As a Functional Medicine practitioner, I’m interested in finding out the causes of your health problems and this means a lot of detective work to discover imbalances in your organs and systems. To help pinpoint these I use specific tests allowing me to take a detailed look at the biochemistry of your body.
In this blog we’ll dive into one test I use to examine hormone balance, the Dried Urine Test for Comprehensive Hormones, or DUTCH test.
Functional tests are incredibly useful as although during a consultation I take a detailed case history, it’s impossible to always predict accurately what’s happening inside your body. Often, similar symptoms have different causes.
Functional testing pinpoints the precise biochemical imbalances occurring within your body’s cells. This means I can target your treatment programme to reverse the problems causing your symptoms, avoiding the need for any guesswork.
In this article we’ll concentrate mainly on the sex hormones oestrogen, progesterone and testosterone. Healthy levels of these hormones are incredibly important, and they’re typically out of balance in PMS, fibroids, period problems, endometriosis, poor bone health and fertility issues.
In many cases, oestrogen levels become too high relative to progesterone. This is called oestrogen dominance, and it’s connected with heavy and painful periods, irregular cycles, mood swings, breast tenderness and an increased likelihood of developing hormone–dependent cancers. High testosterone levels in women, on the other hand, are related to PCOS.
The usual method of testing hormone levels by a GP is by a blood test, which you may have been told shows your hormone levels are perfectly fine. You might have found his strange because many of your symptoms point to a hormone imbalance.
One reason for this relates to the form in which hormones such as oestrogen and progesterone travel around your body. They can exist unbound or free, capable of causing an effect when they latch onto a hormone receptor. Or they may be carried along bound to a protein molecule, and in this form they have no effect. Blood tests don’t usually distinguish between free and bound hormones. This can give a misleading result if most of your hormones are bound and therefore inactive.
Urine is a good reflection of sex hormone levels in your body because the test can separate free and bound hormones. The DUTCH test uses samples of dried urine to look at oestrogen, progesterone and testosterone.
If you are menstruating, your hormones will vary over the month. A single sample, of blood or urine, will only give you a snapshot of events during a certain second in time. So it’s best to take several samples over the course of a month and this is included in the DUTCH test for women who are still having cycles.
The other major disadvantage of a blood test is it doesn’t distinguish between the different types of oestrogen metabolites. These are various forms of oestrogen produced by your body once the hormone has done its job.
Because your body eliminates oestrogen in your urine, it must be changed from its original fat-soluble form to something which mixes in water. This happens in your liver, and many factors from diet to genetics can influence the precise type of oestrogen metabolite produced. Each metabolite differs in its potency.
The most widespread oestrogen metabolite is called 2-hydroxyoestrogen, and it’s fairly weak. If most of your oestrogen exists in this form, it’s likely you’ll have less of a risk of developing oestrogen dependent cancers such as breast cancer than if much of your oestrogen is in the form of the more potent 16-hydroxyoestrogen.
Because the relative quantities of each type of oestrogen produced affect your oestrogen load and hormonal health, it’s incredibly useful to measure the levels and ratio of these oestrogen metabolites. There’s no way of determining your oestrogen metabolite ratio by looking at you or even examining your symptoms.
Because your body uses certain nutrients to produce 2-hydroxyoestrogen, once your levels are known, liver support and the use of these nutrients can encourage the production of less harmful oestrogen metabolites.
Stress and sex hormones can’t be separated, because stress strongly affects oestrogen and progesterone levels. So it’s often useful to also measure stress hormones as well as levels of brain neurotransmitters, involved in mood and motivation, and hormones related to sleep patterns.
These are included in the DUTCH plus test using separate saliva samples.
Your body is very good at giving clues or symptoms that your hormones could be out of kilter. But the complex balance between the various hormones and their different forms can confuse the picture, with similar symptoms arising from different causes.
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