In Part One, I talked about how the DUTCH hormone test gives us a much deeper view of hormone function than standard blood tests. In this post, I’ll show you how I use the DUTCH test in more complex cases — particularly in peri/menopause, endometriosis, fibroids, and with men — where symptoms often don’t match conventional test results.
Peri and Menopause
If you’re in your 40s or 50s and your sleep is bad, you’re gaining weight without changing anything, or you feel wired, anxious, flat, or just not like yourself — it could be perimenopause.
This isn’t just about your hormones “dropping.” In fact, perimenopause is full of fluctuations. One week your estrogen might spike, and the next it crashes. It’s common to have symptoms of both high and low estrogen — heavy periods, tender breasts, mood swings… followed by vaginal dryness, low libido, and night sweats. I’ve seen women start HRT because they felt depleted, only to feel worse, gain weight, or feel anxious — because no one looked at what was really going on underneath. They didn’t really need being put on HRT
This is where the DUTCH test really helps.
It shows:
- Estrogen, progesterone, and androgen levels — and how your body is clearing them
- Cortisol production across the day — not just free cortisol, but total metabolised cortisol, which blood and saliva tests can’t measure
- Melatonin, neurotransmitter and inflammation markers
- Whether your adrenals are keeping up with the transition
In Dr. Kharrazian’s Functional endocrinology training, he explains that hot flushes and other menopause symptoms often aren’t just about low estrogen. They’re about poor adrenal adaptation. When your ovaries slow down hormone production, your adrenals are supposed to take over some of that load — especially for precursors like DHEA. But if your nervous system is already dysregulated, you’re more likely to experience symptoms like hot flushes, mood swings, poor sleep and anxiety.
This is something I look at closely — because if cortisol is flat, too high, or clearing too fast, you may not tolerate HRT well until we support your adrenals.
I also use the DUTCH test with women who are already on HRT — to check whether it’s being metabolised properly and whether the current dose is actually working for them.
Fibroids and Estrogen Metabolism
Fibroids are more common than most people realise—around 70% of women will have at least one in their lifetime. While some women have no symptoms at all, others deal with heavy periods, clotting, spotting, pain, bloating, iron deficiency, and fatigue that affects their daily life.
I often use the DUTCH test when working with clients who have fibroids. One of the patterns I see again and again is estrogen being metabolised down the 16-OH pathway—a route that’s known to promote tissue growth. This pathway produces estrogen metabolites that bind more strongly to receptors and can drive proliferation, which isn’t ideal when fibroids are already present.
Even when estrogen levels don’t look dramatically high, how your body clears estrogen makes all the difference. If your clearance is slow or skewed toward 16-OH, symptoms like heavy bleeding, fibroid growth, and PMS can follow.
I also look for other patterns on the DUTCH test that might be contributing:
- Elevated estradiol, estrone, or estrogen metabolites
- Quinolinate (an organic acid linked to environmental exposures like phthalates)
- Signs of adrenal stress — either high or low cortisol
- Increased 5-alpha reductase activity or elevated androgens
- Obesity-related hormone shifts like high aromatase, sluggish detox, or insulin resistance
The good news? These patterns are actionable. Supporting estrogen clearance, improving gut and liver health, reducing xenoestrogen exposure, and lowering inflammation can all help. It’s about shifting your internal environment so that fibroids are less likely to grow—and ideally, become less symptomatic.
Endometriosis and Local Estrogen Activity
In some cases of endometriosis, systemic estrogen can look low — yet symptoms are still present. This is something I’ve seen in practice. One of my clients had very low estradiol but still experienced significant pain and mood changes.
This is because endometriotic tissue can make its own estrogen by converting androgens like DHEA and testosterone into estrogen — due to:
- High aromatase activity in the lesions
- Increased estrogen receptor expression
- Impaired estrogen inactivation
- Local progesterone resistance
In this case, we also saw high DHEA levels, likely feeding into the local production. We supported adrenal health, lowered inflammation, and focused on gently reducing DHEA. Over time, her symptoms improved.
Hormonal Imbalances in Men
I’ve also used DUTCH testing with men. One client came to me with fatigue, low libido, mood issues, and weight gain. His testosterone levels were “normal” on bloodwork, but the DUTCH showed:
- Low free testosterone and DHEA
- Increased conversion of testosterone to estrogen
- Flattened cortisol curve
We worked on reducing insulin resistance, supporting androgen production with key nutrients like zinc, B vitamins, and carnitine, and supporting liver function to clear excess estrogen. He also changed his training routine — swapping daily cardio for resistance-based sessions. Within 6–8 weeks, his mood, sleep, and energy all improved.
Choosing the Right DUTCH Test
Which test we choose depends on the client’s symptoms and goals:
- DUTCH Complete – This is the one I use most. It gives us a full picture of sex hormones, adrenal markers, detox pathways, and organic acids like melatonin, B6, and oxidative stress.
- DUTCH Plus – This includes everything from the Complete test but also adds the cortisol awakening response (CAR), which is useful when we want to look at HPA axis health or suspect burnout.
- DUTCH Cycle Mapping – This test tracks estrogen and progesterone across the whole cycle, helping us understand whether and when ovulation is happening. The lab pulls 9 urine samples out .It’s helpful for irregular cycles, long or short cycles, PCOS, and fertility concerns.
Sometimes I combine Cycle Mapping with DUTCH Complete or Plus for a fuller picture. The Cycle Mapping test follows different collection patterns based on whether you have a regular, short, long, or absent cycle.
If you want to know which DUTCH test is right for you, head over to this blog: ‘Which DUTCH Test Is Right For You?’
What About Supplements and Test Prep?
I’m often asked whether you need to stop supplements before the test. Here’s what I usually tell clients:
- Stay in your normal routine — I want to see your hormones as they usually are
- No need to cut out coffee or alcohol unless we’ve discussed it
- If we’re starting completely fresh with a new plan, I might suggest stopping supplements 2–3 weeks before testing
Some supplements can affect results:
- Tyrosine, mucuna and other dopamine-boosting supplements can falsely increase the HVA marker
- DIM may reduce parent estrogens and increase 2-OH estrogen metabolism
- Resveratrol may slow down COMT activity
- Pregnenolone can raise progesterone metabolites and give the impression of ovulation, so I may ask clients to stop it a few days before testing
It’s Never Just the Hormones
I always look at the bigger picture. In each of these client cases, we also worked on:
- Diet – under-eating, over-restricting, or too many blood sugar crashes can all affect hormone balance
- Fasting – which can be a stressor if not done carefully
- Exercise – too much HIIT or cardio, or not enough strength training, can throw off hormones
- Sleep – going to bed too late or poor quality sleep can impact cortisol and melatonin
Hormones are messengers — and they’re influenced by all these inputs. Testing is just one piece. What matters most is what we do with the information.
Disclaimer: This blog is for educational purposes only and is not intended to diagnose, treat, or cure any condition. Always speak with a qualified health professional before making changes to your health plan. All client cases have been anonymised for privacy.
