DUTCH Plus provides a comprehensive assessment of 35 different sex and adrenal hormones, including oestrogen, progesterone, testosterone, DHEA and cortisol along with their metabolites. It also looks at the overall diurnal pattern of free cortisol and cortisone along with a more in-depth assessment of the Cortisol Awakening Response.
 
The oxidative stress marker 8-OHdG, melatonin and nine organic acids including markers for vitamin B12 (methylmalonate), vitamin B6 (kynurenate and xanthurenate), biotin (β-hydroxyisovalerate), glutathione (pyroglutamate), dopamine (homovanillate), norepinephrine/epinephrine (vanilmandelate), neuroinflammation (quinolinate) and tryptophan putrefaction (indican) are also included.

The Cortisol Awakening Response
When we wake in the morning and open our eyes, cortisol levels naturally begin to rise by an average of between 50-160% in the first 30 minutes after waking. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise of cortisol levels at waking, known as the Cortisol Awakening Response, can be used as a “mini stress test”. Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.
 
Cortisol, cortisone, 8-OHdG, melatonin (6-OHMS), organic acid tests and metabolites related to cortisol are tested by Liquid Chromatography with tandem mass spectrometry (LC-MS/MS). The remaining hormones are tested by Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS).
 
 
DUTCH Plus can help identify the root causes of sex hormone and adrenal imbalances in men and women and includes assessment of the Cortisol Awakening Response (CAR) to give further insight to the HPA axis.