In order for sex hormones to be excreted, they have to be processed by the liver. The liver is our main organ of detoxification, the goal of the liver is to take your hormones and make them more water-soluble so your body can excrete them in urine (and stool).
There are two phases to liver processing of hormones: aptly named phase 1 and phase 2:
Phase 1 takes your hormones and makes them more potent. It is during this phase that hormone metabolites are made through a process called hydroxylation. These metabolites can exert negative and positive effects in the body.
Phase 2 takes your hormones and tries really hard to get rid of them through a process called conjugation. Think of conjugation as tagging your hormones with a sticker that says “I don’t want this anymore”. Once hormones are conjugated they are ready to be excrete by your body. The hormones that are found in urine are conjugated with a sulfate or glucuronide group (now we’re getting fancy). After you’ve sent you urine samples to the lab, the lab has to break the conjugation bonds in order to measure your hormone levels.
Urine hormone testing measures free hormone levels only, because bound hormones are not metabolically active and thus are not broken down by the liver. Urine hormone testing allows you to get a picture of the active hormones in your body, not the bound and inactive hormones.
For example, androstenedione is a mother hormone that makes testosterone but it also makes androsterone, eticholanolone, and estrone. Elevation in androstenedione can be found in PCOS and can cause symptoms of acne and male pattern hair growth.
This is a photo from my personal DUTCH test. You will see that of the three “daughters” of androstenedione, the smallest daughter is testosterone and the highest daughter is androsterone. This is okay news for me. It shows that my body is converting androstenedione into androsterone instead of testosterone, which is an extremely weak androgen. (I owe this ability to certain enzymes I will save for another blog). This explains why I don’t have symptoms of hyperandrogenism, even though my androstenedione metabolites are extremely high! Sure serum blood tests measure androstenedione and testosterone, but they typically don’t measure androsterone…which turned out to be crucial information for me.
As I mentioned earlier, estrogen has many potential metabolites. The DUTCH test measures three estrogen metabolites: 16-OH-E1, 4-OH-E1, and 2-OH-E1.
2-OH-E1 is considered the healthiest and most protective form of estrogen. 16-OH-E1 and 4-OH-E1 are more potent and harmful and have been indicated in cancer risk. Here is the breakdown of my estrogen metabolites: My production of 16-OH-E1 is low, which is good, however I’m not making much of the protective 2-OH-E1 estrogen either. Having this information is extremely valuable, because naturopathic medicine has the potential to alter the metabolism of estrogen in a more favourable way and preferentially metabolize estrogen into the protective and healthy 2-OH-E1. Both 2-OH-E1 and 4-OH-E1 can be methylated by an enzyme called COMT, and naturopathic medicine can support the function of specific enzymes! Pretty awesome!
Remember that the DUTCH test is based on the urinary excretion of hormones, so you may be wondering “what if my body isn’t excreting the hormones properly, does that mean my hormone levels will look deceptively low?!?!” I’ve wondered the same thing!
The three estrogen metabolites all come from a form of estrogen called estrone, except for 16-OH-E1, which is produced from a number of reactions! Below you will find my estrone level. Next to the photo of estrone, are my metabolites. Now look at where all of the green arrows are pointing. My estrone level is midrange, however my metabolites are all low range. The makers of the DUTCH would like to see the arrows of the metabolites all pointing in the same direction as their precursors- meaning they are all in the same range. This is not to say that the metabolites should directly equal their precursors, hormone production is much more complicated than that! Given this information, my results indicate that I have high circulating levels of metabolites and I am not excreting efficiently. Do I buy this information? I’m not sure that I do! Estrogen metabolism is so interconnected that each form cannot be expected to be in the same range as another form at any given moment in time. If you have thoughts on this please comment!!!
Holy smokes?!?! I know that’s a lot of information to take in! I would like to leave you with a pros and cons summary of the DUTCH test so you can make the most informed decision possible when it comes to hormone testing.
HORMONE TESTING SUMMARY