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For all patients experiencing:

• Fatigue, especially on waking
• Insomnia
• Chronic fatigue
• Depression or anxiety, especially on waking
• High-stress lifestyle
• Loss of resiliency

For female patients experiencing:

• Fatigue or low energy
• PMS
• Vaginal dryness
• Brain fog
• Low libido
• Weight gain
• Fertility concerns
• Hot flashes or night sweats

For male patients experiencing:

• Erectile dysfunction or low libido
• Decreased muscle mass
• Abdominal weight gain
• Fatigue or low energy
• Brain fog

What is the DUTCH Plus?

The DUTCH Plus is a comprehensive dried urine and saliva test that maximizes the available information from sex and adrenal hormone production and metabolism. With easy, at-home sample collection over the course of one day, providers can gain insights into the overall diurnal pattern of free cortisol and cortisone, along with the total distribution of cortisol metabolites. This test offers further insight by including organic acid testing, which evaluates potential nutritional deficiencies, oxidative stress, gut dysbiosis, melatonin levels, and neuroinflammation.

With the DUTCH Plus, providers also get a closer look into adrenal function with details about a patient’s cortisol awakening response (CAR) by showing cortisol's natural rise and fall within the first hour of waking.

What's included in the DUTCH Plus?

The DUTCH Plus is a bundle that includes all panels from the DUTCH Complete (sex hormones, adrenals, and organic acids) and the DUTCH CAR. Individual panels are also available for purchase, see below for more details.

DUTCH PLUS Sample Reports: |

HIGHLIGHTS FROM THE REPORT

The DUTCH Sex Hormone panel is great for baseline hormone measurements and provides insights into HRT monitoring with estrogen metabolites. It is a unique method for more accurately monitoring vaginal hormones and oral progesterone.

What does this test?

• Estrogen metabolites: E1, E2, E3, 2-OHE1, 4-OHE1, 16-OHE1, 2-MeOE1, 2-OHE2, 4-OHE2
• Androgen metabolites: testosterone, DHEAS, DHT, and more
• Progesterone metabolites: a-pregnanediol, b-pregnanediol
• Graphical representation of results
• Provider notes with specific additional information created for each patient

View Sample Reports: |

The DUTCH Adrenal panel provides free cortisol patterns that parallel saliva with the addition of metabolite measurements for improved data on total cortisol production. This test is run on LC-MS/MS—the most accurate way to test cortisol and metabolites.

What does this test?

• Daily free cortisol pattern
• Daily free cortisone pattern
• Cortisol metabolites (a-THF, b-THF)
• Cortisone metabolites (b-THE)
• DHEA-S
• Graphical representation of results
• Provider notes with specific additional information created for each patient

View Sample Reports: |

DUTCH OATs

Organic acid tests (OATs) are a popular tool to evaluate health. The OATs included with the DUTCH Test provide a comprehensive view of possible nutritional, hormone, and metabolite imbalances or deficiencies that can influence overall health, energy, and quality of life.

What does this test?

• 6-OHMS, melatonin marker
• 8-OHdG, oxidative stress marker
• Vanilmandelate (VMA), primary metabolite of norepinephrine/epinephrine
• Homovanillate (HVA), primary metabolite of dopamine
• Quinolinate, neurotoxin derived from tryptophan
• Kynurenate (KYNA), vitamin B6 marker
• Xanthurenate, vitamin B6 marker
• Methylmalonate (MMA), vitamin B12 marker
• Pyroglutamate, glutathione marker
• Indican, gut health marker
• b-Hydroxyisovalerate, biotin marker

View Sample Reports:

The DUTCH CAR is a saliva test that provides insight into adrenal function with details about a patient’s cortisol awakening response (CAR). Along with the CAR, this test also shows the patient’s daily free cortisol and cortisone patterns.

View Sample Reports:

When is the DUTCH Plus recommended?

This test is recommended when you are looking for information about:

• Sex hormone production and metabolic patterns
• Adrenal hormones (DHEA and cortisol) production and metabolic patterns
• Diurnal free cortisol and cortisone patterns
• Melatonin production during sleep
• Micronutrient availability and oxidative stress

You may be considering the DUTCH Complete or the DUTCH Plus:

Both panels provide the above information but what’s the difference? You should use the DUTCH Plus when you want a more complete picture of HPA axis function. The cortisol awakening response (CAR) provides an additional evaluation of HPA axis function and can independently suggest HPA axis dysfunction. There are times when the diurnal cortisol curve will be within normal limits, but the CAR is not. The DUTCH Plus® provides both looks at adrenal function.

Another test is better suited when:

• You wish to evaluate a female’s full menstrual cycle. The DUTCH Cycle Mapping Plus provides the detail of the DUTCH Plus while also measuring sex hormones at timepoints throughout the menstrual cycle.
• HPA axis dysfunction is not suspected. The DUTCH Complete™ provides insights into the overall diurnal pattern of free cortisol and the total distribution of cortisol metabolites.

What does the cortisol awakening response add?
A healthy individual’s free cortisol production should rise in a predictable pattern in response to physiologic stress. Cortisol’s rise in response to the stress of waking provides insight into hypothalamic-pituitary-adrenal (HPA) axis function and its ability to respond appropriately to daily stressors. The cortisol awakening response (CAR) is a mini-ACTH stimulation test.

During an ACTH stimulation test, the patient is given ACTH and the adrenal cortisol response is recorded. This test and the CAR both test adrenal reserve; in other words, how well an individual adapts to a stressor. HPA Axis dysfunction (abnormal cortisol responses) may be represented as changes in the CAR. An abnormal CAR may arise from chronic stress and is also documented in conditions like depression, chronic pain, insomnia, hypertension, metabolic syndrome, fatigue, and in autoimmune diseases.

PATIENT COLLECTION SCHEDULE

The DUTCH Plus uses 4 urine and 5-6 salivary samples collected throughout the day (and night in some cases).

Caffeine, alcohol, and strenuous exercise may affect results.

Sample #1: Waking Samples Urine Saliva

Collect saliva immediately upon waking, complete within 5 minutes, and set a timer for 30 minutes for Sample #2. Collect the first urine sample, do not lay awake in bed before collecting samples.

Sample #2: 30 Minute Sample Saliva Only

Collect saliva 30 minutes after waking, complete within 5 minutes, then set the timer for 30 minutes for Sample #3.

Sample #3: 60 Minute Sample Saliva Only

Collect saliva 60 minutes after waking, complete within 5 minutes. Avoid morning food, drink, and brushing your teeth until after this collection.

Sample #4: 2–3 Hrs After Waking Sample Urine Only

Collect urine only, two to three hours after waking.

Sample #5: 4–5pm Samples Urine Saliva

Rinse your mouth with water 10 minutes prior to collecting saliva. Collect both urine and saliva between 4-5pm (before your evening meal).

Sample #6: Bedtime Samples Urine Saliva

Rinse your mouth with water 10 minutes prior to collecting saliva. Collect both urine and saliva at bedtime, but no later than midnight.

Sample #7: Optional Extra Sample Saliva Only

If you struggle with staying asleep during the night, keep the collection tube close to your bed and collect at the time of your sleep disturbance.

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 NOT AVAILABLE FOR NEW YORK STATE ADDRESSES*

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.