Natural Health and Wellness for the Whole Family

The Importance of Assessing Hormone Metabolism: the DUTCH test

By Sarah Axtell, ND May 8, 2020

So many women struggle with PMS, debilitating menopausal symptoms, weight gain, breast tenderness, and cramps. While these are common symptoms, they are not normal or optimal. Rather than simply take the pill to mask the symptoms, our goal as NDs is to identify and address the root cause. To determine root cause, this is where hormone testing comes in.

Saliva testing

We commonly order salivary hormone testing to assess cortisol (stress hormone) and sex hormones, such as estrogen, progesterone, and testosterone. Salivary testing is the gold standard for assessing cortisol. It is also a much preferred way to assess female hormones over serum (blood testing) because it tests the free, active hormones that aren’t bound to proteins.

Urine testing- DUTCH

An additional way to test for hormone imbalances is the DUTCH test. DUTCH stands for Dried Urine Test for Comprehensive Hormones

The DUTCH test is a urine test that measures hormone metabolites. This is especially important when monitoring women on hormone replacement therapy to determine if they are properly detoxing these hormones. It can also provide useful information for women struggling with the common hormonal woes, such as PMS, cramps, and weight gain.

Why test hormone metabolites?

Measuring hormone metabolites gives us insight as to how well your body is detoxing hormones. This is especially important in cases of personal or family history of breast cancer or other hormone sensitive cancers. It can also explain why you have difficulty losing weight or why you are struggling with so many hot flashes (as compared to your friend who is soaring through menopause…frustrating!).

We have 3 primary estrogen metabolites that the DUTCH test assesses: 2-OH-estrogen, 4-OH-estrogen, and 16-OH estrogen. The 2-OH-estrogen metabolite is less carcinogenic (less cancer-causing) has it has a lesser affinity for and binds less to estrogen receptors. The 16-OH-estrogen metabolite is more potent and can lead to estrogen dominant symptoms if it is in excess. These symptoms include breast tenderness, weight gain, and PMS. And the 16-OH metabolite is overall less stable and thus more carcinogenic.

It is also valuable information to assess how well you are “methylating” estrogen. Methylation of estrogen is part of phase 2 detoxification that takes place in the liver. It is a protective step that turns estrogen into a less carcinogenic form. If a woman does not methylate well, then we think about B12/folate deficiency and/or a genetic mutation, such as the MTHFR mutation.

What does this DUTCH test involve?

The DUTCH test is an easy urine test administered at home. Our doctors meet with you to determine which test is most appropriate for you and then send you home with a test kit to collect at home and send it off. They would then discuss the results with you at a follow-up visit along with an individualized wellness plan to address any imbalances found.

Common natural therapies to address imbalances found on hormone tests:

  • Transdermal or oral progesterone if indicated
  • Food is medicine: Cruciferous vegetables; flaxseeds; deeply pigmented, anti-oxidant rich fruits and vegetables; Green tea
  • DIM (cruciferous vegetable extract)- increases the conversion of estrogens to 2-OH-estrogens (the “good” metabolite of estrogen)
  • EGCG (green tea extract)
  • NAC (N-acetyl cysteine)- promotes glutathione production, which improves liver detoxification of certain hormones
  • Chaste tree berry
  • Methyl-B12 and methyl-folate
  • Exercise

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.


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