This month, I want to tell you about my most recent experience with Precision Analytical and its DUTCH test.  ‘DUTCH’ is an acronym for ‘Dried Urine Test for Comprehensive Hormones’ and, as the name suggests, it involves the testing of hormone levels using dried urine!  I wrote in detail last month about the pros and cons of different methods of hormone testing, so I will not repeat that information in today’s post.  Please go back and read the previous blog post if you would like to know how dried urine testing compares to blood or saliva testing.  Similarly, I am not going to go into much detail about what DUTCH testing is and when you might choose to have it done.  I covered that in this blog post comparing Genova Diagnostic’s Rhythm Plus test to Precision Analytical’s DUTCH Complete.  If you have never heard of DUTCH testing, I would suggest you read those two blog entries first before coming back to this one. 

I first used Precision Analytical’s dried urine hormone testing in 2017 when I was fortunate enough to be able to take advantage of a practitioner special offer that my mum received via a webinar.  At the time I was impressed with the ease of obtaining the samples when compared to blood tests (for which you need a nurse) or saliva tests (which take 30 minutes each to gather).  I was also incredibly impressed with range of markers tested and the detailed results I received.  These were too complex for me to understand on my own, but I eventually booked a consultation with someone who had experience with DUTCH testing and had him talk me through them a bit. 

Over the last couple of years, I have suspected that my oestrogen and progesterone levels might be low.  I’ve had low oestrogen in the past and have recently noticed a significant decrease in cervical secretions, as well as shorter menstrual cycles.  My sleep has been worse, my periods lighter, and my skin is starting to show its age.  Admittedly, I have been under a lot of stress, but I felt as if all was not right with my hormones and wanted to get things checked out.  On a rather vain note, I had also heard that applying oestrogen cream to the face could help maintain a youthful complexion and I wanted to make sure I didn’t have excess oestrogen before trying this out! 

Over Christmas, I purchased Precision Analytical’s DUTCH Complete Adrenal and Sex Hormone Panel for Women via Smart Nutrition, a UK company that I have used before.  Smart Nutrition offers a wide range of functional health tests from leading laboratories including Genova Diagnostics, lifecodeGX, Great Plains, Blue Horizons and Precision Analytical, the company that makes the DUTCH tests.  It is a essentially an online store that lets you purchase professional health tests directly and sends you your results when they are ready.  Most labs will not supply functional tests direct to consumers and require them to be ordered through a health professional.  Smart Nutrition acts as that professional, enabling you to access tests without a prior consultation, which vastly reduces the cost.  It does offer you the opportunity to book a consultation once you have received your results, but this is not obligatory.

I ordered my test kit on 23^rd December, after Smart Nutrition closed for Christmas, and it was shipped on 2^nd January, the day they reopened.  This was very impressive service, which I thought worthy of a mention!  Women with menstrual cycles need to conduct the test 5-7 days after ovulation, so I got a Clearblue ovulation test kit to help me pinpoint this.  I had never used an ovulation test kit before, but seeing the smiley face on the relevant day made my own face surprisingly smiley too!  Because of the timings of when I received the test kit in relation to my own cycle, I ended up taking the DUTCH test at the beginning of February. 

Collecting samples for the test is extremely simple.  All you need to do is urinate on a strip of paper and leave it on a flat surface to dry.  The paper itself resembles filter paper and it is attached to a folded piece of cardboard.  You unfold the cardboard when you are ready to take your sample and hold it as you wee onto the filter paper (or dip the filter paper into a specimen cup of urine, if you prefer).  You lay the strip out so the urine can dry and the cardboard helps to stop the filter paper from touching the surface.  You take samples at four specific times relative to your own wake-sleep cycle, and there is a fifth sample to be collected only if you wake in the night.  You can begin the test with any of the collections, but it is suggested that you begin with the dinner sample, then bed, then night-waking (if applicable), then waking, and then finally two hours after waking.  Once all of the samples have been collected and have dried, you fold up the test strips and post them to the lab in the prepaid envelope provided. 

You are supposed to limit your fluid intake during the test, but if you begin at dinnertime as suggested, this is not as bad as it sounds.  The instructions say that you must not have more than 32oz (about 900ml) of fluid on day 1 and not more than 8oz (about 220ml) until after you have completed the test on day 2.  However, you don’t need to begin restricting your fluid on day 1 until a few hours before your first sample.  Assuming a typical bedtime of around 10pm, your first sample is taken around 5pm.  You are allowed to drink normally all morning and up until lunchtime; you only begin restricting fluids after that.  That means your 32oz allowance begins at lunch and applies until after your bedtime sample.  Once you have collected your bedtime sample, you can drink again. 

In the morning, you don’t drink anything at all before the first sample, which is collected immediately upon waking.  You are then allowed to drink 8oz of fluid before your final sample, which is collected two hours after waking.  After that, the test is over and you can go back to drinking normally! 

I had been very concerned about the fluid restriction aspect of the test.  Like many women who have in the past succumbed to urinary tract infections after becoming dehydrated, I drink water almost obsessively throughout the day!  After reading the instructions that arrived with the test kit, I was so concerned that I contacted Precision Analytical for guidance.  I online chatted to a lovely advisor, who outlined to me what I have explained above – that the restrictions don’t begin as soon as you wake on day 1, but only start a few hours before sample 1.  She also gave me a bit of leeway in the amounts – the main thing, she said, was not to drink in the two hours before samples. 

I forget what allowance she advised, but I recall having three bottles of water labelled on the sideboard that were to last me from the time the restrictions started until the end of the test.  If, like me, you drink a lot out of habit, I highly recommend pre-measuring your water allowance and putting it somewhere specific so that you don’t absent-mindedly drink too much at the wrong times! 

Another thing I wanted to check was what time I should begin my restriction.  I do not keep to a typical daily schedule, so my waking time is not at 7am and my bedtime is not at 10pm.  It is fine to move the collection and restriction timetable to match your own typical day, so those of you who work nights or keep unusual hours can take the test with no upheaval.  I consider that a big advantage! 

Fluid is not the only thing you need to restrict during the DUTCH test.  You also have to abstain from caffeine and alcohol from lunchtime on day 1 until the test is over.  If you are interested in the HVA organic acid biomarker, you additionally have to avoid avocado, banana and fava beans for 48 hours before collecting, as they can elevate the result.  I was not bothered about this particular marker, so I ate as normal. 

There are various DUTCH tests available.  The one that I took was the DUTCH Complete, which includes biomarkers for:

• The oestrogens, progesterone, testosterone, DHEA-S, and some of their metabolites. 
• Cortisol and metabolised cortisol.
• Organic acids, including markers for vitamin B6, vitamin B12, biotin, dopamine, norepinephrine, glutathione, and melatonin.  One organic acid for each of gut health and neuroinflammation is also measured. 

Some of the other DUTCH tests do not include all of these.  Some of them include the cortisol awakening response (which my test did not) or are Cycle Mapping tests which check sex hormones across multiple days of a menstrual cycle.  Make sure you choose the version of the DUTCH test that includes the particular biomarkers that are relevant to you. 

I took my test on the 5^th and 6^th of February, posted it back to the lab on the 7^th, and got my results back via Smart Nutrition on the 22^nd.  The results were very comprehensive and for each of the 30+ biomarkers you get a numerical reading, as well as being told whether it is below range, within range, or above range.  You also get some personalised written comments in a report style document.  As I’ve said previously, the results are extremely detailed and not for the novice consumer, which is presumably why Precision Analytical do not supply direct to the public, but go through health professionals or middle organisations like Smart Nutrition.  I did find them easier to understand than when I first took a DUTCH test in 2017, because this time I knew what to expect and they didn’t seem as overwhelming. 

As I had suspected, my results showed that I had very low oestrogen – in fact several of my sex hormone markers were low.  This was a relief, because there is always a sense with vague, undefined health issues that everything might in fact be in your head.  That somehow you are bringing it all upon yourself with wrong-think and a bad attitude.  It was quite vindicating to see so many readings below range, because, if nothing else, it tells me that not every health flare I have is my own fault!  Thanks to my DUTCH test, I have begun using bioidentical hormone creams and I have already seen my menstrual cycle lengthening back out again.  As a result, I’ve been able to experience more of my ‘good’ times of month, which naturally were the bits lost as my cycles shortened – it couldn’t be the bad bits, could it?!  Unfortunately I’m still quite highly strung and don't sleep very well, but I suppose we can’t have everything!     

In summary, this has been my second time taking a DUTCH test and I highly recommend it.  The service from both Precision Analytical’s customer service team and Smart Nutrition was excellent and the test was easier to perform, for me personally, than salivary testing.  The results were very illuminating and have allowed me to make a properly informed decision about the use of bioidentical hormone creams going forwards.  I would definitely take another DUTCH test in the future! 

If you have had a DUTCH test conducted and need help interpreting the results, you might like to book an appointment with naturopath, Nick Dale. Nick frequently recommends DUTCH tests to his patients and has a particular interest in treating chronic UTIs and interstitial cystitis. He will be able to talk you through your results and help you put together a plan of action. He can also recommend and supply other functional medicine tests that might be relevant to your circumstances. Nick offers face to face appointments at his practices in Eye, Suffolk and Harley Street, London. He can also conduct remote consultations via telephone or Zoom.

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