I spent a whole day this week assessing the new DUTCH adrenal and hormone tests for us, so thought it might be useful for you if I put down my thoughts about them.
DUTCH stands for Dried Urine Test for Comprehensive Hormones and I’ve had them on the shop for quite a while for you – because you asked – but I always like to immerse myself in new tests to make sure we have the most up to date, valid and treatment-practical offering there for you. And so I can understand and help you with them, of course.
Anyway, my thoughts in case they are useful..this was the question I was really trying to answer for us:
If you want to test your adrenals or hormones, is it now better to use the DUTCH tests?
Well, yes and no.
In short, I think there is real value in the extra adrenal info you get (more of why below), but the hormone elements included in the DUTCH Complete, Sex & Metabolites and Cycle Mapping are pretty comparable to the ones we already do with Genova: the Complete Hormones and Rhythm respectively.
However, the DUTCH is much cheaper (when they do the combination tests), is dried urine so a bit more convenient than collecting 24 hours’ worth of urine and has a lot more guidance for people who are on meds and supplements like HRT to test effectively, and for those with irregular cycles – the bane of my life with the Rhythm!
On the down side, the reports are really complicated and even scared me until I ‘got’ them.
To clarify, there are several DUTCH tests:
The DUTCH Adrenal – which gives you the free cortisol in 4 measurements and total, the same as the Genova Adrenal Stress Test, but it also gives you the adrenal metabolites which can give you a much deeper picture if you need it.
DUTCH Sex & Metabolites – which gives you info on the sex hormones: oestrogen, progesterone and androgens (inc DHEAs and testosterone metabolites).
The DUTCH Complete – which gives you all of the adrenal and hormones as above. Sort of the new DUTCH Adrenal plus Genova’s Complete Hormones – much cheaper and the best all-round test for men and post menopause.
The DUTCH Cycle Mapping – this is the monthly cycle look at the hormones, much like the Genova Rhythm test we know and love.
The Dutch Complete with Cycle Mapping – all of the above! The most useful test in my view especially for women still having period cycles. And, of course, the most pricey – but far cheaper than the equivalent separate tests from Genova (which would be the Adrenal test, Complete Hormones and a Rhythm).
Phew. I am now going to be recommending the DUTCH Complete with or without Cycle Mapping because it gives you loads of the same and more info for less money than combined the Genova tests. And, I am recommending the DUTCH Adrenal test as a more complex look at those.
What’s the benefit of the adrenal metabolites?
The normal 4 sample saliva adrenal test is great at showing you the daily pattern of free cortisol – and you could only do that with saliva until DUTCH. Then, they discovered you could get comparable results from a dried urine sample too – although there hasn’t been anywhere near as much research to prove that and there has been a LOT of studies backing up the standard salivary test up to now, so both are probably valid.
The free cortisol and daily pattern gives you a good indication of what might be going wrong somewhere with your adrenals and, having done it for over a decade, I have found it very reliable. However, we have to acknowledge that free cortisol is a very small amount of what is actually available in the body so, in some cases, there might be something hidden going on.
In the DUTCH Adrenal, you also get the adrenal metabolites and an idea of inactive cortisone. Why is that important?
Well, say you had someone who looked on the normal adrenal test like their cortisol was low, you would think they had low production of cortisol. However, if you looked at the metabolised cortisol levels and they were high, that might suggest instead that their free cortisol – what’s measured in the normal adrenal test – was low but their overall total cortisol production was high. That could be important as someone might be actually making too much, or they might be not clearing it from the body well.
Of course the body doesn’t know the difference and high cortisol is high cortisol. High cortisol means inflammation, belly fat, stress etc.
Or, say someone was making a lot of the inactive cortisone. It might be that their free cortisol looks low but downstream their metabolites suggest the production looks OK in total. Then you see they are converting a lot of it to cortisone so that person is making enough cortisol itself but needs to stop converting so much of it.
I told you it was complicated!
Anyway, the upshot is that I think the extra metabolites info you get on DUTCH could prove very useful. It seems to me from reading what other US based practitioners are doing (it’s not quite so used in the UK yet – our Victoria is getting really good at it and was an early-adopter of it, I am pleased to say ) that they are using it for when people don’t respond to the normal adrenal protocols to dig a bit deeper. I think that is right, although I can see the usefulness of getting the extra info at the start too.
So, conclusion overall is that I will continue to offer the usual Genova salivary adrenal test which I think can give you a good snapshot – and all the protocols I’ve used in-clinic successfully for over a decade are in the corresponding Adrenal Plan for you – but offer the DUTCH for those who want a deeper look either at the beginning or later on.
There is, of course, quite a large difference in price too: £82 versus £179 (the DUTCH has just come down happily from £199).
With the sex hormones though, I will swap to DUTCH as you get the same info for much less money. Reports aren’t quite as good or useful but as long as we can interpret them, that’s fine!
My head hurts – hormones always do that to me, in more ways than one since I had flat adrenals, insulin resistance and PCOS 😉