Many women who arrive at SeshDx frustrated may have already had their hormones tested. Estrogen came back normal. Progesterone was fine. Testosterone wasn't flagged. Yet they're exhausted, can't sleep, gaining weight without explanation, dealing with mood swings that don't match their life circumstances, and cycling irregularly. They've been told their hormones are fine. Their body is telling them otherwise.
The problem isn't always that hormones are too high or too low. It's what the body does with them after they're produced.
Hormone levels are only half the story
Standard hormone testing (whether blood or saliva) measures circulating hormone levels at a single point in time. What it doesn't measure is how those hormones are being metabolized: broken down, converted, and cleared from the body. That metabolic pathway is where a significant amount of hormonal dysfunction actually lives, and it's invisible to standard testing.
The DUTCH Complete uses dried urine sampling to measure not just hormone levels, but their downstream metabolites: the byproducts of how hormones are processed by the liver and other tissues. This distinction matters enormously in clinical practice.
Estrogen is metabolized through several competing pathways. The 2-OH pathway produces metabolites that are largely protective. The 4-OH and 16-OH pathways produce metabolites that are more proliferative, associated with higher estrogen-related cancer risk and more pronounced estrogen dominance symptoms. A woman can have normal circulating estrogen levels while metabolizing heavily through the 4-OH pathway, producing significant symptoms and long-term risk that a standard estrogen test would never detect.
Cortisol is a pattern, not a number
Cortisol testing in standard medicine typically involves a single morning blood draw. This captures one data point in what is fundamentally a circadian rhythm: a pattern that rises sharply after waking, peaks in the morning, and gradually declines through the day and into the night.
The DUTCH Complete captures free cortisol at four to five points across the day, mapping the full diurnal pattern. This reveals things a single draw never could: whether cortisol is rising appropriately in the morning, whether it's staying elevated into the evening and disrupting sleep, whether the adrenal response is blunted in a way that explains the afternoon energy collapse, and whether the overall cortisol burden is high or low relative to what's being excreted.
HPA axis dysfunction (the dysregulation of the hypothalamic-pituitary-adrenal stress response system) is one of the most common and most underdiagnosed contributors to hormonal symptoms in women. It doesn't show on a morning cortisol draw. It shows as a pattern.
Progesterone, testosterone, and the androgens
Progesterone is frequently low relative to estrogen in women of reproductive age and perimenopause, a pattern commonly called estrogen dominance, though the mechanism is often more nuanced than estrogen being objectively high. The DUTCH measures progesterone metabolites alongside estrogen metabolites, giving a functional picture of the estrogen-to-progesterone ratio that a single blood draw can't provide.
Testosterone and its downstream androgens (DHT, DHEA-S, and their metabolites) are evaluated through the androgenic pathway. Elevated androgens drive symptoms including acne, hair thinning, and hirsutism. Low androgens contribute to fatigue, low libido, and loss of lean mass. The direction of androgenic metabolism, specifically whether testosterone is converting preferentially toward DHT through the 5-alpha pathway, determines which symptoms are most prominent and what intervention is most appropriate.
What does the DUTCH Complete add that blood testing can't?
Melatonin output (the marker for circadian rhythm regulation and sleep quality) is measured through a urinary metabolite that reflects nighttime melatonin production. Low melatonin is associated with poor sleep quality, immune dysregulation, and increased oxidative stress. It's not tested on any standard hormone panel.
Organic acid markers for nutritional status (B6, B12, biotin, and glutathione) are included because nutritional deficiencies directly affect hormone metabolism. Low B6 impairs estrogen clearance. Low glutathione is frequently seen alongside high-risk estrogen metabolites. Neurotransmitter metabolites for dopamine and epinephrine provide context for mood and energy symptoms that hormone levels alone don't fully explain.
What happens after the test
When Shae reviews a DUTCH Complete, she's not just looking at whether levels are in range. She's reading the full metabolic picture: how hormones are being produced, how they're being processed, and what the pattern of cortisol and melatonin output reveals about the stress and sleep systems driving everything else. Then she builds a protocol around what's actually showing. Not averages, not assumptions, not generic hormone support. A specific plan built around specific data.
