Hormone Panels

Thyroid

Thyroid-Stimulating Hormone (TSH) - Evaluates overall thyroid function

• Total Thyroxine (T4) - Measures the total amount of T4 produced by the thyroid gland
• Total T4 - Measures the total amount of T4
• Total T3 - Measures the total amount of T3
• Reverse T3 - Measures the non-functioning form of the active hormone T3
• Antithyroglobulin antibody (ATA) - Often measured along with TPO, these antibodies can attack proteins involved in the production of thyroid hormones rendering them dysfunctional
• Thyroid Peroxidase antibody (TPO) - Often measured along with ATA, these antibodies can attack proteins involved in the production of thyroid hormones rendering them dysfunctional

Male/Female Comprehensive Panels

Dutch Complete

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/upregulated HPA axis,” 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.
• If you use hormone replacement therapy, you want 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, 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.

DUTCH PLUS

DUTCH PLUS KEY ADVANTAGES

• Takes hormone testing to a whole new level: Dutch Complete + Cortisol Awakening Response (CAR)
• Includes Metabolites of Estrogens, Androgens, Progesterone, Cortisol, Melatonin, Adrenaline, Noradrenaline and 8-OHdG. 
• The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response. An optional nighttime Insomnia Cortisol measurement is also available.*

The DUTCH Plus™ takes hormone testing to a whole new level. In addition to sex hormones and their metabolites, the DUTCH Complete looks at the overall diurnal pattern of free cortisol, and the total and distribution of cortisol metabolites. The DUTCH Plus adds the Cortisol Awakening Response (CAR) to bring another important piece of the HPA-axis into focus.

DUTCH Plus™ is a game changer in the world of hormone testing. It provides the most comprehensive look at adrenal and sex hormones available in one test, which means more accurate diagnoses and more effective treatments.”
-Chris Kresser

New York Times Bestselling Author and Founder of the Kresser Institute for Functional and Evolutionary Medicine

What is the Cortisol Awakening Response and how do we test for it?
When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50%. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provide what is required to assess a patient’s Cortisol Awakening Response.

A low or blunted Cortisol Awakening Response can be a result of an under active HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response can be a result of an over-reactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine), and general depression (not SAD). A recent study1 showed that neither the waking nor post-waking cortisol results correlated to Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.
What’s Included in the DUTCH Plus™?

The DUTCH Plus™ uses four dried urine samples and five saliva samples. These samples are collected over the course of one day, from waking to bedtime.

The DUTCH Plus™ report includes:
Metabolites of Estrogens (8, including E1, E2, E3, 2-OH-E1, 4-OH-E1, 16-OH-E1, 2-methoxy-E1), Androgens (8, including Testosterone, DHT and DHEA-S), Progesterone (2), Cortisol (3), and Melatonin and 8-OHdG. The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response and an optional nighttime Insomnia Cortisol measurement.*

What can the DUTCH Plus™ tell us that the DUTCH Complete™ and other adrenal tests cannot?
Even though a patient may have “normal” free cortisol levels throughout the day, that doesn’t always mean everything is functioning properly. The graph below shows two good examples. A blunted or exaggerated CAR can appear, even when single samples return “normal” results. The HPA axis might not be appropriately responding when faced with a stressor, even when cortisol levels are fluctuating nicely throughout the day. The “stress” of waking, allows us to test the HPA axis in a way that has been independently correlated to clinical outcomes and cannot be assessed by other cortisol tests on the market.
Why aren’t true Cortisol Awakening Response tests readily available?

A true CAR assessment requires salivary samples to be collected at the moment of waking, and twice more, at 30 minutes after waking and 60 minutes after waking. These specifically timed collections are difficult and impractical with urine and traditional salivary options. The DUTCH Plus™ uses specialty, FDA-approved, and patented collection devices called Salivettes™. Salivettes™ are specifically made for testing cortisol when timing needs to be precise and are used in nearly all of the published CAR studies. The small synthetic cotton swab can be quickly saturated with saliva, providing a very fast and simple collection. Unfortunately for labs using saliva to test reproductive hormones, they are not a viable option as the swabs cannot be used when testing progesterone. The DUTCH Plus™ offers the most accurate salivary cortisol sampling with Salivette™ collection and analysis using LC-MS/MS. An unparalleled clinical tool is created when combining salivary cortisol with the extensive urine metabolites from DUTCH.