Hair Loss and Hormones: What Can a DUTCH Test Reveal?
Hair loss can be incredibly distressing for both men and women, particularly when you don't understand why it's happening. Beyond the physical changes, it can have a significant impact on self-confidence, self-esteem and your sense of self-worth. For many people, hair is closely tied to their identity, and experiencing hair thinning or excessive shedding can be emotionally difficult, especially when the cause remains unclear.
For some people, the explanation may be pretty straightforward. Genetics, ageing or hormonal changes may be contributing. For others, hair loss can be one of several symptoms suggesting that something else is going on.
Thyroid dysfunction, low iron stores, nutritional deficiencies, illness, stress and changes in hormone activity can all affect the normal hair growth cycle.
We often see people who have been experiencing hair thinning or excessive shedding for months, sometimes years, without understanding what is driving it.
And when conventional blood tests come back normal, it can leave people wondering whether their hormones might still be playing a role.
So, what is the connection between hair loss and hormones? And can a DUTCH hormone test help us understand what might be happening?
Can hormonal imbalances cause hair loss in women?
Hormones play an important role in regulating the hair growth cycle.
Changes in thyroid hormones, androgens such as testosterone and DHT, and oestrogen can all influence hair growth and shedding.
This is one reason why some women notice changes in their hair during perimenopause, menopause, after pregnancy or alongside thyroid dysfunction.
But hormonal hair loss isn't always straightforward.
Two women may have similar hormone levels and experience very different patterns of hair thinning.
One may notice gradual thinning around the parting, whilst another experiences excessive shedding across the entire scalp.
And importantly, women can experience hormone-related hair loss even when their blood hormone levels fall within the normal reference ranges.
This is why we need to consider the individual, their symptoms and their wider health picture rather than focusing on one hormone result.
What is the DUTCH test, and can it help investigate hair loss?
The DUTCH test (Dried Urine Test for Comprehensive Hormones) provides information about sex hormones, cortisol and how these hormones are metabolised.
It can be a useful additional tool when exploring someone's hormonal picture, particularly when hair loss is accompanied by other symptoms.
The DUTCH test measures urinary hormone metabolites, including those associated with testosterone, DHEA, DHT and cortisol.
But it's important to understand that the DUTCH test isn't a diagnostic test for hair loss.
It doesn't tell us whether someone has a particular type of hair loss, and it doesn't necessarily identify the cause.
What it can do is provide additional information that, when considered alongside symptoms, medical history and conventional blood tests, may help us understand whether hormonal factors deserve further investigation.
And this is where context becomes so important.
Hair loss and thyroid function: what's the connection?
Hair follicles are particularly sensitive to changes in thyroid hormone availability.
Both an underactive thyroid (hypothyroidism) and an overactive thyroid (hyperthyroidism) can disrupt the normal hair growth cycle, sometimes leading to diffuse hair shedding across the scalp.
One common form of hair shedding is called telogen effluvium.
This happens when more hairs than usual enter the resting phase of the hair growth cycle before eventually shedding.
What makes this particularly interesting is that the shedding doesn't necessarily begin when the triggering event happens. It often starts around two to three months later.
Someone may experience a significant infection, a period of stress, surgery, rapid weight loss or a nutritional deficiency, and only notice their hair falling out several months afterwards.
By that point, they may not immediately connect the two events.
This is why we always want to understand someone's timeline, rather than simply looking at what is happening today.
Can thyroid dysfunction affect cortisol metabolism?
Thyroid hormones also influence how the body processes other hormones, including cortisol.
Research has identified differences in urinary cortisol metabolite patterns in people with hypothyroidism and hyperthyroidism, suggesting that thyroid status can influence cortisol metabolism.
This is relevant when interpreting DUTCH test results, particularly if someone is also experiencing symptoms of thyroid dysfunction.
However, the DUTCH test doesn't assess thyroid function directly.
Blood tests such as TSH, free T4 and free T3 remain important when investigating suspected thyroid-related hair loss.
Cortisol and hair loss: can stress hormones affect hair growth?
Stress is frequently blamed for hair loss.
And whilst significant physical or psychological stress can contribute to hair shedding, we need to be careful about assuming that someone is losing their hair simply because their cortisol is too high.
Cortisol is produced by the adrenal glands and plays an important role in regulating blood glucose, immune activity, the stress response and our sleep-wake cycle.
It isn't a hormone we want to eliminate or automatically reduce.
We need cortisol. The question is whether its production, daily rhythm or metabolism may provide useful information about someone's wider health picture.
The DUTCH cortisol test looks at several aspects of cortisol production and metabolism.
Free cortisol: what does your daily cortisol pattern look like?
Most cortisol circulating in the bloodstream is bound to proteins, whilst a smaller proportion remains unbound.
The DUTCH test measures free cortisol excreted in urine at different points throughout the day.
This allows us to look at the daily pattern of urinary free cortisol.
For example, we might see someone whose cortisol follows a relatively healthy daily rhythm, or someone whose results suggest a different pattern.
Metabolised cortisol: how much cortisol is your body processing?
This is another part of the DUTCH test that we really find useful when looking at the bigger picture.
After cortisol has circulated around the body, it is processed into metabolites that are eventually excreted.
The DUTCH test measures several of these metabolites, including tetrahydrocortisol (THF), allo-tetrahydrocortisol (α-THF) and tetrahydrocortisone (THE).
Together, they provide an estimate of metabolised cortisol.
What's interesting is that free cortisol and metabolised cortisol don't always tell the same story.
Someone may have relatively low free cortisol but higher metabolised cortisol, suggesting that cortisol is being processed and cleared more rapidly.
Another person may show relatively higher free cortisol alongside lower metabolised cortisol, potentially reflecting slower clearance.
These patterns don't automatically mean something is wrong, but they may provide clues worth exploring.
Cortisol clearance rate: why does it matter?
Cortisol and cortisone are closely related hormones.
Cortisol is the more biologically active form, whilst cortisone is less active and can be converted back into cortisol in certain tissues.
Enzymes help regulate this process, influencing how much active cortisol is available.
The DUTCH test calculates an estimated cortisol clearance rate by comparing cortisol metabolites with free cortisol and cortisone.
This gives us some insight into how cortisol is being processed relative to the amount measured in its free forms.
And this brings us back to thyroid function.
Because thyroid hormones influence cortisol metabolism, changes in thyroid status may help explain certain cortisol patterns.
But we wouldn't want to look at someone's cortisol clearance rate and immediately conclude that this explains their hair loss.
We would also want to understand their thyroid function, sleep, stress levels, medication use, nutritional status and wider health picture.
Testosterone, DHT and hair loss in women
This is another area where there can be quite a lot of confusion.
Androgens are a group of hormones that include testosterone and dihydrotestosterone (DHT).
Although they're often described as male hormones, women produce and need androgens too.
They play important roles in several physiological processes, including hair growth.
However, in genetically susceptible individuals, androgen signalling can contribute to female-pattern hair loss.
This typically presents as gradual thinning around the parting or crown rather than sudden shedding across the entire scalp.
One important point is that women can experience female-pattern hair loss even when their circulating androgen levels are within the normal reference range.
What androgen markers does the DUTCH test measure?
The DUTCH test provides information about several androgens and their metabolites.
DHEA and DHEA-S
DHEA is an androgen precursor produced mainly by the adrenal glands.
DHEA-S is its sulphated form, which acts as a circulating reservoir that can be converted back into DHEA when needed.
The DUTCH test also measures metabolites such as androsterone and etiocholanolone, providing information about how androgens are being processed.
Testosterone
In women, testosterone is produced by the ovaries and adrenal glands, as well as through conversion from other androgen precursors.
Urinary testosterone can provide additional information about androgen metabolism, although it isn't necessarily interchangeable with a blood testosterone measurement.
Dihydrotestosterone (DHT)
DHT is formed from testosterone through the action of an enzyme called 5α-reductase.
It has potent androgenic activity, meaning it has a strong effect on tissues that respond to androgens, including hair follicles.
However, measuring urinary DHT doesn't tell us exactly how much DHT is acting within the scalp.
This distinction is important because local hormone activity and the sensitivity of individual hair follicles can matter just as much as circulating hormone levels.
The 5α and 5β pathways: why do we look at these?
Androgens can be metabolised through different pathways.
Androsterone is associated with the 5α pathway, whilst etiocholanolone is associated with the 5β pathway.
Their relative levels can provide information about androgen metabolism.
For example, someone may show a greater preference for the 5α pathway.
These findings may be more relevant when hair thinning is accompanied by other symptoms, such as acne, increased facial hair, irregular menstrual cycles or signs of possible polycystic ovary syndrome (PCOS).
In these situations, appropriate blood tests and medical assessment are also important.
Hair loss during perimenopause and menopause
Hormonal changes during perimenopause and menopause are another important consideration when investigating hair thinning in women.
As oestrogen levels fluctuate and eventually decline, many women notice changes in hair density, texture and growth.
Oestrogen plays a role in the hair growth cycle, and changes in oestrogen availability can contribute to hair thinning for women.
At the same time, changes in the balance between oestrogens and androgens may influence how hair follicles respond to androgen signalling.
But menopause-related hair loss isn't necessarily caused by low oestrogen alone.
Ageing, genetics, thyroid function, iron status, nutrition and other health factors may also contribute.
And this is why we wouldn't want to assume that every woman experiencing hair thinning during perimenopause needs hormone treatment or a DUTCH test.
The wider clinical picture always matters.
Don't overlook iron, ferritin and nutrition when investigating hair loss
It's very easy to become focused on hormones when investigating hair loss.
But hormones are only one piece of the puzzle.
Iron deficiency is a well-recognised contributor to hair shedding, sometimes even before someone develops overt anaemia.
Ferritin, which reflects the body's iron stores, is therefore an important marker to consider.
However, there isn't one particular ferritin level that guarantees healthy hair growth.
We need to interpret the result alongside a full blood count, iron studies, symptoms and the person's wider health picture.
Nutrition also matters.
Hair growth requires sufficient energy, protein and a range of essential nutrients.
Someone following a restrictive diet, experiencing digestive problems, losing weight rapidly or struggling with nutrient absorption may not be getting everything they need to support normal hair growth.
Depending on the individual, we may also want to investigate vitamin B12, vitamin D and zinc status.
And we shouldn't forget recent illness, medication changes or other physiological stressors.
Sometimes the explanation isn't complicated, but we need to ask the right questions to find it.
Your hair loss timeline can tell us a lot
One of the most useful things we can do when investigating unexplained hair loss is look at when it started and what else was happening around that time.
Did the shedding begin suddenly or gradually?
Was there an infection, including COVID, in the preceding months?
Were you going through a particularly stressful period?
Had you recently lost weight, changed your diet or started a new medication?
Were there changes in your menstrual cycle, thyroid function or hormonal treatment?
Are you experiencing other symptoms, such as fatigue, cold intolerance, acne, digestive problems or changes in your periods?
And is the hair loss diffuse, or are you noticing thinning in particular areas?
These details can help us distinguish between different possible contributors and decide which investigations are most appropriate.
They may also help us identify situations where a referral to a GP or specialist is needed.
Persistent, patchy or rapidly progressing hair loss should always be medically assessed, as different types of hair loss require different approaches.
Is the DUTCH test worth doing for hair loss?
It depends.
The DUTCH test may be worth considering depending on what other symptoms you are experiencing and what wider investigations have already been carried out.
For some people, conventional blood tests, a review of nutritional intake and a detailed discussion about their symptoms and medical history may be the most appropriate starting point.
For others, particularly when hair loss is accompanied by hormonal symptoms or concerns about cortisol metabolism, the DUTCH test may provide useful additional information.
Ultimately, the value of any test lies in whether it helps us better understand what may be contributing to someone's symptoms and informs the next steps.
At The Autoimmune Clinic, we take an individualised approach to understanding complex health concerns, looking beyond individual test results to explore the wider factors that may be contributing to your symptoms.
If you're experiencing unexplained hair loss alongside other ongoing health concerns, we can help you explore the bigger picture and identify appropriate next steps.
