DUTCH Plus provides a comprehensive assessment of 35 different sex and adrenal hormones, including oestrogen, progesterone, testosterone, DHEA and cortisol along with their metabolites. It also looks at the overall diurnal pattern of free cortisol and cortisone along with a more in-depth assessment of the Cortisol Awakening Response. The oxidative stress marker 8-OHdG, melatonin and nine organic acids including markers for vitamin B12 (methylmalonate), vitamin B6 (kynurenate and xanthurenate), biotin (β-hydroxyisovalerate), glutathione (pyroglutamate), dopamine (homovanillate), norepinephrine/epinephrine (vanilmandelate), neuroinflammation (quinolinate) and tryptophan putrefaction (indican) are also included.
The Cortisol Awakening Response
When we wake in the morning and open our eyes, cortisol levels naturally begin to rise by an average of between 50-160% in the first 30 minutes after waking. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise of cortisol levels at waking, known as the Cortisol Awakening Response, can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.
Cortisol, cortisone, 8-OHdG, melatonin (6-OHMS), organic acid tests and metabolites related to cortisol are tested by Liquid Chromatography with tandem mass spectrometry (LC-MS/MS). The remaining hormones are tested by Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS).
When should I use
DUTCH Plus can help identify the root causes of sex hormone and adrenal imbalances in men and women and includes assessment of the Cortisol Awakening Response (CAR) to give further insight to the HPA axis.
Measuring the body’s response to the stress of waking allows us to test the HPA axis independently of the patient’s free cortisol levels throughout the day.
DUTCH Plus is a great test to assess your patients’ sex and adrenal hormones. It is easy for them to collect the samples due to the unique combination of methodologies (dried urine and saliva) and provides more detail than traditional serum or saliva testing on their own. The inclusion of relevant nutritional, detoxification and neurotransmitter organic acids, melatonin and oxidative stress markers allows a thorough and comprehensive insight to guide your therapeutic dietary, supplemental and lifestyle recommendations.
DUTCH Plus provides a unique assessment of sex and adrenal hormones by assessing both dried urine to include extensive metabolite testing (especially for oestrogens and cortisol) AND saliva to closely assess the Cortisol Awakening Response (CAR).
A true CAR assessment requires salivary samples to be collected on waking, and twice more, at 30 minutes after waking and 60 minutes after waking. These specifically timed collections are difficult and impractical with urine and traditional salivary options. The DUTCH Plus® uses specialty, FDA-approved, and patented collection devices called Salivettes™. Salivette™ are specifically made for testing cortisol when timing needs to be precise and are used in nearly all of the published CAR studies. The small synthetic cotton swab can be quickly saturated with saliva, providing a very fast and simple collection.
Combining salivary cortisol with the extensive urine metabolites from DUTCH measuring oestrogen and androgen metabolites, gives a fuller picture for more precise clinical assessment of hormonal imbalances and (B)HRT monitoring.
Combining both sex and adrenal assessment with relevant organic acids for nutrients, neurotransmitters and detoxification as well melatonin and 8-OHdg gives further insight as to how best support the patient.