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How Your Urine Can Show You How Your Body Processes, Uses, and Clears Hormones

Dr. Valorie Davidson

In many newsletters, I talk about blood testing and interpretation for hormones. Blood testing can be super useful, but it is just a snapshot. While a urine test for hormones can be much more comprehensive.
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Serum (blood) testing shows

• How much circulating hormones are present.
• Not what the body ‘does’ with the hormones.

Of course, comprehensive testing can also be a little complicated to interpret. In this article, I am going to break down a DUTCH (urine) hormone test.

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​What is a DUTCH test?

• Dried urine test for comprehensive hormones

What Does It Measure?

• Hormone production
• Hormone metabolism
• Hormone clearance
• Detox pathways
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Let’s Get Oriented:

• The first page of the DUTCH test is an overview. It will show:
  • Estrogen and progesterone summary
  • Androgen summary

The following pages will have:

• All the hormones and metabolites
  • Progesterone metabolites
  • Primary estrogens (estrone, estradiol, and estriol)
  • Estrogen detoxification metabolites
  • Hormone ratios
• Hormone pathways (visual maps)
  • How hormones are produced from a precursor
  • Phase 1 and 2 estrogen metabolism
  • Methylation and detox processes

How Do I Even Do This Urine Test?

• The kit includes four urine collection strips.
  • Some people may collect an additional overnight sample if they wake up in the night to urinate.
• Step 1: Choose the right day
  • Premenopausal women collect your urine in the luteal phase (ideally, days 18-23)
  • Menopausal women or non-cycling women, collect your urine on any day
  • Women on HRT:
    • Static dosing: collect urine on any day
    • Rhythmic dosing: collect urine in the luteal phase (ideally, days 18-23)
• Step 2: Fill out the collection cards
• Step 3: Collect urine on the filter paper
  • Let the sample dry for 24 hours before packaging.
• Step 4: Make sure to collect at scheduled times
  • Dinnertime 3-6 pm
  • Bedtime 8-11 pm
  • Optional overnight if you wake up to urinate in the night
  • Within 10 minutes of waking
  • Two hours after waking
• Step 6: Guidelines
  • Try to avoid too much fluid two hours before each sample.
  • No alcohol, caffeine, or large fluid intake after lunch and dinner samples
  • No more than one glass/cup of fluids between the waking and 2-hours-after-waking sample.
• Step 7: Ready to send away for processing
  • Mail it back and don’t forget the requisition form.

Let’s break down the test even more to understand what it means.

Progesterone:

The DUTCH test cannot test for progesterone itself. But will test the urine metabolites to get a picture of the progesterone.

The metabolites are:

• Beta-pregnanediol
• Alpha-pregnanediol

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​If a woman is premenopausal and not taking any hormones:

• The progesterone metabolites will tell us if she ovulated, as we do not make progesterone until ovulation.

If a woman is taking progesterone HRT:

• The progesterone metabolites are going to be quite high because the body has metabolized the progesterone HRT, and it is showing up in larger quantities in the urine. In this case, you want to make sure that the levels reflect those of progesterone HRT.

Other considerations of the progesterone metabolites:

• Is the level of progesterone ideal for this person and their phase in life? We don’t want to just treat #s on a piece of paper, but also the individual and their symptoms.
• Are the progesterone metabolites low relative to their estrogen levels? Now on to estrogen!

Estrogen: The DUTCH test will have the primary estrogens:

• Estradiol (E2)
• Estrone (E3)
• Estriol (E3)

These primary estrogens will show us how much estrogen is in the system overall. It lets us know if the estrogen is too high, too low, or just right.

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​Estrogen Metabolism:

I think this is the coolest part of the DUTCH test, the estrogen metabolism or pathway that your estrogen will get broken down into. This is important in how your body processes estrogen, not how much you are making (or taking).

The three main metabolites that estrogen will be broken down into are:

• 2-OH: This is the more beneficial, protective pathway
  • Weaker estrogenic activity
  • Lower association with hormone-driven cancers for breast and endometrial tissue.
• 4-OH: More reactive pathway
  • Associated with more DNA potential damage, oxidative stress and mutations
  • Linked to higher cancer risk, in particular breast cancer.
• 16-OH: more proliferative pathway
  • Stronger estrogenic activity
  • More stimulation of breast tissue and endometrial (uterine) lining growth
  • Contribute to fibroids, endometrial hyperplasia, and increased breast density.
  • It can contribute to estrogen dominance.

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​Estrogen Metabolite Ratios: This is important in determining how well you clear estrogen and also the risk for breast cancer, increased uterine lining, fibroids, and increased breast density.

• 2-OH : 16-OH RATIO: Protective or Proliferative?
  • If the ratio is LOW (more 16-OH to 2-OH): increased proliferation which can lead to endometrial growth, fibroids, breast tissue stimulation and increased density.
  • If the ratio is HIGH (more 2-OH to 16-OH): More favorable and less stimulation for growth.
• 2-OH : 4-OH RATIO: Protective or Reactive/Risk?
  • If the ratio is LOW (more 4-OH to 2-OH): increase risk for oxidative stress, DNA changes, and breast cancer.
  • If the ratio is HIGH (more 2-OH to 4-OH): safer and more protective to estrogen-sensitive tissues.

Check Methylation:

• 2-methoxy estrogens: This tells us how well your body clears estrogen (aka: estrogen cleanup crew).
  • What you really want to zero in on is:
    • 2-methoxy : 2-OH RATIO
      • A higher ratio is better because it means that estrogen is being more effectively methylated and cleared.

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​Testosterone and Adrogens:

The DUTCH tests look beyond just the testosterone. It tells us what is happening with your androgens and what pathway they are metabolizing in your body.

• DHEA-sulfate
• Testosterone
• Androsterine
• Etiocholanolone
• 5 alpha - DHT
• 5 alpha and 5 beta androstanediol
• Epi-Testostereone

DHEA-sulfate: This is the foundation of your androgens. DHEA is synthesized in your adrenal glands, and for women will convert to testosterone in your peripheral tissues. If DHEA is low, that means there is less reserve to convert to testosterone. This is especially important for a menopausal female, as the ovaries can produce about 15-20% testosterone.

Testosterone: This is a great hormone for women that can influence libido, motivation, muscle, and energy. The DUTCH test will show us how much testosterone is currently available and active.

Androsterone and Etiocholanolone: These are the metabolites of your androgens, in particular, testosterone. This is important because it tells us how you are processing your testosterone.

• Androsterone Pathway
  • This is the same pathway that makes DHT (dihydrotestosterone). Higher levels of DHT are associated with:
    • Hair loss on the scalp
    • Hair growth everywhere (except the scalp)
    • Acne
    • Oily skin
• Etiocholanolone Pathway:
  • Higher levels correlate with less conversion to DHT
    • Less acne and oily skin
    • Less hair loss
    • But sometimes can cause lower libido, lower energy, and feeling flat

DHT: Dihydrotestosterone

• DHT is much stronger than testosterone
• Higher levels can cause hair loss, acne, irritability, and oily skin and scalp.

5 alpha vs the 5 beta Pathways: This tells us which direction the androgens are converting into

• 5 alpha is more strongly directed to DHT
• 5 beta has a lower conversion to DHT and is more balanced.

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​EpiTestosterone is like testosterone’s quiet twin.

• It looks almost exactly the same in molecular structure as testosterone (just slightly different orientation). But it doesn’t have the strong androgen effects as testosterone. We use this as a reference point for how much is produced vs testosterone to make sure they are balanced.

The DUTCH test doesn’t just show up as numbers on a piece of paper. It shows how your body processes hormones, whether those are your own hormones or HRT. Seeing the pathways and processing of hormones helps us reduce risk in hormone-sensitive tissues. This test can also help us make targeted changes in your lifestyle, supplementation, HRT, and diet to help optimize your health without just guessing.

Looking at individual numbers is helpful, but what I am really looking for are patterns. Patterns tell the story of what your body is doing, and more importantly, why you may be feeling the way you are.

​Upgrade to the paid version to see the common patterns I see in women.
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PS: In the DUTCH Complete urine test will show adrenal hormones and function. In the next newsletter, I will go into urine adrenal testing.

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Simon Says: Add a serving of cruciferous vegetables today to support estrogen metabolism. These vegetables contain compounds like indole-3-carbinol (I3C), which is converted into DIM, along with sulforaphane, all of which support healthy estrogen detox pathways.

Broccoli sprouts Brussels sprouts Kale Broccoli Cauliflower Cabbage (especially red cabbage) Bok choy Arugula Collard greens Mustard greens

Did the copper peptide injections do anything?

In my last newsletter, I wrote about how I am doing the copper peptide injections. I wanted to show my blood tests of ceruloplasmin, copper, zinc, and my zinc:copper ratio. And those tests are in the proper range. I could have a little more zinc dietarily, but it was fine.
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What everyone is asking is if I noticed anything from the copper peptide injections?

Peptides are messengers. They don’t do the work themselves, but instruct your cells what to do (healing, repair, restore, etc).

So even after stopping the peptide, it could still have benefits. That is why I think it is important to cycle peptides to help prevent receptor desensitization (or receptor fatigue).

So what has been my experience so far:

• Skin on the face is less dry and softer.
• Skin in my arms does look more hydrated.
• Skin above my knees looks more hydrated.
• Skin on my hands, no change, and still dry (my cuticles are terrible lol).
• Skin on the front of my neck looks more hydrated
• Wrinkles on my face are the same
• Brown spots are still there (but the copper peptides are not supposed to get rid of spots, but a girl can wish).
• I was surprised to see that I have less hair shedding.

There is more limited evidence for hair shedding and growth. So maybe it is a coincidence, but my hair shedding in the shower (and bathroom floor) is remarkably less. I find this incredibly encouraging for others who experience hair thinning and loss in perimenopause and menopause.

So I am my own experiment, and I can’t say for sure these changes are from the copper peptide injections, but it seems hopeful. I’ve had other patients report they are noticing benefits as well, so I think this could be promising.

I’m on a pause or a cycle break right now, but I will keep you posted!

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​DrValorie

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