The DUTCH Test

The DUTCH Test: a new approach to hormone testing

In Pelvic Floor Physical Therapy by Jandra Mueller7 Comments

By Jandra Mueller, DPT, MS, PHRC Encinitas

The DUTCH test is a newer technology created by Mark Newman, MS. He has spent many years with various labs specifically on developing and testing hormones until he created his own lab, Precision Analytical Inc. and the DUTCH test is his flagship product. The name stands for Dried Urine Test for Comprehensive Hormones. Hormone testing is most commonly performed by blood tests (known as serum tests) and occasionally by saliva or urine tests. 

To date, the DUTCH test is the most comprehensive test to evaluate your sex and stress hormones. In addition to measuring hormone levels, this test also takes into consideration metabolites (metabolites are breakdown products of these hormones) and specific nutrients (which are necessary for our body to use the hormones).  The importance of these groups of hormones are that they play a vital role in many aspects of our life that if left unbalanced, they can wreak havoc in our bodies and leave us feeling anxious, tired, moody, and fatigued among many other things. 

This blog explains the DUTCH test and the information it can provide you. 

What does the DUTCH test measure?

  • Estrogen (Estradiol, Estriol, and Estrone) 
  • Progesterone 
  • Testosterone 
  • Cortisol
  • Nutritional organic acids
  • Neurotransmitter metabolites
  • Melatonin
  • Hormone metabolites (the breakdown products of hormones which can tell us how your body is effectively, or ineffectively using the hormone – this may be the cause of one’s hormone imbalance). 

Various environmental factors, medical treatments and age-related changes affect hormones in men and women. The DUTCH test is beneficial for both sexes, not just women as many people assume!

There are a few different types of DUTCH testing. Depending on which test you take, you will either collect 4-5 strips of urine and/or 4-5 tubes of saliva that get sent into a lab. The results will be analyzed and then you will have a comprehensive picture of what is going on in all those little cells inside your body. 

The full picture

In addition to your sex hormones (the three primary estrogens, progesterone, and testosterone) and adrenal hormones (cortisol), the DUTCH test looks analyzes hormonal metabolites which can be just as important as your hormone levels. But, there are also other key players in how your body can use its hormone. People need key nutrients for optimal function, therefore  this test also measures nutritional organic acids, which are markers to show how much B6, B12, and glutathione your body has (or is lacking). Nutritional organic acids are not typically evaluated in standard medical hormone assessments. In order to have a comprehensive knowledge of your hormones, you need to know these other key factors. The additional benefit of these markers is that they show your risk of oxidative stress (or your potential for DNA damage) as well as your risk of estrogen related cancers and other estrogen related issues. 

People are understandably concerned about hormones and cancer risk. There is a tremendous amount of misinformation about hormones and generalized confusion, both in patients and amongst medical professionals. This is an additional topic we will address in another post, but in short, how your body metabolizes estrogen plays just as much of a role as the amount of estrogen itself and this test helps to identify this information. The DUTCH test helps identify patterns and risk factors, it helps guide safe lifestyle and medical treatments to restore balance. For example, if you show higher or lower numbers in your organic acids that may be affecting your hormone breakdown and treatment may be as simple as saying, you need more B12 in your diet, versus you need hormone therapy. Or, if your cortisol levels are very high, mindfulness and meditation may be more important for someone’s treatment than compared to someone without high cortisol. 

How does this test compare to other ways of evaluating your hormones?

Serum blood test

Most people are used to getting a blood draw to assess hormones, this is the standard of care to measure hormones, this is called a serum test. There are many benefits of this test including convenience and it is inexpensive. However, the drawbacks are that it will only show you what is circulating in your blood at that moment in time. Hormones fluctuate throughout the month and throughout the day, so it may not capture as precisely as the DUTCH test would, especially for cortisol. A blood test cannot accurately determine what is going on with your cortisol levels. The DUTCH test has been studied and is comparable and as accurate as performing a blood test. 

Saliva Testing

Saliva testing does have clinical value for cortisol especially if you do it over the course of a day, this is called a diurnal pattern which is the best way to measure cortisol but doesn’t necessarily give the full picture of what is going on in the body in regards to cortisol. Additionally, saliva testing is not the most accurate measure for sex hormones. The benefit of the DUTCH test is that it is one test that will measure both your cortisol and sex hormones accurately. 

Standard 24-hour urine test

This test is another type of urine test for hormones and cortisol. Sex hormones and cortisol can be measured well in urine which is why the DUTCH test uses urine, but for cortisol, without a saliva comparison it cannot be as accurately measured in that diurnal pattern. This test has a high error rate (40%) and can be messy (it is collected in containers throughout the day). The DUTCH test uses dried urine, not wet urine, and studies have shown that the accuracy is very comparable and just as accurate, but this is an easier method of collection and again, takes out the need for multiple tests. 

Who would benefit from this test?

This test is useful to help anyone wanting to get a better picture of overall hormone and metabolite balance. It helps people identify if there are lifestyle and diet changes to better balance  hormones. We all have stress, and we are all predisposed to dietary and environmental stressors that can affect our hormone levels. But beyond this, anyone that is dealing with symptoms of hormonal  imbalance or chronic stress or disease – insomnia, obesity, weight gain, fatigue, pelvic pain, endometriosis, vulvodynia, erectile dysfunction, PCOS, infertility, mood changes, brain fog, etc can benefit from taking a closer look with the DUTCH test. This is a great test also for those that are experiencing symptoms of hormonal changes but their blood tests are coming back pretty normal. For more info on hormones check out our previous blog post Hormones: Your Body’s Frenemies. 

Benefits and drawbacks

The benefit of the DUTCH is that it gives you a more complete picture and overview of the key components your body needs to both produce and utilize your hormones. It is a great compliment to that blood test your doctor ordered for you, and it is good for both men and women as the results  can help identify the root cause of issues you may be having. 

The DUTCH test is not currently covered by insurance. Running the test requires restrictions during testing, certain supplements and medications are recommended to be out of the system and for some women, it is necessary to take it at a specific time during your cycle. 

If you are suffering from any of the issues mentioned in this blog, the DUTCH test could be right for you. We live in a country where there are culprits everywhere responsible for throwing off our hormones – pesticides and hormones in our food and chemicals in our cleaning and beauty products, to just name a few. 

Precision Analytical Inc.,  shares educational blogs and videos about the DUTCH test on their website, which you can find here. We are now offering the DUTCH test through PHRC! If you are an existing PHRC patient and interested in the test please ask your physical therapist for more information. If you are not a PHRC patient and are interested in the test please call us at 760 – 487- 5118 or send us an inquiry via this link.

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Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $85.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page. 

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

Comments

  3. Reply

    Hello! I’m interested in this test for my sister. I’m a pelvic rehab center patient. Please let me know the process. I would like to learn a little bit more of the test as well to determine if it’s suited for my sister. Thanks!

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