Understanding Integrative Hormone Testing

by Dr Alex Jimenez | Adrenal Fatigue (AF), Chiropractic, Functional Medicine, Health, Hormone Balance

Trouble concentrating, mood swings, headaches, and fatigue could be a common occurrence in one’s day to day life.� These symptoms are commonly brushed off as lack of sleep but did you know these symptoms are also side effects of hormone imbalance?�

Hormone imbalance is fairly common and can be tested for and treated. One of the most accurate tests to date that checks for hormone imbalances is the D.U.T.C.H test.�

What Is It?

D.U.T.C.H is a type of hormone testing that stands for Dried Urine Test for Comprehensive Hormones. Dried urine samples make it possible for scientists to see a whole day of hormones and quantify aspects that are distinct. Unlike obtaining information from a blood draw, urine contains different components that provide scientists with a new line of insight.

What Is The Goal?

When it comes to a hormone imbalance, the adrenal glands may have a large impact. The adrenals are two small glands that sit on top of the kidneys. These small glands are responsible for producing vital hormones such as sex hormones and cortisol. These hormones help the body respond to stress along with other functions.�

With the turn around time being around 10 business days, individuals can gain control and receive the insight they may have been missing. �Precision Analytical (the founders of D.U.T.C.H) employs the most innovative instruments to achieve the best outcomes for patients. The main purpose is to create an understanding of what is currently going on in the patient’s body and allows the treatment to become more specific and targeted to the needs of the individual.

There are different D.U.T.C.H tests that may be completed depending on the patient’s needs. The three main tests are

• Dutch Complete– This is a comprehensive assessment of sex and adrenal hormones and their metabolites. This test measures progesterone, androgen, estrogen metabolites, cortisol, cortisone, cortisol metabolites, creatine, DHEA-S.�
• Dutch Plus– This test uses 5 -6 saliva samples as well as 4 urine samples to provide the up and down pattern of cortisol and cortisone throughout the day. This test adds salivary cortisol measurements of the cortisol awakening response (CAR) to the dutch complete to bring another important piece of the HPA axis into focus
• Dutch Test Cycle Mapping– This test maps the progesterone and estrogen pattern throughout the menstrual cycle. It provides the full picture of a woman’s cycle to answer important questions for patients with month-long symptoms, infertility, and PCOS. This test is targeted to measure 9 estrogens and progesterone that are taken throughout the cycle to characterize the follicular, ovulatory, and luteal phases.�

How Does This Operate?

Precision Analyical, Inc. has found a way to utilize scientists who have extensive experience and coupled them with the most advanced analytical methods and instruments. This permits them to achieve the best outcomes when it comes to the D.U.T.C.H test.

One of the reasons that many practicing offices have started to utilize D.U.T.C.H evaluations is because they have an extremely simple sample collection. Patients will collect dried urine samples within a span of 24 hours. The urine samples offer results that are excellent because the collections provide the span of a patients entire day of hormones.�

For the D.U.T.C.H test, the patient will collect 4-5 urine samples throughout a 24 hour time period. Upon opening the kit, the patient will be faced with a folder. This folder includes step by step instructions as well as a pocket. Inside the pocket, the patient will find a requisition form, an envelope, and a small clear plastic bag containing the collection paper.�

Each sample will be completed on a separate collection sheet that is labeled with the time. Once the patient opens this bag, they will be able to unfold the first sample paper. The patient will obtain the initial sample at approximately 5pm ( dinnertime). Once the samples are taken, they are to be left open to dry for 24 hours. The second sample is to be taken around 10 pm (bedtime). This third sample depends upon each individual, but in the event, the patient awakens to urinate during the night, a sample is to be gathered. The next sample ought to be collected within 10 minutes of rising. It’s very important that the patient does not lay in bed after waking and they amass this sample within the 10 minute time period that is allotted. Once the patient has collected their morning sample upon rising, they should set an alarm for two hours, since this is when the final sample will be collected. As soon as all the samples have been collected and set out open to dry for 24 hours, the patient can fold them back up and fill out the information on the back of the card ( i.e first name, last name, date of collection, time, and day of cycle for women) and place them inside the clear plastic bag.�

From here, the patient can place the plastic bag full of their samples along with the requestion form in the envelope provided. Next, place 8 stamps in the correct corner, and send it off to the lab!�

For the D.U.T.C.H Plus test, individuals will collect dried urine samples as well as saliva samples. This is best so researchers can utilize information from both collection samples to measure the cortisol and cortisone markers as well. For this test, it is completed in a 24 hour time window with 4 dried urine samples and 5 or 6 (depending on the individual) salvia samples. This test may sound more complicated, but it has a fairly easy schedule that makes it just as simple as the D.U.T.C.H complete. The kit will include labeled urine and salvia collection methods along with easy to read instructions.�

When opening this test, the patient will find an instruction book, a requisition form, 4 collection sheets for the urine (labeled with the time) and 6 labeled tubes for the saliva. For all the urine samples, fill out the backside of the card as prompted (last name, first name, date, and time). Saturate the filter paper or urinate into a clean cup and dip the filter paper for 5 seconds. Once this step is completed, leave the sample open to dry for 24 hours.�

For the saliva samples, take out the appropriate tube for the time it is to be collected. Just as done with the urine, fill out the allotted area requesting last name, first time, sample date and time. The saliva tubes have a blue cap that needs to be removed. After this cap is removed, a long cotton swab will be visible. Take out the cotton swab but leave the small tube in the long tube. The patient will then take the cotton swab and leave it in their mouth until it is fully saturated. Once this is done, place the cotton swab back in the tube as it was found and place the blue cap back on. The small tube should stay intact. There is no need to spit in the tubes.�

The first sample will be salvia and urine. These samples are to be collected immediately upon waking (no brushing of the teeth). The next two samples will be saliva. These are to be taken 30 minutes and 60 minutes after waking. After these are completed, the patient may brush their teeth. The fourth sample will be collected 2-3 hours after waking and is urine only. The fifth and sixth samples will be urine and salvia. The patient will collect these around 4-5 pm (dinnertime) and again anywhere from 10pm-midnight (bedtime). Place all saliva tubes in the freezer until they are ready to be shipped.�

The seventh saliva sample is optional. This will be collected at the time the patient wakes throughout the night if they do so.�

After all the samples have been collected and urine has dried for 24 hours, fold up the urine samples and place them back in the small plastic bag in which they came. Then, take the frozen saliva samples out of the freezer and place them in the plastic bag they arrived in. From here, take the urine samples, the frozen saliva, and the requestion form and place them all back in the kit box. Place the kit box in the return envelope provided and return using the provided carrier.�

The D.U.T.C.H cycle mapping test is the most extensive test provided, with 25 urine samples needed. Due to the fact that this test is for cycle mapping, the collection time frame will be one entire cycle. To start, the patient will need to identify the type of cycle they have ( less than 24 days (normal) long (34 days or more) or no cycle). When the patient opens this kit, they will see an instruction book, 25 urine collection cards, a requestion form, a clear bag, and an envelope.

Day one of the patient’s cycle is the first day of full menstrual flow. The collections for this test will begin on the seventh day and the last four samples will be collected on the fourth day of the patient’s next menstrual cycle. Inside the instruction book, the patient will find an easy to use collection schedule to keep track of their samples.

The ideal time to collect samples throughout this test is upon waking. This will give the lab the most concentrated urine, making the results more conclusive. The patient will collect their sample every morning for day 7 through day 36. Once collected, the patient will leave the urine sample out to dry for 24 hours before putting it in the clear bag provided. It is important for the patient to write the date of the sample on the collection schedule included in the kit.�

The final four samples (22-25) are all to be collected on the same day. Sample 22 should be taken within 10 minutes of waking. Sample 23 is to be taken two hours after waking. Sample 24 should be collected at dinnertime and the patient should not have any fluids two hours before this sample. The final sample should be collected at the patient’s bedtime (approximately 10pm).�

Once the patient has collected all of the samples and let them dry for 24 hours, they are to be placed in the clear plastic bag that was provided in the kit. Next, the patient is to place the clear bag full of samples, the completely filled out collection schedule, and the requisition form in the envelope provided in the kit. Finally, place 8 stamps on the indicated corner and send it off to the lab!�

When sent to the lab as you can see above, these urine samples will be dry. Studies show that dried urine samples will give an accurate representation of the hormone and are stable for weeks. From here, the outcomes are gone over on a team call that includes the patient’s physician and clinicians at Precision Analytical. This helps to ensure that the treatment protocol is created specifically to fit the patients needs.��

Testing is now able to be done by using top of the line integrative techniques. There are numerous reasons and advantages for an individual to complete a hormone evaluation. These tests have the capability to help a patient understand their cycle, testosterone levels, estrogen levels, why they are tired upon waking, throughout there day, and much more.

Hormone imbalances can affect anyone. People tend to associate hormone imbalance with those who are aging, but in reality, it can affect anyone of any gender or age! It might seem like a hassle at first to compelete these tests, but in reality, they are very simple and provide a great deal of information! The symptoms are common and should be discussed with a healthcare practitioner. October is Chiropractor Health Month and our office can help if you are an individual who has these symptoms. Our office implements the D.U.T.C.H test, which allows us a hassle free and easy way to let us help you get back to feeling how you used to. – Kenna Vaughn, Senior Health Coach

The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or chronic disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 .