Can You Get Your Dopamine Tested?

spoiler alert: no! also, an ode to the slow magic of 35mm film

This week, I received a response to an essay I wrote last year on Medium challenging the concept of ADHD as a dopamine deficiency:

I am not in the habit of checking comments, but Medium sends them to my email (because apparently Medium hates me) and this one piqued my curiosity.

What is the DUTCH test?? I simply had to spend multiple hours of my life figuring it out!

Dopamine has been on my mind this week since Marta and I livestreamed about it, so I was all too pleased to have an excuse to dig back into one of my favorite controversies. And I discovered some things, dear readers!

So, take my hand, and let us traipse down the rabbit hole of the Neurotransmitter Test Grift.

The Shady World of Laboratory Developed Tests

DUTCH stands for Dried Urine Test for Comprehensive Hormones, and it’s developed, marketed, sold, and processed by a company-slash-lab called Precision Analytical Inc.

This is called a “laboratory developed test” or LDT, and according to Consumer Reports, these kinds of tests aren’t regulated or reliable:

…the FDA has been paying attention to LDTs and in a 2018 statement identified potential problems, such as claims not supported by evidence, erroneous results, and faked data.

At-home tests have gotten really popular during the pandemic, especially the kind that look at your hormone levels and neurotransmitters to (supposedly) tell you the neurochemical reason you are suffering so much. Many of these companies sell their tests directly to providers, so some psychiatrists may even sell them to you.

The DUTCH Test does not directly measure dopamine, though. As I said in my original essay, a neurotransmitter test does not exist. If it did, psychiatrists would use it in diagnostics, but it doesn’t, so they can’t!

The action of neurotransmitters is extremely complex and in constant flux across various parts of the brain and body, and attempting to measure them in urine is dubious at best and flat-out inaccurate at worst. It’s barely possible to quantify them with electrodes in the brain or special glowing nanotubes!

The DUTCH test actually measures the levels of neurotransmitter metabolites. Every chemical in the body is always being turned into other chemicals, and scientists call this “metabolizing” and the byproducts of this process “metabolites”. The primary metabolite of dopamine that the DUTCH Test measures is called homovanillate.

But the thing is, low homovanillate (HVA) does not automatically equal low dopamine, because this metabolite is also affected by a ton of other stuff, like hormones and magnesium and even bicycle riding (seriously).

Precision Analytical’s own materials admit this:

…if there are low levels of SAM, Magnesium, FAD and NAD, dopamine cannot be converted to HVA. In these cases, HVA may be low even though circulating dopamine levels may be normal or elevated. [emphasis mine]

So this test tells you…basically nothing about your dopamine. I dug around for some studies on the relationship between HVA and dopamine and found this one that (in addition to the bike riding tidbit) basically says HVA production is influenced by your nervous system activity in various parts of the body and not always linked directly to your dopamine levels.

Like I said, it’s complicated! But these tests exist to un-complicate and invent easy answers to your problems. This makes it possible for people to sell you easy solutions, like their patented miracle supplements or special hormone detox diets.

The DUTCH Test is apparently big in the “hormone imbalance” neighborhood of Wellness World, so big that it made OB/GYN and menopause expert Dr. Jen Gunter’s list of hormone scam red flags: