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DUTCH test, hormone testing,hormone test, women's hormones, hormone health

DUTCH: Gold Standard in Hormone Testing

In my work with women’s health and hormones, one of the biggest areas of debate is hormone testing. Women are confused about when and how to test their hormones, and if I’m honest, a lot of doctors are confused as well. Which is leaving women under-diagnosed and under-treated for their very real (and very annoying) hormone imbalances.

But no more. Science has come a long way and right now we have the ability to test for hormones in ways that we never have been able to before. And women everywhere can benefit. So if you’ve ever wondered, “Do I have a hormone imbalance?”, now we can easily answer that question.

The DUTCH Test

Hormone testing with the DUTCH testDUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them.

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.

8 Reasons the DUTCH Test is the Gold Standard for Hormone Testing

  1. Simple collection

Nothing is easier than peeing on a piece of filter paper. (Ok… some people might get a little pee on themselves, but still… is that the worst thing that can happen to you today?)

  1. In depth hormone levels

If you have a question about your hormones, the answer is likely to be found in the DUTCH test. While your Naturopathic Doctor may still recommend blood testing for hormones like thyroid hormone, FSH or LH, just about every other hormone is covered in the DUTCH test.

  1. Metabolism matters

Hands down, the reason the DUTCH test is the best, is that it measures metabolites. The absolute level of your hormones matter – but what can matter more is what your body does with those hormones. This is metabolism – does your body turn testosterone into nasty acne-promoting 5a-DHT?? Does your body turn estradiol into DNA damaging 4-OH estrone? Are you healthfully metabolizing and eliminating estrogen from your body? The DUTCH test can tell you.

  1. It’s all about those curves

Not every hormone has stable levels over the entire day. In particular, our primary stress hormone, cortisol, and its metabolite cortisone, have a curve that changes over the course of the day. Blood tests only give us a single snapshot of your cortisol levels, but the dried urine test gives us not only the total levels of cortisol and cortisone, but also the curve – how those levels change over the day. This is some VALUABLE information for people who are struggling with stress, fatigue, anxiety, decreased libido, trouble sleeping and insomnia.

  1. Balanced estrogen

Estrogen is one of the most important hormones in our bodies, and it has so many benefits for our health, but it can also have negative impacts if it is not in balance.

Typical hormone testing for estrogen looks just at estradiol, the dominant estrogen in the body. But that only tells us such a small bit of information. If we want to balance our estrogen, and prevent complications of estrogen dominance, then we want to understand how our body copes with our burden of estrogen. What metabolism pathways does our body use? Are those the best pathways?

If you are considering bioidentical hormones (BHRT) for perimenopause, or menopause symptoms, then the DUTCH test is highly recommended at the initial visit to understand how you will metabolize the hormones.

  1. Androgens and acne and hair health

In my work with women, no one condition is more loathed or baffling than acne. WTF, am I right ladies? How did we reach our 30s and still have to deal with acne?? Often it’s an issue of androgen metabolism. But typical hormone testing just looks at the amount of testosterone being made, and not what your body is doing with it. If your body is sending more testosterone towards the DHT metabolites, you will have more acne and possibly hair loss (and chin/ upper lip hair growth!) The DUTCH test will tell you if this is happening – and then we can talk about what to do about it!

  1. Melatonin

If you are having difficulty sleeping, knowing your melatonin levels is amazing information to have. But not only those with insomnia or sleep challenges should know their melatonin levels. Melatonin is also a powerful antioxidant in our bodies, and optimal levels of melatonin have been found to reduce the incidence of hormonal cancers (including breast cancer). No other hormone test looks at melatonin, but the DUTCH test does.

  1. Organic acids

Natural treatments and testing for depression and anxietyA new addition in 2018 to the DUTCH test is the 6 OAT (organic acid tests). I’m so excited for this new information!

Three new markers for neurotransmitters – to help us understand your mood. If you struggle with depression, anxiety or insomnia, this information can be very significant. If you have tried antidepressants without benefit, your organic acid markers for specific neurotransmitters, like serotonin, may tell you why.

Additionally there are three new markers for nutritional levels – looking at your B6 and B12 metabolism as well as your glutathione status. If you are concerned about weight gain or inflammation as part of your hormone imbalance, now we may be able to identify why.

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

I know. Such an aesthetic issue. But the test results are ugly – seriously. The results are clear. The information is valuable. But the results look a lot like a airplane dashboard, and some patients find this overwhelming. So take the time to talk through the results with your ND to understand what they mean for you.

Toronto, naturopath, doctor, naturopathic doctor, holistic, functional doctor

Next Steps

If you are interested in DUTCH testing, I suggest booking a 15 minute complimentary meet and greet to discuss the details. It is an amazing, useful, sophisticated test. But it’s not the right test for everyone. So let’s talk and see if it is the right test for you.

Dr. Lisa

Further Reading


Female Hair Loss: Lab Testing

My expertise in treating hair loss in women started with a personal experience of hair loss in my 20s. After being dismissed by my Medical Doctor who assured me it was “totally normal” I persisted in understanding why a healthy woman in her 20s would start losing hair.

Laboratory Testing for Female Hair Loss

As I discuss in my article, Getting to the Root of Female Hair Loss, treating hair loss can only be effective if you understand the root cause – why is a woman losing hair? Through laboratory testing an answer can often be found.

When I am working with women with hair loss I generally advocate for a tiered approach to lab testing for hair loss – starting with the most likely causes and progressing to the more complex.

For myself, the issue was an iron deficiency. By correcting that iron deficiency I was able to resolve my hair loss in under a year and it hasn’t recurred since.

Use the checklist below with your Medical Doctor or Naturopathic Doctor to determine the root cause of your hair loss. And if you’re ready to work with someone experienced in hair loss in women, get in touch and book an appointment today.

Female Hair Loss – Printable PDF


The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.


Alopecia Areata – The Naturopathic Approach

Hair loss can be a devastating symptom for men and women alike.  When it happens during adolescence or young adulthood it can be even more so.  Alopecia areata, a type of hair loss that affects up to 0.2% of the population (that’s over 50 000 people in Toronto alone) most often starts in people under 20 years of age.

Men and women suffer equally from alopecia areata and it occurs in all ethnic groups.  While we don’t know exactly what causes alopecia areata the evidence suggests it is an autoimmune condition with genetics and environmental factors contributing to its onset.


Alopecia areata has a characteristic appearance of well-defined round or oval areas of hair loss.  Typically occurring on the scalp, the circular patches of hair loss are free from scarring and the skin is not discoloured.  Around the patch of hair loss some hairs will have an “exclamation point” appearance showing signs of the abnormal transition of the hair through it’s growth phase.

While alopecia areata usually occurs as defined patches on the scalp, alopecia totalis occurs when there is  total loss of the scalp hair and alopecia universalis refers to loss of all hair on the scalp and body.

Diagnosis of alopecia areata should consist of a detailed history, a thorough clinical examination and appropriate laboratory testing.   Markers of inflammation and nutritional status should be included in any blood work to identify potential contributing factors in the onset and development of alopecia areata.


Treatment of alopecia areata is difficult to assess because spontaneous recovery and hair regrowth occurs within 6 to 12 months for more than half of all patients.  However, recurrence is high so efforts should be made to determine the underlying cause of alopecia areata and treat accordingly.

While many things can contribute to the development of alopecia areata research suggests that some of the most significant factors are:

  • Stress (physical or emotional)
  • Hormone fluctuations
  • Infectious diseases or illnesses
  • Autoimmune conditions
  • Pre-existing health conditions such as celiac disease, ulcerative colitis, psoriasis, multiple sclerosis, vitiligo and lupus
  • Nutritional deficiencies – especially zinc and iron
crisp bread
Seeds are a good source of zinc.

As a Naturopathic Doctor my focus is on uncovering potential imbalances that may be contributing to the development of disease.  With alopecia areata there are often multiple factors that must be addressed – nutrient deficient diets, stress, poor immune function and hormone imbalances being the most common.

Potential natural treatments depend on individual needs – unfortunately there is no one diet or supplement that can cure alopecia areata.  The best course of action is to understand your health – what are the potential causes of your hair loss and how can they be addressed through dietary, nutritional and supplemental support.

To learn more about my individualized approach to hair loss, book a complimentary 15 minute meet-and-greet.  Learn how you can improve your health today.


  1. Shapiro J. Hair Loss in Women. N Engl J Med. 2007;357:1620-1630.
  2. Springer K, Brown M, Stulberg DL. Common hair loss disorders. Am Fam Physician. 2003;68(1):93-102.
  3. Tosti A. Diseases of hair and nails. In: Goldman L, Schafer AI eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 450.
  4. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update part I. Clinical picture, histopathology and pathogenesis. J Am Acad Dermatol. 2010;62(2):177-188.
  5. Brajac I, Tkalcic M, Dragojevic DM, Gruber F. Roles of stress, stress perception and trait-anxiety in the onset and course of alopecia areata. J Dermatol 2003;30:871-878.
  6. Harries MJ, Sun J, Paus R, King LE Jr. Management of alopecia areata. BMJ. 2010;341:c3671.
  7. Rushton DH. Nutritional factors and hair loss.  Clin Exp Dermatol. 2002;27(5):396-404. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss.  J Am Acad Dermatol. 2006;54(5):824-844.
  8. Park H, Woo Kim C, Seok Kim S, Wook Park C.  The therapeutic effect and the changed serum zinc level after zinc supplementation in alopecia areata patients who had a low serum zinc level. Ann Dermatol. 2009;21(2)142-146.


Getting to the Root of Female Hair Loss

Hair loss is a condition affecting many adults – both men and women.  Women are more likely to question why they are experiencing hair loss and may be more negatively affected by the hair loss than men.  Women with hair loss report lower self esteem and often have higher levels of fear, stress, depression and anxiety.

Conventional medicine is often dismissive of female hair loss.  The hair loss is most often not severe alopecia (the medical term for hair loss) and it is often diffuse (scattered over the scalp).

So why are women in their 20s, 30s, and 40s experiencing hair loss?  There are a number of potential causes.  By addressing the root cause of the hair loss, many women are able to stop the hair loss and in some instances, reverse it.


Unfortunately, hair loss is a normal part of aging.  By the age of 40, the rate of hair growth slows down.  New hairs are not replaced as quickly as old ones are lost.  This age-related hair loss affects both men and women.  In men the hair loss can be more prominent due to the effects of androgens (male sex hormones – such as testosterone).


Androgens can contribute to hair loss in women just like in men.  It has been known since the time of Hippocrates that male sex hormones (androgens) contribute to hair loss.  This androgen-related hair loss is very common in women.  A report published in the Clinical Dermatology journal states that it affects approximately 30% of women before age 50.   When it occurs in women it is often referred to as “female pattern hair loss”.

There are a number of reasons why a woman may be affected by androgen-related hair loss.  Genetics, excess androgens, insulin resistance, diabetes, polycystic ovarian syndrome, and low antioxidant status are all associated with female pattern hair loss.

Drug-Induced Hair Loss

A long list of pharmaceutical drugs can cause hair loss.  Some of the most common ones are:

  • Medications_hair loss
    Many common medications can contribute to female hair loss


  • Anticoagulants (Coumadin, heparin)
  • Antidepressants (Prozac, lithium)
  • Antiepileptics (Valproic acid, Dilantin)
  • Cardiovascular drugs (ACE inhibitors, beta-blockers)
  • Chemotherapy drugs
  • Endocrine drugs (Clomid, danazol)
  • Gout medications (Colchicine, allopurinol)
  • Lipid-lowering drugs
  • Non-steroidal anti-inflammatory drugs (Ibuprofen, naproxen)
  • Ulcer medications (Zantac, tagamet)

When possible, natural alternatives to these drugs should be considered if hair loss is occurring.

Nutritional Deficiencies

A deficiency of almost any essential nutrient can lead to hair loss.  A Naturopathic Doctor can assess your overall nutrient status, but there are a few signs you can look for at home.

Zinc – white lines on the nail can indicate poor wound healing, a common sign of low zinc levels.

Vitamin A – bumps on the back of the arms (called hyperkeratosis) is a common sign of vitamin A deficiency.

Essential Fatty Acids dry skin on the elbows and other parts of the body is a common sign of low essential fatty acid levels.

Another nutrient deficiencies that may lead to hair loss is iron.  A simple blood test is needed to determine iron levels.  Your Naturopathic Doctor can help you interpret this test – many labs have normal ranges that include low iron levels that should be corrected with iron supplements.

If you are deficient in any of these nutrients a test of hydrochloric acid (stomach acid) should be considered to determine if you are not absorbing nutrients properly from your diet.


Hair loss is one of the first features noticed by most women with hypothyroidism.  10 to 20% of the adult population has mild to severe hypothyroidism.  A blood test can be done to determine if hypothyroidism is causing your female hair loss.

Celiac Disease and Gluten Intolerance

Gluten Free LogoCeliac disease is a medical condition where gluten (a protein found in wheat, barley, and rye grains) damages the small intestines and causes systemic symptoms by cross-reacting antibodies that attack various cells in the body, including hair follicles.  The hair loss with celiac disease is often complete – a condition known as alopecia areata.

In people with gluten intolerance, the condition may manifest as hair loss (not complete) rather than digestive symptoms (which are a predominant feature of celiac disease).

Consider being tested for celiac disease if you have any of the following symptoms:

  • Bulk, pale, frothy, foul-smelling bowel movements
  • Weight loss
  • Signs of multiple vitamin and mineral deficiencies

A gluten-free diet will virtually eliminate symptoms in people with celiac disease.  A trial elimination of all gluten containing foods is recommended for anyone with hair loss to determine if gluten sensitivity is a cause.

Treatment of Hair Loss in Women

One of the central philosophies of Naturopathic Medicine is to treat the cause.  The treatment for female hair loss depends on the underlying cause of the hair loss.

hormone balance_feet
Hormone balance, addressing nutrient deficiencies and addressing the cause will improve hair loss in women.

Treatment of Androgen-Related Hair Loss in Women

  • Address underlying causes of androgen excess
  • Improve blood glucose regulation – low glycemic index diet, blood glucose normalizing supplements (such as glucomannan, fenugreek, or bitter melon), and regular exercise
  • Increase antioxidant intake – vitamin C, vitamin E, selenium, green tea
  • Saw palmetto extract – reduces the formation of dihydrotestosterone (DHT) a more potent form of testosterone that is often elevated in male and female pattern hair loss.  Works in a similar manner to Propecia (finasteride) – a prescription drug often used in female hair loss.

Treatment of Nutrient Deficiency-Related Hair Loss in Women

  • Test hydrochloric acid levels to ensure nutrients from food are being absorbed and supplement when necessary
  • A high-potency multivitamin and mineral formula (with iron when indicated)
  • Flaxseed or fish oil daily as a source of essential omega-3 fatty acids

Hair loss in women is a concern that should be taken seriously.  Although some hair loss naturally occurs with aging there may be another underlying cause of hair loss.  Consult with your Naturopathic Doctor if hair loss is a concern for you.  There is help available.


The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.