One of my favorite tests in assessing hormone status, is the DUTCH (Dried Urine Test for Comprehensive Hormones) test used for comprehensive hormone testing. Production of our hormones occurs from an elaborate process via cholesterol and enzyme conversions. Ultimately, hormones are detoxified and then need to be excreted via stool, urine and sweat. This pathway is vital in hormonal health.
 
Let’s break this pathway down. See figure

Cholesterol can get a bad rap without deserving it, but thanks to “Big Pharma,” it has been vilified specifically the LDL-c (low dense lipoprotein-cholesterol). Hormone replacement therapy has been looped into the “bad” category as well and is also misunderstood. Let’s take a look at how cholesterol (LDL-c) converts to hormones.
 
Within the liver, cholesterol will begin its part of the metabolism process to become hormones via enzymes breaking it from one hormone into another one. Enzymes are necessary as well as co-factors to start the process of this steroid-hormone pathway. It is a downstream process. As the diagram reflects, cholesterol’s first hormone conversion is pregnenolone (a hormone naturally produced in the body by the adrenal gland). On one side of that conversion, progesterone is made. Progesterone (a hormone released by the corpus luteum in the ovary) has enzymes that cleaves (adheres to or sticks to) it into metabolites which can then be detoxified and will then enter the bowels, bladder and sweat glands for excretion. The same process occurs for our androgens, testosterone, cortisol, and estrogens, and also neurotransmitters, caffeine, alcohol, etc. The DUTCH test will reflect how your body does this breakdown.
 
When you lack an enzyme and/or cofactors (i.e., folate, B12, zinc, etc.), the hormone pathway can be shunted in another direction and create a burden elsewhere. And remember, there are many endocrine disruptors in our environment that enter these pathways to be metabolized and compete at hormone receptor sites and/or create a huge toxic burden within this pathway.  Ultimately, these hormones become metabolites. Also, 2-hydroxy (2-OH-E1) is considered the protective pathway, while 4-OH-E1 and 16-OH-E1 are oxidative in nature and cause DNA damage. Think of the rusting process that could occur on a car-that’s oxidation.
 
When I review your DUTCH test, we will make a treatment plan on how to help your detoxification pathway to better excrete toxic metabolites. Remember that your bowel habits, water intake and exercise inducing sweating, help these toxins leave the body and why they are pivotal to hormone health. When prescribing bio-identical hormone therapy (BHT), it is essential to have this testing done on a regular basis along with other laboratory testing.

Hormonal declines are inevitable and when it arrives at our doors, the symptoms can be mild to a staggering feeling of exhaustion, depression, and not belonging to one’s own skin any longer. Symptoms include weight gain, mood changes, hot flashes, insomnia, joint pain, no sex drive, brain fog, and low energy. The neurohormonal shifts begin a decline in bone loss (osteopenia/osteoporosis), cholesterol changes atherosclerosis (hardening of the arteries caused by buildup of plaque), cognitive decline (Alzheimer’s), collagen loss (skin elasticity, wrinkles), vaginal atrophy (painful sex), and cortisol/stress hormone fluctuations (weight gain especially around the waist).
 
Bioidentical Hormone Replacement Therapy (BHRT), which is FDA-approved (except when compounded — a custom formulation of medication to fit a unique need of a patient), has been shown in research to reduce rates of heart disease, osteoporosis, Alzheimer’s, and vaginal atrophy. On the other hand, risks may include blood clots, stroke, and Myocardial Infarction (heart attack). However, because there is no long-term data with bioidentical hormones, the risks are not known. The studies for these side effects come from Premarin® and Provera® (conjugated estrogens) which are not bioidentical and taken in oral form.
 
When I prescribe BHRT, I have them compounded and have them in patch, trouche (lozenges that dissolve slowing in the mouth), suppository or liquid form; they do not pass through the liver on its first phase of metabolism and where oral estrogen pass through the liver which is the reason the rate of blood clots increases. The oral birth control pill has the same risk due to the first pass in the liver.
 
When patients initially establish care with me, labs and DUTCH test are necessary to assess their baseline hormonal status. The timing for starting BHRT is paramount to make sure bone density is established as well as warding off other disease processes. Once BHRT are prescribed, I require a yearly DUTCH test and labs. To remain as an established patient, the minimum visits will be two times per year. Most patients on average see me three times per year. Appointments can be conveniently held via telemedicine.