Specialty Test and Panel Questions | ACT 2 Health FAQ

Question 1

Is the DUTCH test better than a blood hormone test?

Accepted Answer

Neither is better, because they answer different questions. Blood testing is the standard for measuring how much hormone is circulating and for diagnosing a deficiency; the DUTCH test adds metabolite and daily-rhythm information that a single blood draw cannot show. The DUTCH test complements standard labs rather than replacing them, and a clinician who treats it as a substitute for serum testing is using it wrongly.

Question 2

Is the DUTCH test worth it?

Accepted Answer

The DUTCH test is worth it when there is a specific question standard labs have failed to answer — symptoms that disagree with a normal serum panel, or a suspected problem with the cortisol rhythm across a day. It is not worth it as a first step, before ordinary blood work has been done, or out of general curiosity, because a result with no question attached to it mostly generates more tests. It is typically paid out of pocket, which is a further reason to have the question straight first.

Question 3

Is the DUTCH test accurate?

Accepted Answer

The laboratory methodology behind the DUTCH test is well regarded; what is genuinely debated is interpretation — how much clinical meaning any particular metabolite pattern carries. Mainstream endocrinology does not consider dried-urine metabolite testing validated for guiding treatment decisions, which is why ACT 2 Health treats a DUTCH result as an additional input rather than a decision-maker. The DUTCH test is a laboratory-developed test performed by a single CLIA-certified laboratory and has not been cleared or approved by the FDA.

Question 4

How is the DUTCH test collected?

Accepted Answer

The DUTCH test is collected at home as dried urine on filter paper, at set points across a day, then mailed to the laboratory. The timing of those collections is what produces the cortisol rhythm data, so following the kit instructions precisely is the difference between a result that means something and one that does not. Your clinician will tell you beforehand which medications, supplements and hormone products need to be noted on the form.

Question 5

Can the DUTCH test diagnose adrenal fatigue?

Accepted Answer

No, because adrenal fatigue is not a recognized medical diagnosis — the adrenal glands do not wear out from stress in the way the term implies. What a DUTCH test can show is that your cortisol pattern across a day differs from the expected one, which is a real finding and sometimes a useful one, but a pattern is not a disease. The symptoms usually attributed to adrenal fatigue — exhaustion, poor sleep, low mood, weight change — have causes a proper workup finds, including thyroid disease, anemia, sleep apnea, perimenopause and depression.

Question 6

What does the DUTCH cortisol pattern show?

Accepted Answer

The DUTCH cortisol pattern shows free cortisol and cortisone at several points through a single day, alongside the metabolites that reflect total production. The output is a curve — the rise after waking and the fall toward bedtime — rather than one number, and it is the shape of that curve that carries whatever information the test has. A flattened or shifted curve is a description of your day, not a diagnosis, and it is read alongside sleep, shift work, alcohol, illness and medication before anything is concluded from it.

Question 7

Can the DUTCH test detect Cushing's syndrome or Addison's disease?

Accepted Answer

No. The DUTCH test can raise suspicion of a serious adrenal disorder, but it cannot confirm Cushing's syndrome or Addison's disease — both are diagnosed with specific blood and stimulation testing and specialist assessment. A markedly abnormal DUTCH pattern is a reason for referral rather than a result to act on directly. If an adrenal disease is the actual suspicion, the standard diagnostic tests should be done first and the DUTCH test is not the right starting point.

Question 8

What are estrogen metabolites on the DUTCH test?

Accepted Answer

Estrogen metabolites on the DUTCH test are the breakdown products of estradiol and estrone as the liver processes them through three routes, reported in urine as amounts and as ratios between the routes. The biology underpinning the measurement is real; what is unsettled is how much a given pattern should change anyone's care, which is why the result is read as context rather than as an instruction. Nothing on the estrogen metabolite panel diagnoses cancer or predicts it.

Question 9

Does the DUTCH estrogen panel decide whether I can take hormone therapy?

Accepted Answer

No. Whether hormone therapy is appropriate for you is decided on symptoms, personal and family history, blood work and guideline evidence — not on a urine metabolite profile. A DUTCH estrogen panel is context inside a careful conversation, and it is not a gate a patient has to pass to be offered treatment. Any provider who declines or prescribes hormone therapy on the strength of a metabolite ratio alone is going beyond what the test supports.

Question 10

Can I do a DUTCH test while on hormone therapy?

Accepted Answer

Yes, and the DUTCH test is usually done on therapy rather than off it. How well it reads depends entirely on the route you use: oral products are interpreted well, transdermal patches reasonably, vaginal products barely, and topical progesterone cream badly. Tell your clinician exactly what you take and where you apply it, because a result interpreted against the wrong route is worse than no result.

Question 11

Should I stop hormone therapy before a DUTCH test?

Accepted Answer

Do not stop hormone therapy before a DUTCH test on your own initiative. A true off-treatment baseline is only meaningful before therapy has ever been started, and interrupting an established regimen to produce one usually costs more in returning symptoms than the result is worth. The test is normally run while you are on therapy, at consistent timing relative to when you take or apply it, and any change to a hormone regimen belongs to the clinician who prescribed it.

Question 12

Why does my DUTCH test show low progesterone when I use progesterone cream?

Accepted Answer

Topical progesterone cream produces very low urinary metabolites, so a DUTCH result showing little progesterone in someone using the cream is the expected finding rather than a sign the cream is not working. It is specifically not a reason to apply more. The more important point sits underneath the question: progesterone cream does not protect the uterine lining in a woman taking estrogen, at any amount, and uterine protection comes from oral micronized progesterone prescribed for that purpose.

Question 13

When is a blood test better than a DUTCH test on hormone therapy?

Accepted Answer

A blood test is the better choice whenever the question is whether you are absorbing your hormone therapy — serum estradiol answers that directly and a urine metabolite panel does not. It is also the right test for diagnosing a deficiency and for the monitoring that guidelines actually specify. The DUTCH test earns its place on pathway questions instead: how estrogen is being metabolized, what the cortisol rhythm looks like, how androgens are being routed.

Question 14

Does insurance cover the DUTCH test?

Accepted Answer

Generally no. Specialty panels of this kind are typically paid out of pocket, and the DUTCH test is not usually a covered benefit. ACT 2 Health shows an indicative price up front and confirms it at eligibility, so the cost is known before anything is ordered.

Question 15

Is a gut microbiome test worth it?

Accepted Answer

A gut microbiome test is worth it if the question is contextual — how your gut community relates to diet, energy and metabolism — and it is the wrong test if the question is why your gut hurts. For actual digestive symptoms, a comprehensive stool panel measuring digestion, absorption and inflammation is the more useful purchase, because those markers are the clinically established part. Microbiome panels of this kind are laboratory-developed tests performed by a single CLIA-certified laboratory and have not been cleared or approved by the FDA.

Question 16

Can a gut microbiome test diagnose IBS?

Accepted Answer

No. A gut microbiome test cannot diagnose irritable bowel syndrome, inflammatory bowel disease, celiac disease or any other gastrointestinal condition, and it does not replace a colonoscopy or a medical evaluation of persistent symptoms. Any report that assigns you a condition on the basis of bacterial proportions is overreaching. Persistent change in bowel habit, bleeding, unintended weight loss or pain belongs with a clinician and, frequently, with a gastroenterologist.

Question 17

Should I get a gut microbiome test or a comprehensive stool panel?

Accepted Answer

Choose the comprehensive stool panel if you have persistent gut symptoms, because its digestion, absorption and inflammation markers are where usable answers tend to be. Choose the simpler microbiome analysis if you have no symptoms and are exploring how gut health relates to energy or metabolism, where it is the more proportionate starting point. The comprehensive panel is the more expensive of the two, and neither is generally covered by insurance.

Question 18

What does a comprehensive stool panel measure that a microbiome test doesn't?

Accepted Answer

A comprehensive stool panel measures how well the gut is working — digestion, absorption and inflammation — where a microbiome test only profiles which organisms are present and in what proportions. The clearest example is calprotectin, an established marker of intestinal inflammation that carries real diagnostic weight and does not appear on a bacteria-only report. These panels are laboratory-developed tests performed by a single CLIA-certified laboratory and have not been cleared or approved by the FDA.

Question 19

Can a stool test detect SIBO?

Accepted Answer

No. Stool is the output of the colon, and the bacteria involved in small intestinal bacterial overgrowth live upstream of it, so a stool panel has no window on the part of the gut where SIBO happens. A report describing a colonic pattern as "consistent with overgrowth" is not a SIBO diagnosis, and no guideline accepts a stool result as evidence of one. Where the symptom pattern genuinely points at SIBO, a breath test is the investigation that addresses it.

Question 20

Can a stool test find the cause of bloating?

Accepted Answer

A stool test can find some causes of bloating — intestinal inflammation, poor digestion or absorption, pathogens, and a microbiome weighted toward fermentation — and it cannot find others, including SIBO, celiac disease, structural problems and irritable bowel syndrome. Which test is the right first move depends on the pattern of your symptoms, which is a conversation rather than a purchase. Calprotectin is usually the most decision-changing marker on the panel: a normal result makes inflammatory bowel disease unlikely, and a raised one is a reason for a colonoscopy.

Question 21

Is leaky gut real?

Accepted Answer

Increased intestinal permeability is real and measurable, and it occurs in defined diseases such as celiac disease, inflammatory bowel disease and severe infection. "Leaky gut syndrome" as a widespread condition causing fatigue, brain fog and joint pain in otherwise healthy people is a different claim, and it is not recognized by any medical body or supported by the evidence a diagnosis requires. ACT 2 Health does not order zonulin as a permeability test, because a zonulin number says less about the state of the gut lining than the calprotectin, secretory IgA and absorption markers already on a comprehensive panel.

Question 22

Do leaky gut supplements work?

Accepted Answer

No trial has shown that glutamine, collagen, zinc or a packaged "gut-healing" protocol improves the symptoms attributed to leaky gut. Some of those ingredients have modest evidence in specific diagnosed gut diseases under specialist care, which is a narrower claim than the one on the label. If digestive symptoms are persistent, the useful spend is on finding out what is causing them rather than on a protocol aimed at a condition that has not been established.

Question 23

What is a gut microbiome diversity score?

Accepted Answer

A gut microbiome diversity score is a single figure — usually the Shannon index — summarizing how many types of organism were found in your sample and how evenly they were distributed. A higher score generally reflects a more varied community. It is a summary statistic rather than a health measurement, and it moves with diet, recent antibiotics, illness and travel, so the same person can produce different scores weeks apart.

Question 24

Is low gut microbiome diversity bad?

Accepted Answer

Low gut microbiome diversity is associated with a long list of conditions and is diagnostic of none of them, so a low score on its own does not tell you that anything is wrong. Treat it as a prompt to look at the things that actually move — diet, recent antibiotic courses, and the digestion and inflammation markers that change decisions — rather than as a result to treat. Nobody should be buying a supplement protocol on the strength of a diversity number.

Question 25

How do I increase gut microbiome diversity?

Accepted Answer

Eat a wider variety of plant foods, which tracks gut microbiome diversity more closely than any other single factor — the count of different plants across a week matters more than the quantity of any one of them. Fermented foods, adequate fiber and avoiding unnecessary antibiotic courses point the same direction. Probiotic supplements rarely change a diversity score, whatever the packaging implies.

Question 26

Should I get tested for MTHFR?

Accepted Answer

MTHFR testing is usually not the most useful thing to order, because MTHFR variants are common and most people who carry one have no clinical consequence from it. The question that matters more is your homocysteine: if that is normal, the pathway is doing its job whatever your genotype says. Testing homocysteine and B-vitamin status is cheaper, more informative and more likely to change what anyone does next.

Question 27

I have an MTHFR variant — what should I do?

Accepted Answer

Check your homocysteine and your B-vitamin status, and act on those if either is off — an MTHFR variant on its own rarely warrants a specific protocol. The common variants are carried by a large share of the population, and in someone with adequate folate their clinical impact is limited, so a variant is very unlikely to be the explanation for how you feel. A provider issuing a supplement list purely on the basis of your genotype is ahead of the evidence.

Question 28

Do I need methylfolate if I have an MTHFR variant?

Accepted Answer

Not on the basis of the genotype alone. If your homocysteine is normal, the methylation pathway is working and there is nothing for a special folate form to fix. Methylfolate becomes a reasonable next step when homocysteine is elevated and has not responded to ordinary folic acid, which is a decision made on your results rather than on your DNA report.

Question 29

Can I get my MTHFR status from 23andMe?

Accepted Answer

Your MTHFR genotype is present in the raw data file from consumer DNA services, and third-party interpretation sites will report it back to you. The major consumer companies deliberately leave MTHFR out of their own health reports, on the grounds that it does not change medical care — which is the more informative fact about it. A genotype pulled out of a raw data file is not a clinical result and should not be treated as one.

Question 30

Is a methylation panel better than a consumer DNA test?

Accepted Answer

They answer different questions: a consumer DNA test reports genotype — how the enzymes are built — while a methylation panel measures function, including homocysteine, folate, B12 and B6. Function is what changes clinical decisions, which is why the panel is the more useful purchase for someone trying to act on results, and it includes genotype as context anyway. Neither is a substitute for a clinician reading the numbers alongside your history.

Question 31

My DNA report says I have MTHFR and COMT mutations — is that serious?

Accepted Answer

Almost certainly not. MTHFR and COMT variants are common polymorphisms carried by very large shares of the population, and calling them mutations makes an ordinary piece of human variation sound like a disease. What determines whether anything needs doing is function — homocysteine and your B-vitamin levels — and if those are normal, the pathway is working. Bring the report to a clinical review rather than to a supplement store.

Question 32

How accurate is the Galleri test?

Accepted Answer

Galleri's published specificity is high, meaning a false positive is uncommon and a positive result is worth taking seriously. Its sensitivity is the weaker half: across all cancers and stages it detects roughly half of the cancers present, doing better on the aggressive cancers that shed more DNA into the blood and worse on slower ones. In practice that means a positive Galleri result is meaningful and a negative one misses a substantial share of cancer — it cannot rule cancer out.

Question 33

Does a negative Galleri result mean I don't have cancer?

Accepted Answer

No. A negative Galleri result means no cancer signal was detected in that blood sample, and because the test misses roughly half of the cancers present, it cannot rule cancer out. A negative result is not a reason to skip or delay mammography, colonoscopy, cervical screening or lung screening, all of which detect cancers Galleri does not, and it is not a reason to ignore a new symptom. Galleri is designed to add a layer to guideline-recommended screening rather than replace any part of it.

Question 34

Is Galleri FDA-approved?

Accepted Answer

No. Galleri is a laboratory-developed test performed by a single CLIA-certified, CAP-accredited laboratory, and it has not been cleared or approved by the FDA. It is also not part of any guideline-recommended screening program — no professional body currently recommends multi-cancer early detection testing for the general population, and the trials designed to show whether it reduces cancer deaths are still running.

Question 35

Does insurance cover the Galleri test?

Accepted Answer

Generally not, because multi-cancer early detection is not yet part of guideline-recommended screening and coverage tends to follow guidelines. Galleri is normally paid out of pocket. Worth knowing before you order it: the diagnostic workup that follows a positive result — imaging, referrals, sometimes a biopsy — is handled separately from the screening test and is its own cost and its own decision.

Question 36

Is the Galleri test worth it?

Accepted Answer

Galleri is a reasonable choice for someone already up to date with standard screening who wants an additional layer and understands what they are buying: a real chance of catching a cancer that has no routine screening test, weighed against the cost, the possibility of a false positive and the workup that follows one, and the fact that a mortality benefit has not yet been demonstrated. It is the wrong choice for anyone hoping to replace mammography or colonoscopy with a blood draw. Anxiety is a genuine cost on both sides of this decision and belongs in the conversation.

Question 37

Do I need to have diabetes to use a continuous glucose monitor?

Accepted Answer

No. Continuous glucose monitors are available to people without diabetes, and ACT 2 Health prescribes them within metabolic and weight programs. The honest framing matters though: the strongest evidence of benefit in people without diabetes is in those whose glucose already sits in the prediabetes range. If your labs are clean and you have no symptoms, a clinician may tell you a wear is unlikely to change anything — that is a legitimate answer rather than a failed consultation.

Question 38

Do I need a prescription for a continuous glucose monitor?

Accepted Answer

Not for the over-the-counter monitors — Stelo, Lingo and Libre Rio are sold without one. Prescription monitors exist because they add real-time alarms, data sharing and insulin-pump integration, which are features for people whose glucose can fall to a dangerous level rather than features for general metabolic curiosity. For someone without diabetes wearing a sensor to understand their own patterns, the over-the-counter versions do the job.

Question 39

Is an over-the-counter CGM as accurate as a prescription one?

Accepted Answer

Essentially yes — the over-the-counter and prescription sensors are built on the same underlying hardware, and accuracy of the glucose number is not what separates them. What differs is alarms, data delay and the software around the reading. The more useful question is who interprets the trace: an app that labels an ordinary post-meal rise a "spike", or a clinician who can tell you which rises are normal and which are not.

Question 40

Is a continuous glucose monitor more accurate than an A1c test?

Accepted Answer

Neither is more accurate, because they measure different things: A1c reflects an average across roughly the previous three months, while a CGM shows the pattern across a wear of a couple of weeks. When the two disagree, that disagreement is information rather than an error — anemia, iron deficiency, kidney disease or a hemoglobin variant can all push A1c away from what glucose is actually doing. A clinician reads them together rather than picking a winner.

Question 41

Does one high reading on a continuous glucose monitor mean something is wrong?

Accepted Answer

No. Glucose rising after a meal is what a healthy trace looks like, and a single reading is never a diagnosis. CGM apps frequently label ordinary post-meal rises as spikes, which generates a lot of unnecessary worry and some unnecessary food restriction. What a clinician looks at instead is the overall pattern across the wear, read against your blood work — prediabetes and diabetes are still diagnosed by A1c and fasting glucose, not by a sensor.

Question 42

Should I wear a continuous glucose monitor during perimenopause?

Accepted Answer

A CGM is more informative in perimenopause than in most groups without diabetes, because the risk of prediabetes genuinely rises across the transition and a sensor shows that change while it is happening. A typical trace shows larger rises after meals, a higher overnight line, and day-to-day glucose that tracks the previous night's sleep. It describes what is going on rather than treating it, and it needs a clinician to read it — a CGM cannot diagnose insulin resistance or prediabetes on its own.

Question 43

Do I need a continuous glucose monitor if I'm taking semaglutide or tirzepatide?

Accepted Answer

Most people on a GLP-1 medication do not need a continuous glucose monitor. It earns its place in three situations: where glucose was already in the prediabetes range at baseline, as a short diagnostic wear during a genuine stall, and across the period of coming off the medication, where it shows what the drug had been doing and what diet and training now have to cover. A CGM does not add to the medication's effect, and ACT 2 Health does not change a GLP-1 prescription between reviews on the basis of a trace.

Question 44

How do I prepare for a semen analysis?

Accepted Answer

Follow the abstinence window the laboratory specifies in the kit, because both a much shorter and a much longer gap than the stated range will shift the result. Collect when you are well: a fever in the previous two to three months can visibly affect a sample, which is roughly how long sperm take to develop. Note any recent illness, new medication or heavy travel on the form, since those change how the result should be read. The male fertility test is a laboratory-developed test performed by a single CLIA-certified laboratory and has not been cleared or approved by the FDA.

Question 45

Does age affect male fertility?

Accepted Answer

Yes, more gradually than in women and more than men are usually told. From around the forties, motility and semen volume decline slowly, DNA fragmentation rises, and the average time to conception lengthens. It is a shift in the odds rather than a cliff edge, and because the shift is measurable, a semen analysis answers the question far better than an assumption in either direction does.

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