DUTCH Plus Test

The DUTCH Plus is a comprehensive assessment of 35 analytes, including five important sex and adrenal hormones as well as their metabolites. Below are details:

• Sex Hormones & Metabolites
• Estrogens – Estriol (E3), Estrone (E1), and Estradiol (E2), and important estrogen metabolites via 2-OH, 4-OH, and 16-OH pathways
• Progesterone and its metabolites
• Testosterone and androgen metabolites, which include Androsterone and Etioccholanolone
• DHEA-S – Adrenal Precursor hormone that becomes both Testosterone and Estrogen 

Adrenal and Cortisol Markers

• Diurnal free cortisol – captured across multiple time points throughout the day to reveal the full daily cortisol rhythm
• Cortisol metabolism – metabolized cortisol reflects total cortisol production over time, distinct from free cortisol levels
• Cortisone – the inactive form of cortisol; the ratio between cortisol and cortisone reveals important information about cortisol activation and deactivation
• Cortisol Awakening Response (CAR) – the defining addition of the DUTCH Plus. Measured through saliva samples taken within the first hour after waking, the CAR reveals how the brain and adrenal glands are communicating and how the body primes itself for the day ahead

DUTCH OATs (Organic Acid Tests)

• Melatonin (6-OHMS) – measured as an overnight urinary metabolite, reflecting the body’s sleep hormone production
• 8-OHdG – an oxidative stress marker indicating DNA damage from free radicals
• Methylmalonate – a marker for Vitamin B12 status
• Xanthurenate – a marker for Vitamin B6 status
• Kynurenate – reflects tryptophan metabolism, immune activity, and inflammatory pathways
• Pyroglutamate – a marker for glutathione status and antioxidant capacity
• Homovanillate – reflects dopamine metabolism
• Vanilmandelate – reflects norepinephrine and epinephrine metabolism

This combination of sex hormones, adrenal markers, CAR data, and organic acids makes the DUTCH Plus one of the most comprehensive single-hormone and metabolic tests available anywhere.

This is what makes the DUTCH Plus unique and should be well understood.

Healthy individuals have a large increase in cortisol levels within 30 to 45 minutes from wake time – the natural daily cortisol spike in their bodies that helps to prepare them for the day ahead. It occurs due to signaling from the brain’s hypothalamus and pituitary glands through the HPA axis to the adrenals. The intensity and form of this daily cortisol spike reflect how well signaling works.

The reduced or nonexistent CAR – the failure of cortisol levels to rise sufficiently when one wakes up – correlates with exhaustion, burnout, fatigue, depression, and HPA axis dysregulation. The elevated CAR, in turn, can be related to perceived stress, anxiety, and some immune system issues. None of these phenomena can be detected using regular tests or even the DUTCH Complete test.

By evaluating the cortisol levels in saliva samples at waking time, 30 minutes after waking, and 60 minutes after waking, the DUTCH Plus allows getting the CAR value in a manner that cannot be achieved using any urine-based test.

DUTCH Plus is a home test kit, easy to use, and containing all necessary materials for both urine and saliva tests:

• Detailed instructions for collection
• Four (4) dried urine collection strips – for regular hormone and metabolites analysis
• Six (6) Salivettes for saliva collection – for Cortisol Awakening Response test
• Requisition form – with patient info, supplements, medications, hormone replacement info, and a questionnaire about the patient’s health status
• Sealed, pre-paid return envelope

Having urine strips and saliva tubes in one test kit makes the DUTCH Plus test the only one among other tests in the DUTCH series that requires the collection of two types of samples, since CAR testing is better done with saliva, not urine.

The report for the DUTCH Plus test results is comprehensive and well-structured for practical use by medical practitioners. This report consists of:

• Full analysis of the 35 markers, including hormones, metabolites, and organic acid markers, with the corresponding ranges and visual references
• Free cortisol patterns for each day are plotted throughout the day, illustrating the diurnal rhythm from morning to evening
• Morning cortisol curve, known as Cortisol Awakening Response, results – one of the most unique clinical results from this test
• Graphical representation of all hormones included in the test
• Tutorial videos are embedded in the report to assist medical practitioners in understanding and presenting the results to their patients
• Clinical notes for organic acid markers, with each organic acid marker result included in the report

Sample reports for both males and females are provided.

The DUTCH Plus test is indicated for all the same symptoms as the DUTCH Complete test, with the added benefit of the CAR, which makes it particularly suitable if there are adrenal-related symptoms involved. Particularly, the DUTCH Plus test is especially suitable for the following issues:

• Fatigue upon waking – problems feeling alert or energized after adequate sleep during the night
• Insomnia – inability to fall asleep, stay asleep, or wake up feeling unrefreshed
• Chronic fatigue – ongoing fatigue that does not go away even when resting
• Morning depression or anxiety – feelings of depression, dread, or anxiety that appear particularly strong upon waking
• Stressed lifestyle – high levels of stress that may put a strain on the HPA axis
• Loss of resiliency – inability to bounce back from stressors, get sick more easily, and become emotionally unstable because of challenges that used to seem manageable

All of these symptoms are indicative of HPA axis dysregulation – a condition that can be detected and measured using the Cortisol Awakening Response test.

The DUTCH Plus shares the core differentiators of the entire DUTCH platform, with its own additional distinction:

Easier, more natural collection

Urine specimen collection occurs at home over the course of 24 hours. Dried specimens have a shelf life of up to several weeks, meaning that they can easily be shipped nationally or internationally without refrigeration.

Comprehensive reporting

The DUTCH Plus provides what is considered the most comprehensive combination of sex hormones, adrenal hormones, hormone metabolites, CAR markers, and organic acids that one test can offer. The report provides truly actionable information that is the basis for a tailored treatment approach.

The CAR advantage

Not another test within the DUTCH panel – nor are there many hormone tests available anywhere for that matter – captures the Cortisol Awakening Response (CAR). Patients whose symptoms manifest themselves in the morning or have an HPA axis component to them will frequently find this to be the crucial element.

Backed by research

Precision Analytical makes use of mass spectrometry – perhaps the most accurate way to measure any kind of molecule – which ensures that hormones and their metabolites can be measured accurately. The lab has made considerable investments in validating its testing procedure through scientific studies.

Effective HRT monitoring

Just like its counterpart, the DUTCH Complete, the DUTCH Plus monitors almost all kinds of bioidentical hormone replacement therapy, measuring the levels of absorption, metabolism, and elimination of the prescribed hormones.

Expert education and clinical support

Providers registered for the DUTCH testing enjoy access to an extensive education program and can even have their consultations either in groups or individually with clinical educators of Precision Analytical.

Choosing the right DUTCH test matters. Here’s how the DUTCH Plus compares:

The DUTCH Complete is the test that gives you the entire hormone and metabolic profile and is therefore your best choice in terms of assessing hormone status. DUTCH Plus is what you need if symptoms that occur in the morning, fatigue, burnout, or dysfunction in the HPA Axis are the main issues of concern. Finally, the DUTCH Cycle Mapping is a specific test that is meant for the analysis of hormones during a whole menstrual cycle.

It may be appropriate to use the DUTCH Plus test kit if:

• You wake up tired, no matter how much sleep you get
• Morning anxiety, sadness, or dread, which improves throughout the day
• You have been dealing with chronic stress and feel that you do not have any more reserves left to fight the effects of it
• You experience symptoms of burnout that cannot be reversed with rest over the weekend
• You have either been diagnosed with or suspect adrenal fatigue/HPA axis dysfunction
• You have insomnia issues, specifically trouble falling back to sleep or waking up too early
• You are taking hormone replacements and need an extensive analysis of how your body responds to treatment
• You have already done the DUTCH Complete and need a closer look at your adrenals and morning cortisol function

In case you still cannot decide which one of the DUTCH tests to take (DUTCH complete or DUTCH plus), you should consult a certified functional medicine specialist or use a free consultation service from dutchtesting.org. 

DUTCH Plus is the most detailed single test panel among all other DUTCH tests, which include hormones as well as metabolism tests that are indicated to be performed when the patient’s symptoms indicate the involvement of the adrenal glands and hypothalamus-pituitary-adrenal axis dysfunction. The DUTCH Plus test combines all the information that is provided by the DUTCH Complete test and an additional Cortisol Awakening Response Test.

When you have fatigue upon awakening, stress, burnout, or morning anxiety as your symptoms, the DUTCH Plus can provide the answer.