I frequently see patients who have struggled with acne since puberty and tried just about everything to get it under control without success. Quite often these patients are frustrated and feel like nothing will improve their skin but desperately want to get to the bottom of their chronic skin struggles. One of the most valuable tools I can offer these patients is the DUTCH test.
What is the DUTCH test?
The DUTCH test stands for Dried Urine Test for Comprehensive Hormones and is the gold standard when it comes to hormone testing. Not only does this test assess your hormone production but it also provides information about your adrenal function, melatonin, oxidative stress and hormone metabolites. This test is my preferred way to determine the underlying cause of persistent hormonal acne.
Why is the DUTCH test better than salivary or blood testing?
Hormone testing is important to best understand hormonal imbalance and to then create a plan to restore harmony. Unfortunately, the accuracy of the tests used to determine hormone levels vary widely. Salivary hormone testing assesses hormones (cortisol, DHEA, estrogen, progesterone and testosterone) available at the cellular level but fails to give any information about how those hormones are processed and metabolized by the body. Serum/blood testing can be used to assess both free and total hormones but doesn’t provide an accurate reflection of bioavailable hormones (those hormones available within the tissues). Quite often I see women (and men) who have received “normal” blood test results for cortisol, DHEA, estrogen, progesterone or testosterone but still experience symptoms of hormone imbalance, which is revealed with a more thorough assessment.
The DUTCH test provides a comprehensive look at cortisol production by the adrenal glands. The DUTCH test measures both free and total/metabolized cortisol; metabolized cortisol is one of the most accurate ways to determine adrenal health.
The DUTCH test allows us to review how the body is metabolizing the hormones produced. This is helpful for understanding how these hormones are eliminated from the body. One of the most valuable measurements from the DUTCH test is an assessment of how estrogen is being processed and the ratio of protective (2-OH) and detrimental estrogens (4-OH and 16-OH).
Not only does the DUTCH test provide a comprehensive assessment of your estrogen production and metabolism but it also provides a better understanding of the breakdown of testosterone. When testosterone is metabolized it becomes either 5α-DHT or 5b-DHT; 5a-DHT is more “androgenic” form of testosterone and is responsible for things like acne, thinning head hair and excess body hair. If you have this, there are specific things that can be done to reduce this type of testosterone, but you need to test in urine, such as the DUTCH test because salivary testing will not give you this data.
What the DUTCH test measures:
The DUTCH test covers a wide range of markers including:
- Free cortisol
- Free cortisone
- Cortisol metabolites
- DHEA & DHEA Sulfate
- Androgens such as etiocholanolone and androsterone
- Melatonin (your sleep hormone)
- Sex hormones: progesterone, estrogen, estrogen metabolites, testosterone, and 5α-DHT
- Neurotransmitters: MMA, pyruvate acid, serotonin, norepinephrine, dopamine,, 8-OHdG
- Nutrient markers: glutathione, Vitamin B6, Vitamin B12
It is not enough to just know you are low or high in a specific hormone. I need to understand the WHY. Is there a production issue, metabolism issue or excretion issue? The DUTCH test gives me a complete picture of hormone production, metabolism and excretion and is an invaluable tool in my practice, especially with those patients that have struggled for far to long and tried too many things unsuccessfully. Determining the underlying hormonal imbalance can lead to a more concise and effective treatment plan for acne as well as a number of other concerns.