Happy hormones - the DUTCH test

If you’ve heard me present a lecture or a webinar, especially one that involves the topic of overtraining, adrenal fatigue and/or female hormones, it’s highly likely that you’ve heard me mention the DUTCH test.

DUTCH, which stands for Dried Urine Test for Comprehensive Hormones, is a highly sophisticated test, that provides an incredible overview of steroid hormones, plus their metabolites.

As you can see in Figure 1, the DUTCH test has important utilisation within the consideration of sex hormone balance. In a health realm, oestrogen dominant states are quite common in women, and are linked to health imbalances such as endometriosis and fibroids, plus sometimes issues with weight management. Long-term, if oestrogen is not metabolised adequately, it can lead to potential risks of oestrogen-related cancers, such as breast cancer. This is not a risk factor that’s exclusive to non-active women – Figure 1 actually displays the results of an international long-distance swimmer. Her E1, E2 and E3 levels are in range, but her metabolites are elevated, showing that her methylation abilities may be under-functioning. For a fit young women, it’s a scary consideration that she may be heading towards a cancerous state as she gets older, assuming she doesn’t make changes to her health on route.

You can also see that her progesterone levels were out of range - this can create possible consequences such as: menstrual irregularities, polycystic ovarian syndrome, menstrual cramping, infertility, acne, brittle nails, dry cracked skin, depression, anxiety, mood swings, low libido, fatigue, foggy thinking, slow metabolism, central weight gain, sugar cravings, migraines, headaches, joint pain and allergy symptoms.

Her testosterone and DHEA levels were thankfully in range; these are also steroid hormones that I regularly see depleted in athletes who are erring on the state of overtraining.

This test is not exclusive to women - men have all the same hormones as women, but obviously in different amounts. I regularly see testosterone and DHEA levels heavily depleted in male athletes, especially but not exclusive to, endurance types – this obviously has massive consequences towards anabolic returns from training and recovery capabilities. Additionally, I’ve often seen similar oestrogen dominant states in men, just like my Figure 1 female example. I put this down to an increase in exposure to environmental xenoestrogens and to high levels of stress hormones, leading to the aromatisation of androgens into oestrogens. I’ve even met a very competitive male mountain biker with oestrogen dominance, so much so that the was unable to get his wife pregnant. Taking skinfold measurements, his skin tone was like that of a woman, and his tricep measurements were unusually high for a man.

DUTCH test 1

Figure 1 - example of sex hormone metabolism in the DUTCH test

If we move on to stress hormones, which are also steroid hormones, I deal with a lot of adrenal fatigue and overtrained athletes in my clinic. For many years, I used the salivary Adrenal Stress Index test, which measures cortisol and DHEA levels over the circadian rhythm of 24 hours. However, my preference these days is the DUTCH test because it measures the circadian rhythms of cortisol and cortisone, which in addition to adrenal insufficiency, gives a ratio between the active and inactive forms of cortisol (cortisol: cortisone ratio).

If we return to my long-distance swimmer, looking at Figure 2, we can see at a glance that her cortisol and cortisone levels were incredibly high all the way through the day. This might well have been a contributing factor towards her very imbalanced oestrogen:progesterone levels, plus it more than explained her extremely wired, but fatigued state that I found her in. It also explained her poor recovery profile that she reported to me – high perpetual levels of stress hormones can put the body in an inflammatory state, plus impede the anabolic rebound effect normally seen after exercise sessions.

Additionally, if you look at the bottom of Figure 2, you’ll see a fan shaped diagram, and in this case the red line is heavily slanted towards the right-hand side, meaning that she favoured cortisol metabolites over cortisone metabolites, even though both were well elevated. What this means is that her body is constantly trying to produce the active form of stress hormones to fuel her hectic exercise programme and extremely busy life. This is not adrenal fatigue, because we can clearly see that she can make plenty of stress hormones, but the body can only sustain this pattern for so long, before the adrenal glands start to lay down their tools and under-function. At this point, we experience what is called a ‘following through’ scenario, as both cortisol and cortisol levels become depleted and the body is well and truly in a ‘stuck’ fatigued/overtrained state.


Figure 2 - example of stress hormone balance in the DUTCH test

So, although this is a very expensive test, you can see that it covers an incredible amount of hormonal detail, and if an athlete is underperforming because of suspected hormonal deficiencies or imbalances, many will be willing to pay for such a test. In addition to what I shared with you, the test also measures melatonin levels (for sleep), an indicator of oxidative damage, and several organic acids, which give an indication of B vitamin profile and the status of certain neurotransmitters.