔	✔	✔	✔	✔
2-Methoxyestradiol (2-Methoxy-E2)	✔	✔	✔	✔	✔
2- Hydroxyestradiol (2-OH-E2)	✔	✔			✔
4- Hydroxyestradiol  (4-OH-E2)	✔	✔			✔
Nine targeted estrogen and progesterone measurements			✔	✔

 

Cortisol and Cortisone	DUTCH Complete	DUTCH Plus	DUTCH Cycle Mapping	DUTCH Cycle Mapping Plus	The Eve Complete	Blood Tests
Cortisol Awakening Response (CAR)		✔		✔
Diurnal Pattern of Free Cortisol	✔	✔	✔	✔
Diurnal Pattern of Free Cortisone	✔	✔	✔	✔
Optional Insomnia Sample		✔		✔
a-Tetrahydrocortisol (a-THF)	✔	✔	✔	✔
b-Tetrahydrocortisol (b-THF)	✔	✔	✔	✔
B-Tetrahydrocortisone (b-THE)	✔	✔	✔	✔
Metabolised Cortisol (THF + THE)	✔	✔	✔	✔

 

 

Extras	DUTCH Complete	DUTCH Plus	DUTCH Cycle Mapping	DUTCH Cycle Mapping Plus	The Eve Complete	Blood Tests
Organic Acids (Includes markers for vitamin B12, vitamin B6, glutathione, dopamine and norepinephrine)	✔	✔	✔	✔
8-OHdG (Oxidative Stress and DNA Damage Marker)	✔	✔	✔	✔
Melatonin	✔	✔	✔	✔

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References:

 

Figure 1. DUTCH Testing Graph. Retrieved from Doctors Studio, by Lisbeth Roy, 2019, from https://doctorsstudio.com/dutch-testing/

Figure 3. How does your mood change across your menstrual cycle? Retrieved from Jennis, by Danielle Welton, 2021, from https://www.jennisfitness.com/blog/cyclemapping/how-does-your-mood-change-across-your-menstrual-cycle/  

Jacobson, J. (2019). Ovulation home test. Retrieved from https://medlineplus.gov/ency/article/007062.htm

 

Ogilvie, M., O’Sullivan, S., & Kyle, C. (2013). Reproductive hormones: The right test, at the right time, for the right patient. Best Tests, February 2013. Retrieved from https://bpac.org.nz/BT/2013/February/02_hormones.aspx

 

Precision Analytical Inc. (2021). DUTCH- Dried Urine Test For Comprehensive Hormones. Retrieved from https://dutchtest.com/