DUTCH Individual Panels
Not every patient requires all of the tests included in the DUTCH Complete or DUTCH Plus panels. Some cases call for a more targeted approach from a clinician seeking to test adrenal functioning or from a patient needing to include organic acids in the analysis of an already performed test. This is where the DUTCH Individual Panels come into play.
Precision Analytical provides clinicians with a choice of four distinct standalone panels, which can be ordered separately or alongside other DUTCH test panels. Every panel is aimed at assessing certain aspects of the patient’s hormone metabolism.
What Are the DUTCH Individual Panels?
DUTCH Individual Panels are focused hormone panels and are separate from the comprehensive panels. Instead of testing everything together, each panel concentrates on one aspect only:
- Sex Hormones Only Panel
- Adrenals Only Panel
- Organic Acids Test (OATs)
- Cortisol Awakening Response (CAR)
This test is especially helpful if the practitioner already has some hormonal information but is missing certain pieces of information, or it may be used due to budgetary reasons when the practitioner prefers to conduct a focused test first. The individual panels can be combined; for instance, the OATs test can be added to the Sex Hormones or Adrenals panels.
Sex Hormones Only Panel
The Sex Hormones Only Panel is a targeted test that evaluates the hormones and metabolites that are involved in reproduction. The panel includes estrogen, progesterone, and androgens, as well as their metabolites, but does not include adrenal hormones or cortisol levels.
The Sex Hormones Only Panel is an excellent choice for individuals who have reproductive issues and whose adrenal function has either been evaluated previously or does not require attention at present.
What the Results Include
- Estrogens: Estradiol (E2), Estrone (E1), and Estriol (E3)
- Estrogen metabolites: 2-OH, 4-OH, and 16-OH estrogen pathways – important for assessing estrogen detoxification and cancer risk markers
- Progesterone metabolites – two urinary progesterone metabolites reflecting overall progesterone output
- Androgens and androgen metabolites: Testosterone, DHEA-S, androsterone, etiocholanolone, and additional androgen markers – eight androgen metabolites in total
- Creatinine – used to normalize results across urine samples collected at different times of day
The clinical significance of knowing about the estrogen detoxification pathways cannot be overstated. The 2-OH pathway is the most stable and favorable. The 4-OH pathway produces quinones that may react to cause DNA mutations leading to certain estrogen-sensitive disorders. The 16-OH estrogens are proliferative estrogens known to cause heavy bleeding and breast tenderness. They are responsible for the growth of tumors that have estrogen receptors.
Collection
Samples are collected via dried urine strips at home over 24 hours – the same straightforward collection method used across all DUTCH tests.
Adrenals Only Panel
The Adrenals Only Panel focuses on adrenal hormone function and the diurnal pattern of cortisol without testing sex hormones. This test is most appropriate in cases where adrenal issues, chronic stress, burnout, or problems in the HPA Axis are the main concerns – when there has already been sex hormone testing, or it isn’t necessary.
What the Results Include
- Free cortisol – measured across multiple time points to capture the full diurnal cortisol pattern, from morning peak to evening decline
- Free cortisone – the inactive form of cortisol; the ratio between free cortisol and cortisone reflects the activation and deactivation of cortisol in the tissues
- Cortisol metabolites – three metabolized cortisol markers reflecting total cortisol production over time, not just active levels at collection points
- Cortisone metabolites – reflecting the total cortisone burden
- DHEA-S – the adrenal precursor hormone that reflects adrenal reserve and feeds into testosterone and estrogen production
- Creatinine – for result normalization
One of the most informative results from the DUTCH test is the daily rhythm of free cortisol levels. Such rhythms can show adrenal insufficiency, excessive cortisol output, flattened cortisol rhythm in cases of burnout, or the inverted rhythm when the level of cortisol is low in the morning and high at nighttime, which cannot be detected by a standard blood cortisol test.
Collection
Dried urine samples were collected at home across a 24-hour window, following the same protocol as the broader DUTCH panels.
Organic Acids Test (OATs)
Among the offerings, the DUTCH OATs panel is the most unique one since it doesn’t use hormones at all. This panel deals with metabolic and nutritional indicators, which complement the hormonal information. Among the aspects covered by the OATs panel, there are nutritional deficiencies, neurotransmitter metabolism, oxidative stress, neuroinflammation, gut, and melatonin.
The OATs panel can complement hormone testing to get more information regarding the nutritional state, gut and brain functioning, thus giving healthcare providers an even more comprehensive view of their patients’ health condition. OATs understand that not all the symptoms can be explained by hormones only, since sometimes symptoms have several different origins. Thus, for example, hair loss might be connected with either androgens or cortisol; however, low biotin level also influences it.
What the Results Include
- Melatonin (6-OHMS) – overnight urinary melatonin metabolite; reflects sleep hormone production and circadian rhythm health
- 8-Hydroxy-2-deoxyguanosine (8-OHdG) – an oxidative stress marker indicating DNA damage from free radical activity
- Methylmalonate – a marker for Vitamin B12 status
- Xanthurenate – a marker for Vitamin B6 status
- Kynurenate – reflects tryptophan metabolism, neuroinflammation, and immune activity
- Pyroglutamate – a marker for glutathione status and antioxidant capacity
- Homovanillate – reflects dopamine metabolism
- Vanilmandelate – reflects norepinephrine and epinephrine metabolism
- Indican – a gut health marker reflecting intestinal bacterial overgrowth or dysbiosis
- Quinolinate – a neuroinflammation marker linked to tryptophan metabolism and excitotoxicity
The OATs test can be taken by itself or combined with the Sex Hormones or Adrenals Only test for broader coverage. If combined with a smaller test, the extra charge is very small, which makes it a very cost-effective way of increasing the scope of testing without having to take the whole DUTCH Complete test.
Collection
A single first-morning urine sample was collected on an absorbent filter strip at home.
Cortisol Awakening Response (CAR)
Overview
The CAR test panel is a separate test within the Cortisol Awakening Response that forms part of the DUTCH Plus or DUTCH Cycle Mapping Plus tests. The CAR is a measure of the increase in cortisol that happens during the first 30 to 60 minutes after waking up, giving a unique clinical snapshot into how the brain and adrenal glands communicate with each other via the HPA Axis.
In contrast to the more extensive adrenal panel, where measurements are done for an entire day using urine, the CAR panel uses saliva samples. Saliva is by far the best sample medium when looking at very short-term cortisol spikes, such as those experienced during the awakening period.
What the Results Include
- Cortisol Awakening Response (CAR) curve – saliva-based cortisol levels collected at wake-up time, 30 minutes post-wake-up, and 60 minutes post-wake-up
- In addition to that, there can also be an additional cortisol collection sample, depending on the clinical case
A blunted CAR where cortisol does not increase enough after waking up is indicative of burnout, depression, chronic fatigue, and suppressed HPA Axis activity. A high CAR is indicative of high perceived stress levels, anxiety, and certain immunological disorders. This has clinical significance and cannot be detected using urinary cortisol levels alone.
Collection
The saliva samples have to be collected by using Salivette tubes, not later than an hour after awakening. They must be collected before you get up from bed, eat or drink something, and brush your teeth.
How Individual Panels Compare to the Full DUTCH Tests
|
Panel |
Sex Hormones |
Adrenal Cortisol |
CAR |
Organic Acids |
|
Sex Hormones Only |
Yes |
No |
No |
No |
|
Adrenals Only |
No |
Yes |
No |
No |
|
OATs |
No |
No |
No |
Yes |
|
CAR |
No |
Partial |
Yes |
No |
|
DUTCH Complete |
Yes |
Yes |
No |
Yes |
|
DUTCH Plus |
Yes |
Yes |
Yes |
Yes |
Who Are Individual Panels Best Suited For?
Certain individual panels are ideal for particular scenarios:
- For providers requiring specific information to address a clinical question, using just one area of testing without needing to do the whole comprehensive panel
- For patients whose budgets are limited, and who would like to begin testing in the most pertinent area first, before expanding their tests in the future
- For follow-up testing following a DUTCH Complete or Plus, where only one area requires monitoring, such as adrenal function, without the need for sex hormones
- For add-on testing for providers wanting to add data from OATs testing or CAR testing on top of an existing panel
If you’re unsure about whether an individual panel is what you require or whether a comprehensive test is a better place to start, a complimentary consultation at dutchtesting.org is available.
Frequently Asked Questions
What are the DUTCH Individual Panels?
Individual Panels DUTCH consists of four independent panels of hormones and metabolic testing – Sex Hormones Only, Adrenals Only, OATs, and CAR. They can be ordered separately and used in combination for focused hormone testing.
Can individual panels be combined?
Yes. The design of these panels is such that they can be easily combined. For example, the OATs panel can be combined with the Sex Hormones or Adrenals Only panels, and the CAR panel with adrenal or sex hormones testing as needed.
Who should consider the Sex Hormones Only panel?
This panel is intended for those patients for whom reproductive issues, like estrogen dominance, androgen imbalance, PCOS, or progesterone deficiency, are most important and whose adrenal function does not constitute their current problem or has already been investigated.
What does the Adrenals Only panel measure?
Free cortisol and cortisone are measured throughout the entire day, as well as metabolites of cortisol and cortisone, and DHEA-S, to cover the entire day’s rhythm of cortisol and adrenal production without sex hormones.
How is the CAR panel different from the Adrenals Only panel?
The Adrenals Only panel provides information about cortisol throughout the whole day in a urine sample. The CAR panel assesses the surge of cortisol in the first hour after awakening using saliva samples – a special parameter that urine testing cannot give.
What does the OATs panel measure?
The DUTCH OATs panel tests melatonin, oxidative stress (8-OHdG), Vitamin B12 and B6 status, glutathione, dopamine, norepinephrine/epinephrine, gut dysbiosis (indican), and neuroinflammation (quinolinate).
Are individual panels less accurate than the full DUTCH tests?
No. Each of the panels uses the same LC-MS/MS technique and the same lab analysis process as the entire DUTCH Complete and DUTCH Plus test. The only difference is that each panel covers a portion of the markers covered by the entire test.