Note: this review has been updated to include points from Precision Analytical’s rebuttal of the original post in August 2022.
I just keep on diving into the controversial topics, but I won’t stop. It makes me very angry to see people being taken advantage of, and hormones are the latest grift.
Like, ‘balancing’ hormones.
‘Resetting’ hormones.
Hormone ‘experts’
And of course, hormone testing. As in, the DUTCH test.
I’ve been asked a huge number of times to do a DUTCH test review, and when I started doing research about it, I was stunned to see that there was really no unbiased information online about it.
The company the sells the DUTCH test, Precision Analytical, seems to have bought up all of the SEO around this topic, so the first couple of pages in Google lead right to their website. The other ‘reviews’ and information on the DUTCH test are by people who actually sell it.
How useful is that? Not so much.
As with all of my other posts, I wanted to give you the most up-to-date and reliable information in this DUTCH test review. I did my due diligence here, as I do with all of my reviews, to get the real story.
Because I couldn’t get the answers I wanted online, I decided to interview a gynaecologist and two endocrinologists about DUTCH testing. After all, these people are actual **hormone experts.**
Precision Analytics recently published a post addressing the original version of this review. After consulting with experts, I’ve made some changes to this piece, although perhaps not in the way PA would have liked. As a dietitian with 23 years of experience, and with the backing information of credible experts in the hormone field, I believe I have fairly assessed and presented the relevant evidence on DUTCH in this post.
What is the DUTCH test?
The DUTCH test allegedly measures hormone levels to determine which ones need to be ‘fixed.’ It’s used as a diagnostic test by some medical doctors, and by alternative health providers and some registered dietitians.
DUTCH is an acronym for Dried Urine Test for Comprehensive Hormones.
Precision Analytics claims that “Millions of women suffer from hormonal imbalances. Whether it is menopause, weight gain, fatigue, low libido, premenstrual symptoms (PMS), mood swings, or depression, these symptoms can lead to more serious problems if misdiagnosed. Identifying the root cause of chronic health issues is certainly correctable, but only if properly identified.”
Every time I see the words ‘root cause,’ it’s a red flag.
This is a popular phrase used by a lot of alternative providers to suggest that unlike conventional providers, they find what’s causing symptoms, instead of just treating them with medication.
Nothing could be further from the truth. To suggest that conventional medicine is only interested in prescribing drugs and not treating the cause of illness, is completely egregious in my opinion, and it creates an ‘us vs them’ mentality that hurts, not helps, patients.
In their rebuttal, Precision Analytics implied that conventional docs don’t understand the value in the markers that DUTCH provides, because they haven’t been trained on them:
‘Scientific research highlights the clinical utility of cortisol metabolites, though it is true that conventional medical doctors without training on these markers do not find them useful or necessary.’
It’s interesting to me that PA would imply that endocrinologists and gynecologists don’t know the usefulness of these markers, but far less schooled (and, one could argue, qualified) providers like naturopaths and dietitians can do the training provided by PA to administer DUTCH testing and ostensibly become ‘experts.’
How does the DUTCH test work?
Doing the DUTCH test involves the collection of four urine samples over the course of two days.
The urine is then dried, sent to the lab, and analyzed for hormone metabolites.
Pretty much all of the providers I looked at offered the DUTCH as a way to measure sex and adrenal hormones.
These are:
Adrenal hormones (eg: cortisol and DHEA)
Estrogens and metabolites (eg: estradiol)
Progesterones and metabolites
Androgens and metabolites (eg: testosterone and DHEA)
Is the DUTCH test necessary?
Precision Analytical claims that DUTCH is superior in comparison to serum and saliva hormone tests, because DUTCH is more accurate in measuring cortisol and cortisol metabolites.
But is it?
Not according to Disha Narang, MD, a board certified endocinologist.
She told me this:
Not a single one of these tests is useful for a legitimate practitioner.
Metabolites are never used in clinical practice. It’s very rare for any of the metabolites to be low – that would mean you have dysfunctional enzymes that convert estrogen.
In my experience, the DUTCH is used by providers like naturopaths to say ‘your metabolites are low’ and sell you a supplement.
Karl Nadolsky, DO FACE, and board certified in endocrinology, diabetes & metabolism, agrees.
While the variety of tests in DUTCH may ultimately become validated methods of testing some hormones, there is no currently validated clinical indication for using it. We must have a keen clinical consideration for why, how and when to check any specific hormone lab when evaluating patients for endocrine diseases (excess, deficiency, etc). Having a random slew of hormones checked in the Dutch method does not help diagnose any endocrinopathy at this time that I am aware of.
In other words, the test may be accurate, but expert physicians believe that there is no indication for it.
There is also no benefit to testing four times in a day. Cortisol, for example, follows a circadian rhythm – so it’s naturally low in the evening and higher in the morning. The DUTCH test will show this, but that doesn’t mean there’s anything wrong with you.
Cortisol is a stress hormone that can cause us to gain weight. But the answer to elevated cortisol isn’t diet; it’s decreasing stress as much as possible. Some practitioners will also recommend cutting out coffee, and if you’re drinking a lot, cutting down may help.
But if you typically have one coffee a day, and your body is accustomed to it, research says that cutting out your daily cup won’t do a lot of good for lowering your cortisol.
Even if your cortisol is high, there are no herbs or supplements that can fix that, according to Narang.
And the multiple collections in a day don’t give more or better information.
Narang adds, “even with a multiple collections in a 24-hour period, the DUTCH test won’t give me any extra information that current validated testing doesn’t give me already.”
Dutch testing research
In their rebuttal of my DUTCH review, Precision Analytics claimed that there is peer-reviewed research showing the validity of DUTCH testing. There are some studies posted on their site, but all of them have have been done by Precision Analytics. This isn’t necessarily a bad thing, but it does present a serious risk for bias.
They say they’ve published abstracts with NAMS – the North American Menopause Society, and ASRM, the American Society of Reproductive Medicine. As far as I know, neither society recommends DUTCH testing as a diagnostic tool. It’s also important to note that presenting an abstract in a poster presentation is not the same as having validated research that shows your product is indicated for testing and diagnoses.
To be sure, I contacted NAMS, which told me this: ‘NAMS does not have an official position on this type of HT testing.’
DUTCH testing and diet
The diet recommendations that come along with DUTCH results will probably be the same as anyone would give: regular meals, more fibre, lots of plants, moderate protein, healthy fats. Don’t overdo the coffee and sugar. Eat as many whole foods as possible.
Those recommendations, not the DUTCH testing, may be responsible for your symptom resolution. But you can get them without spending $600 on a DUTCH test.
There’s no secret here.
Beware of providers who recommend numerous supplements to help with your ‘hormone balance’ and ‘adrenal health.’ This is a red flag, since there are no supplements that ‘balance hormones,’ and ‘adrenal fatigue’ is not an actual medical diagnosis.
There’s no specific diet for adrenal health, regardless.
Does ‘adrenal fatigue’ exist? Read all about this diagnosis here.
Aside from being expensive, taking unregulated supplements not only lines the pocket of whoever has sold them to you, it can also be super dangerous.
It’s pretty safe to assume that actual endocrinologists, like the ones quoted above, have all of the facts. They aren’t lying, or somehow complicit in some scheme with ‘Big Pharma’ to hide some fabulous treatment that only your naturopath knows about.
Even Dr. Jen Gunter, MD, board certified gynecologist, author of The Menopause Manifesto, truth teller, all around as*-kicker, had this to say to me about DUTCH for menopausal women:
The DUTCH test is clinically meaningless for menopause and should not be used to evaluate menopausal status or to guide menopausal hormone therapy. In fact, no hormone testing is needed to guide menopausal hormone therapy. This is not just my opinion, but the recommendation of the major medical societies.
I’ve heard from women who say that the DUTCH test solved all of their hormone issues. I am not going to minimize their experiences. Hormones are complicated, and of course there’s a chance that something that provider recommended ended up working. But again, the diet part – if that’s what made symptoms better – isn’t dependent on DUTCH results.
According to Narang, “Some resolution of symptoms may honestly be psychological. Other therapies can have short-term benefit – but a lot of these therapies have no studies on long-term effects or benefits.
There is no guarantee that any of these therapies will make people feel perfect. And unfortunately sometimes that’s what people want to feel, and it’s a set up for failure.”
What I’ve found is that a lot of women who resort to alternative providers and DUTCH testing, have been unable to get answers to their questions and symptoms from conventional medicine.
Sometimes, there are no answers. If someone makes answers up, does expensive testing, or prescribes supplements, this doesn’t automatically make them a better provider.
There is a huge issue in conventional medicine with how women are treated, especially around menopause and hormonal issues. Many women don’t feel heard, they don’t feel as though their concerns are addressed or taken seriously. This is unacceptable, but it’s not necessarily remedied by using hormone testing for which there is no indication.
Precision Analytics says in its rebuttal (typo is theirs):
A trained, evidence-based MD (or healthcare provider) may step in the gap with testing (including DUTCH) and solutions that help the patient make adjustments (lifestyle, diet, neutriceutical and/or pharmaceutical interventions) that initiate legitimate and lasting profound change. We are proud to be associated with this brand of research-backed, evidence-based medicine.
I find this statement insulting to all of the qualified providers who have done years of evidence-based study and practice. Is a naturopath who does DUTCH testing superior and more evidence-based than an endocrinologist who doesn’t see the utility in DUTCH?
Honestly, I feel like it’s a red flag when a practitioner sells unvalidated, unsupported tests like IgG or LEAP food sensitivity, MTHFR, stool microbiome and DUTCH. It’s even more of a red flag when they use your results from those tests to sell their own brand of supplements or special diet to ‘correct’ your ‘condition.’
If DUTCH testing was so insightful, it would be used by all practitioners. But it’s not. Maybe in the future, it will be, but for now, the providers who I’ve spoken to do not believe it to be indicated for hormone testing.
What if you still want to get a DUTCH test after reading this DUTCH test review? DUTCH tests aren’t harmful (except to your wallet), so if you want to try it, go right ahead. But it’s not necessary or indicated to diagnose or treat hormone issues.
Thinking of doing food sensitivity testing? Don’t do it until you read my review of it, here.