Hormonal Testing: The limitations of blood tests and why the DUTCH test tells us so much more.
(Although this article is written for a person that menstruates it's important to state that the Dutch test can be used for any gender or sex identity).
I remember when I had my first hormonal blood test performed. I had no idea where my results were supposed to be in the reference ranges. It's in range so I suppose I am healthy, but I don't feel fine? Little did I know that my hormones were much more complex than these blood tests could ever tell me.
Does this experience sound familiar? Are you feeling hormonally imbalance but your lab tests are telling you you're in range? You're not alone. Since becoming a naturopath I have become passionate about hormonal testing using the DUTCH urine hormone test in combination with some blood tests to be able to see the complete ad complex pathways of our hormonal metabolism and levels. With this information I have seen women become empowered as they learn how to balance their hormones naturally.
What are the limitation of hormonal blood tests?
I love lab testing. I have trained in comprehensive lab test analysis. I just do not love it for comprehensive oestrogen, and progesterone testing. This is because laboratory testing routinely measures E2 forms of oestradiol only, missing E1, E3 and important hormone metabolites (metabolites are what happens when oestrogen is broken down and is being removed from the body). The ranges are also very wide (see image below). It fails to recognise subclinical pictures of hormone imbalances. For example, a woman experiencing a level of oestradiol at 300 pmol/L mid cycle would most likely be experiencing different symptoms to a woman with a 1200 pmol/L level of oestradiol. Both of these numbers are within the reference ranges. A progesterone blood test can be helpful to assess ovulation if used in the luteal phase. However blood tests of progesterone will not show important hormone metabolites. The balance of these progesterone metabolites are essential for to understand mood concerns. They have an anxiolytic effect in women in the luteal phase and have been shown to ameliorate PMDD symptoms (2).
Hormone tests that can be helpful:
FSH: Rises in menopause due to low ovarian reserve and the ovaries not responding to normal levels of this hormone. It can be slow to rise and only show up once you are in menopause but not in the perimenopause transition. (1)
LH: LH rises mid cycle to stimulate ovulation. Testing LH in the luteal phase can be part of a picture to understand if you are ovulating or not. You may want to have this test performed if you are trying to become pregnant or generally interested in the health of your cycle. You want to test LH around your estimated day of ovulation. (1)
Retrieved from: https://www.awanuilabs.co.nz/north/auckland/for-referrers/tests/reference-ranges/
How the Dutch hormonal test is different.
The DUTCH test combines the latest in hormonal research with cutting edge technology to bring human beings comprehensive and accurate information about their hormones. People of any gender and sex can do the DUTCH test.
It offers the most extensive range of sex and adrenal steroid hormones along with their important metabolites in the testing world. See image below.
Easy to do at home: No more going into labs and having your blood drawn. This test requires urine samples over a 24 hour period with options of measuring hormones over a month too.
The company to analyse the results precision analytical goes through a rigorous validation process to test for precision, accuracy and more. This ensures your results are as precise as possible.
Why is it so important to see my hormonal metabolites?
The difference with assessing hormones in the urine is we can measure levels of their metabolites which show important pathways of detoxification and how these hormones are being removed from the body. If detoxification of hormones is impaired this can create hormonal imbalances. Over time this may create inflammation and can lead to symptoms like PMS, acne, bloating, weight gain, heavy periods and much more. (3)Why are adrenal hormones measured?
We all feel different when we are stressed and so often if we are menstruating we also see changes with the length or symptoms associated with our cycle. This is why the Dutch test also assesses cortisol. (3)
Retrieved from https://dutchtest.com/info-dutch-complete/
Blood tests that complement the DUTCH test.
If you are experiencing hormonal symptoms it's essential to get a full thyroid panel so that when combined with the DUTCH test you are able to see if the cause of the hormonal imbalance may be due to subclinical or overt thyroid imbalances.
A full thyroid panel may include but not be limited too: TSH, T4, T3. If these come back abnormal it's important to check for thyroid antibodies (TPOab) to rule out autoimmune thyroiditis.
Testosterone lab test: Some people have a genetic SNP that shows in the DUTCH test as low testosterone. Therefore getting a testosterone lab test can be helpful to confirm it is in the normal range or if you have this gene SNP. (3)
Is the DUTCH test for me?
If you are someone that has been struggling with getting answers through lab tests and you continue to struggle with hormonal symptoms then the DUTCH test may be for you. To get the most out of this test, working with a qualified naturopath to support you with the understanding of your results and what to do after you receive them is essential to repairing your hormonal concerns. If you want to check if the DUTCH test would be right for you please book a functional test call so I can guide you on your testing journey.
If you are after support please book a consultation or a functional test call.
References
1.bpac, 2005. Reproductive hormones: The right test, at the right time, for the right patient. https://bpac.org.nz/BT/2013/February/02_hormones.aspx.
2. Stefaniak M, Dmoch-Gajzlerska E, Jankowska K, Rogowski A, Kajdy A, Maksym RB. Progesterone and Its Metabolites Play a Beneficial Role in Affect Regulation in the Female Brain. Pharmaceuticals. 2023; 16(4):520. https://doi.org/10.3390/ph16040520https://www.mdpi.com/1424-8247/16/4/520.
3.Dutch test complete: https://dutchtest.com/info-dutch-complete/.