The DUTCH Plus takes hormone testing to a new level. In addition to sex hormones, their metabolites, the overall diurnal pattern of free cortisol, the DUTCH Plus adds the Cortisol Awakening Response (CAR) to bring another important piece of the HPA axis into focus.
Why use DUTCH Plus over DUTCH Complete
A patient might have free cortisol levels within the normal range, but this doesn’t always show things are functioning properly. A blunted or exaggerated CAR allows us to measure stress levels upon waking.
This is useful to assess major depression disorder: A recent study showed that neither the waking nor post-waking cortisol results correlated with Major Depressive Disorder, but the CAR calculation (the change between the first two samples) did. This measurement of the response to waking has independent clinical value showing dysfunction that may be hidden by current testing options.
A low or blunted Cortisol Awakening Response
This can be the result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder
(SAD), sleep apnoea or poor sleep in general. It can also be due to post-traumatic stress disorder (PTSD), chronic fatigue , or chronic pain.
A blunted CAR has also been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.
An elevated Cortisol Awakening Response
This can be the result of an overactive HPA axis, anticipatory stress for the day (i.e. due to ongoing job-related stress, relationships, etc.) glycaemic dysregulation, waking with pain, and general depression (not just seasonal affective disorder).
DUTCH Plus includes
Four dried urine samples and five saliva samples. These samples are collected over the course of one day, from waking to bed time. The DUTCH Plus report includes: Metabolites of oestrogens (10, including E1, E2, E3, 2-OHE1, 4-OH-E1, 2-OH-E2, 4-OH-E2, 16-OH-E1, 2-methoxy-E1, 2-methoxy-E2) , androgens (8, including testosterone, DHT and DHEA-S), progesterone (2), cortisol (3), melatonin (6OHMS), 8-OHdG (a useful biomarker for oxidative stress and carcinogenesis, and organic acids (6). The diurnal pattern of Free Cortisol and Cortisone are also provided, including the Cortisol Awakening Response.