The DUTCH Test

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.