About Test

About DUTCH Plus®

Key Details

• Review your kit - When you receive the test kit in the mail, review its contents, and read through the information provided with the kit.
• This is a urine and saliva collection kit that you will collect for at home.

What Days of the Month Do I Collect?

• Cycling Premenopausal Women
  • Begin collection between days 19 and 22 of a 28-day cycle. For longer cycles, add the number of days you usually go beyond 28 days. In a similar manner, subtract if your cycles are shorter (example: collect days 17-20 for a 26 day cycle)
  • For irregular cycles or non-cycling (ablation or uterus removed), watch the irregular cycle collection video in the video library at dutchtest.com/videos for suggestions on collecting.
• Men & Non-Cycling or Postmenopausal Women
  • Collect any day.

Restrictions

• Watch Your Fluid Consumption
  • Please limit the amount of fluid intake the night before and the day of the test. Limit total fluid intake to 32 to 64 ounces on the day of testing. Urine samples are best if they are not too diluted.
• Using Hormones?
  • Collection and dosing timing depends on the question you and your clinician are trying to answer. Our general recommendations for monitoring patients while on therapy are as follows:
  • Hormone creams, gels, or suppositories taken in the morning should be delayed until after sample #4, otherwise, take hormones as directed by your clinician. For patches, pellets,  or injections, it is usually best to collect midway between doses.
  • If taking oral progesterone, continue taking the night before this test at bedtime or as usual.
  • DO NOT TAKE oral DHEA 48 hours before, or any oral or sublingual estrogen* or pregnenolone 72 hours before your first collection. Check with your provider for specific instructions if you are unsure.
  • Any other hormones taken at NIGHT (including oral progesterone) should be taken after the bedtime sample.
  • If you take glucocorticoids (Prednisone, Dexamethasone, etc.), check with your provider. These products may significantly impact results. Sublingual hormones may result in difficult interpretations, and it may be best to skip the day of collection.
  • Do not skip doses of birth control for this test unless instructed by your practitioner.
• Food, Alcohol, Supplements and Exercise
  • Avoid caffeine, alcohol, and strenuous exercise the night before or day of testing because it may negatively affect testing results.
  • Avoid morning food and drink until after collection #3.
  • Some foods and supplements may impact HVA organic acid results. Avoid avocado, bananas, and fava beans for 48 hours before collecting for optimal results. If you do consume, please make a note on your requisition form. If you take any of the following supplements, please consult your provider: Tyrosine, L-Dopa, D, L-Phenylalanine (DLPA), Mucuna, and Quercetin.
• Oral Hygiene
  • Do not brush your teeth until after collections #3 and #5.
  • Do not floss on the day of collection or until ALL samples are collected. Consult your provider if you have questions.

When to Collect

While adhering to your most common wake/sleep schedule, collect as close as possible to the below timeline.

• Sample #1: Waking
  • Collect saliva immediately upon waking, complete within 5 minutes, and set a timer for 30 minutes for Sample #2.
  • Collect the first urine sample.
• Sample #2: 30 Min After Waking
  • Collect saliva 30 minutes after waking, then set the timer for 30 minutes for Sample #3.
• Sample #3: 60 Min After Waking
  • Collect saliva for Sample #3.
• Sample #4: 2-3 Hrs After Waking
  • Collect urine only, two to three hours after waking.
• Sample #5: Before Dinner
  • Rinse your mouth with water 10 minutes prior to collecting saliva.
  • Collect both urine and saliva.
• Sample #6: Bedtime (no later than midnight)
  • Rinse your mouth with water 10 minutes prior to collecting saliva.
  • Collect both urine and saliva.
• Sample #7: Extra Cortisol Collection (optional)
  • If you struggle with staying asleep during the night, this sample can be used overnight. Keep the collection tube close to your bed and collect at the time of your sleep disturbance (minimize light exposure). You may complete the label after rising for the day. Otherwise, you may collect this sample at noon or as instructed by your provider.

How to Collect

• Urine
  • Saturate the filter paper (the paper with two black lines) by urinating directly on to, or urinating into a clean cup and dipping the filter paper for 5 seconds.
  • Leave the sample open to dry for at least 24 hours.
  • Once dry, close each collection device and place them all in the resealable plastic bag provided.

• Saliva
  • Remove the blue cap and place the cotton swab from the collection tube in your mouth. Leave the swab in your mouth until fully saturated, but not longer than 5 minutes. Lightly chewing on the swab may help stimulate saliva flow.
  • Once done, place the swab back in the same tube, just as you found it. Do not remove the inner tube. You do not need to spit into the tube. Touch the swab as little as possible with your hands.
  • Freeze all saliva samples until ready to ship.

Why Use DUTCH?

The Easiest Patient Collection

Patients collect just four or five dried urine samples over a 24-hour period. Dried samples are stable for several weeks making them convenient to ship worldwide.

Analytical and Clinical Validation

Precision Analytical’s testing methods go through a rigorous validation process to verify accuracy, recovery, and linearity. We pride ourselves in relentlessly pursuing the most accurate and precise techniques available for testing. See the data on the next page to support the analytical and clinical validation of this powerful new testing model.

Effective HRT Monitoring

DUTCH testing was designed to be optimally effective for most forms of hormone replacement therapy. Unique methods are used for improved monitoring of oral progesterone and vaginal hormones.

How does DUTCH Compare to Other Hormone Tests?

DUTCH vs. Saliva Testing

While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patient’s HPA-Axis function with saliva testing – measuring cortisol metabolites. To properly characterize a patient’s cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.

DUTCH vs. Serum Testing

While the most universally accepted testing method (due to the availability of FDA-cleared analyzers that are reliable and inexpensive), serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing (especially for cortisol and estrogens).

DUTCH vs. 24-Hour Urine Testing

There are two primary drawbacks to 24-hour urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error (Tanaka, 2002). Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. Some providers add saliva for daily free cortisol. DUTCH eliminates the need for two tests.