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  • Writer's pictureDr. Teresa Rispoli

All Women Should Take The Dutch Complete Hormone Test...Here's Why!

Updated: May 11, 2020

Hundreds of tests later…. I still rely on the Dutch test for my female patients with adrenal and sex hormone imbalances. WHAT IS THE DUTCH COMPLETE HORMONE TEST?

Precision Analytical labs developed this unique test. It measures your hormone metabolites from dried urine samples. The hormones include:

  • Cortisol

  • Cortisone

  • Estradiol

  • Estrone

  • Estriol

  • Progesterone

  • Testosterone

  • DHEA

  • Melatonin

This test also measures your cortisol and cortisone rhythms and levels, and your estrogen metabolism pathways. WHY MEASURE ALL THESE HORMONES?

There are lots of reasons!

  • If you have “adrenal fatigue,” sleep or stress issues, testing your adrenal hormones and their rhythms gives specific information about how to handle these problems. We are specifically looking at your adrenal-brain communication, known as your HPA axis (hypothalamus-pituitary-adrenal).

  • With fertility problems, polycystic ovarian syndrome (PCOS), fibroids, PMS, irregular periods, painful periods, anxiety and moodiness, and endometriosis, this test is highly beneficial. It gives a complete picture of how adrenal and reproductive hormone imbalances contribute to these problems.

  • Compare this test to other hormone tests. It's important to monitor your levels. This test works uniquely well for oral progesterone, vaginal hormones, patches, pellets and injections. Note that this is only for hormone replacement therapy, not hormonal birth control pills!

  • With sleep problems, it’s important to check melatonin. Melatonin can be low and related to your sleep problems, or it can be normal. 

  • You may have low DHEA levels. This is a “feel-good” hormone produced by your adrenal glands. When it’s low, it can cause fatigue, a decrease in muscle mass or bone density, depression, aching joints, loss of libido, and lowered immunity.

  • You may have “estrogen dominance.” This is when the scales are tipped so that progesterone is low and estrogen is high. Estrogen dominance can be a factor in endometriosis, PMS, painful periods, fibrous breasts, fibroids, tender breasts, moodiness, and more. It can make perimenopause symptoms significantly worse.

  • This test shows how you metabolize estrogen through your liver. If you don’t metabolize estrogen well, your risks of estrogen-related cancers such as breast, cervical and uterine cancer can increase.

NEW ADDITIONS! New markers are now included on the Dutch test (as of 2018). These include:

The three B vitamins that are most commonly low: B12, B6 and Folate.

A marker for oxidative stress. If this is high, it’s important to identify the sources, and to check your mitochondrial function to make sure oxidative stress has not affected the structure and function of these energy-producing organelles.

Neurotransmitters that show dopamine and first responder stress hormones (epinephrine and norepinephrine).

Most importantly, it measures your body’s level of glutathione, which is the most important anti-oxidant that you make. You will not detox well or use omega 3 fats properly with low glutathione. It’s often tanked if you have a high level of environmental chemical exposures, such as living next to a golf course or agriculture. WHAT DOES THIS TEST INVOLVE?

It’s easy! It comes in an envelope with little strips to dip in your pee, in the comfort of your home. You dip the strips, let them dry, mail them off. The instructions are very clear. WHAT DOES IT COST - DOES INSURANCE COVER IT?

Insurance does NOT cover this test at this time because it is “investigative.” The cost is $399.

Hormone blood tests are useful too, but they are not the same as this comprehensive test. Blood tests won’t measure your cortisol rhythms and estrogen metabolism. Blood tests will not track hormone replacement as thoroughly. They will not shed light on adrenal, cortisol and sleep problems. Hands down, this test is THE most cutting edge, comprehensive, Functional Medicine hormone test. WHAT HAPPENS WITH THE RESULTS?

We use the information to shed light on any hormone imbalances to effectively gear treatment. Your results will be unique to you, so of course, your protocol is tailored to you. Your health plan can involve lifestyle adjustments, help with sleep, and alterations in exercise and stress management. We may find that the use of supplements, herbs, and low-dose bio-identical hormones are right for you.

NEW: BOOK A DUTCH TEST PACKAGE Choose Wellness, then Consultation Agoura Clinic - Complete Health 28247 Agoura Rd. Agoura Hills, CA 91301 Tue 8:30AM - 5:30PM Thurs 8:30AM - 5:30PM Sat 8:30AM - 3:00PM Remote Video or Phone - Call to make an appointment (818) 707-3126 Mon, Wed, Fri 10:00 AM - 4:30 PM 15 Minute Free Discovery - Call to make an appointment (818) 707-3126 Mon, Wed, Fri 10:00 AM - 4:30 PM WOMEN WHO CHANGED THEIR LIVES WITH THIS TEST:

(Names and photographs are fictitious to protect these patient’s identities.)

Melanie, age 36:

Melanie had not felt “herself” since the birth of her second child one and a half years ago. Her periods had not returned. She suffered from insomnia, fatigue, and severe irritability. Also, frequently felt unable to manage her moods, and found herself snapping at her two young children – which did not feel right to her! She had symptoms of low thyroid even though her thyroid hormones were normal. Melanie also had a low sex drive (libido) and wondered if her testosterone was low.

Results: Melanie produced plenty of the androgen hormones DHEA and testosterone. However, she was in menopausal ranges for progesterone, which isn’t right at age 36, and explains why she may not feel calm or able to sleep. She produced a high level of estrogen, and was estrogen dominant relative to progesterone, which could explain her irritability. Her total cortisol and free cortisol were completely tanked, meaning her HPA function was extremely low – this explains her hypothyroid symptoms (which are sometimes driven by low HPA function), and her fatigue.

For treatment, we tackled her two primary root issues: HPA hypofunction and estrogen dominance with low progesterone. She felt significantly better within a month, and her cycles returned. ___________________________________________________________________________________________ Emma, age 34:

Emma came to see me because of a myriad of hormonal symptoms including anxiety, PMS, painful periods, hair loss, breast tenderness, fatigue, irritability, and migraines. The worst symptom was very frequent and heavy periods.

Results: We were so glad to have these results because as it turned out Emma’s adrenal hormones and HPA function were perfect, which I would not have guessed! We discovered she had low testosterone, extremely low progesterone, and high estrogen. She was in a state of estrogen dominance, which explained most of her symptoms. Also, the test showed that her DHEA was not metabolizing into DHEA sulfate, which in her case was an issue of low sulfur amino acids contributing to low liver function.

Her treatment included nutrients to help her liver perform sulfation, and direct bio-identical progesterone, dosed in an unconventional manner as her cycles came every two weeks. Her first cycle on this protocol was significantly better, and many of her symptoms (such as anxiety and irritability) disappeared within the first cycle. ___________________________________________________________________________________________ Lisa, age 51:

Lisa felt exhausted for about four months, since a demanding overseas work trip. She had a history of chronic stress from her job. She used bio-identical hormones, had high cholesterol, low thyroid, and difficulty losing weight.

Results: Lisa’s test showed high overall cortisol. This correlates with abdominal weight, hypothyroid, and high cholesterol. Her high cortisol levels were most likely from chronic stress. She also had been on a calorie restricted diet, which can increase cortisol. Her test showed her estrogen, progesterone, DHEA, and melatonin levels were all good. It also showed her estrogen metabolism pathways were working well. It was safe for her to continue her bio-identical hormones.

Lisa needed to lower her stress and cortisol. We made lifestyle modifications such as reducing stress, adding calories, and incorporating HeartMath. We also added supplements to regulate her adrenal (HPA axis) and lower cortisol. Her energy improved immediately. ___________________________________________________________________________________________ Judy, age 63:

Judy was extremely fatigued all day long. She relied on strong coffee to get through the days. She slept poorly at night, and had a hard time getting up. Judy was retired and not aware of current stress. However, she did have past excessive stress from a divorce.

Results: Judy’s test showed high overall cortisol, and her cortisol and cortisone rhythms were off: very low in the day and elevated at night. This explains her poor sleep and “night owl” energy.

Her DHEA was very low. We only did the adrenal portion of the Dutch test, so we didn’t have information on sex hormones or melatonin.

Judy simply added supplements to support her serotonin production for sleep, raise her DHEA, and lower her cortisol. Within days she was able to go to sleep earlier and she slept significantly better. Her energy increased. She was able to go back to work (which she wanted to do), and add working out. ___________________________________________________________________________________________ Susan, age 44:

Susan had a hysterectomy and experienced early menopause symptoms. She suffered from anxiety and insomnia. She took Ativan for sleep and anxiety, and wanted to get off it.

Results: Susan’s test showed low female hormones, which was no surprise. It also showed high androgen hormones (testosterone and DHEA). Fortunately, her cortisol and cortisol rhythm were normal. This meant her symptoms were not related to her adrenals.

Since her androgens were high, I did Functional Medicine blood tests to search for signs of PCOS. This may sound like an odd path, as Susan was not going to have more children and PCOS is usually thought of as an infertility problem. However, PCOS can mean problems with metabolism that should be addressed regardless of reproduction. We did find out that she had markers of Metabolic Syndrome. These included high cholesterol and blood sugar.

We revamped Susan’s diet to control her early stage Metabolic Syndrome. We added a single supplement which allowed her to wean off Ativan. She then went off the supplement and used exercise and stress management techniques to successfully work with her anxiety and get good sleep. ___________________________________________________________________________________________ Lucy, age 55

Lucy’s symptoms included chronic small intestine bacterial overgrowth, anxiety, low energy, and poor sleep. She was on hormone replacement therapy.

Results: Her test results showed extremely low cortisol. This demonstrates that we do not know whether symptoms like anxiety, poor sleep, or low energy are due to HIGH or LOW cortisol. Lucy had low daytime cortisol that drifted higher at night. This inverse curve is fairly common with sleep problems. Cortisol should be low at night. Her estrogen was very high, while her progesterone was low. This ratio is not good for any woman. Lucy metabolized her estrogen through an unfavorable pathway, one that increases risks of estrogen-related cancer. Her phase 2 estrogen metabolism pathway, one that uses methylation, was also impaired.

These results are complicated. It’s likely her low cortisol caused her inability to resolve her small intestine bacterial overgrowth. Low cortisol lowers immunity. It can also cause anxiety. Her hormone replacement was imbalanced, with too much estrogen and too little protective progesterone. Her poor estrogen metabolism is of great concern.

These women demonstrate the vast differences in hormonal symptoms and in Dutch test results. Each test result is unique. Each treatment or solution is also unique.
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 Functional  Medicine & Functional Nutrition Alternative Healing (818)-707-3126

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Dr. Teresa Rispoli,
PhD., ND, LAc.

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