211 The Dutch Test vs The Medical Model: Why They Disagree

The DUTCH test has become one of the most talked-about hormone assessments in the menopause space. Some women describe it as illuminating and empowering. Some medical professionals describe it as unnecessary, over-interpreted, or a waste of money.

So why the disagreement?

In this episode, I step back from the noise and explore what’s actually being argued. What assumptions sit underneath functional hormone testing? What assumptions sit underneath conventional medicine? And why does this debate feel so emotionally charged?

Rather than taking sides, we look at the psychological and structural differences between these two paradigms — and what happens when menopausal women find themselves caught in the middle.

If you’ve ever felt validated by testing… dismissed by medicine… or confused by the intensity of the conversation online, this episode is for you.

Join the waitlist for BECOMING

🔗 Join the waitlist:
https://www.sallygarozzo.com/becoming

*********************************************

📲 Connect with Sally:

Email: info@sallygarozzo.com 

[On-Demand Masterclass] How To Heal The Trauma Underlying Your Menopause Symptom Severity [£17]: https://www.sallygarozzo.com/healingtrauma 

[Online Practitioners Diploma - Self Paced] Menopause Wellbeing Practitioner [£127]: https://www.sallygarozzo.com/meno

[One to One] Bespoke Transformational Hypnotherapy & Coaching: https://www.sallygarozzo.com/rapid-transformational-therapist 

Instagram: https://www.instagram.com/sallygarozzomindmentor

LinkedIn: https://www.linkedin.com/in/sallygarozzo/

Send me a WhatsApp: https://wa.me/message/FTARBMO7CRLEL1

Transcript

Sally (00:00.994)
I want to talk about the Dutch test. I don't want to talk about it carefully because I've had it done twice and both times I found it really empowering. It armed me with knowledge and context about why I felt the way that I did. I could see how my body was reacting to stress. I could see how lack of sleep showed up on the dials. I could see how my cortisol

was behaving across the day. could see how metabolism, I could see how I was metabolizing estrogen, progesterone, testosterone. It wasn't just a single number on a blood test. It was a pattern that was revealed. And the first time I saw my cortisol levels flatlining, I cried in this ambivalence.

holding anger and validation at the same time. I was so angry that no doctor had ever spotted this, but also felt so validated because there it was. The exhaustion I couldn't articulate, the stress I'd been carrying, the load right there in front of my eyes translated through these numbers. And at that time in my life,

I don't think I even fully understood what validation actually was. I just knew that something in my system softened when I saw these dials in front of me. For me, it wasn't about diagnosis or pathology. It was about coherence. And the lovely thing is you spend an hour with the practitioner. You're not rushed. You're not squeezed into a 10 minute slot. You're not told.

that your bloods are normal, you're being listened to and your patterns are being explored. So when I started seeing people on social media really having a go at the Dutch test, I was utterly baffled and genuinely confused. I remember seeing one particular menopause influencer describe it as a total waste of money and a scam. And I thought,

Sally (02:26.018)
Well, that doesn't match my experience. Surely if something like this exists, if people keep buying it, if people report finding it helpful, it can't just be complete nonsense. Businesses don't survive on pure hokum, do they? And yet on the other side, you have medics and evidence-based practitioners saying it's overinterpreted, it's misleading, it's unnecessary.

and sometimes even exploitative. And what struck me was the ferocity of their words, that absolute certainty, the tone. That's what made me curious. Because I'm less interested in winning an argument about metabolites and much more interested in how people actually arrive at their positions. What paradigms are operating underneath?

What fears, what assumptions, what is each side actually protecting? And where does that leave the woman in midlife who just wants to feel steady in her body? So I keep coming back to this image. Imagine you're out at sea and a little boat in thick fog. You can't see the coastline. You just...

feel disorientated. The water feels somewhat different. The air feels different. You don't feel like yourself. And this is many women during menopause. Now the Dutch test can feel like a lighthouse beam cutting through that fog. It illuminates something. It gives you shape, of definition, it starts to show a pattern. It says, look, there is something here.

maybe something that you've been missing. And that illumination can be incredibly relieving because it gives you a sign, it gives you hope. But a lighthouse doesn't steer your boat. It doesn't...

Sally (04:38.742)
It doesn't know how deep the water is beneath you. It doesn't know whether there's a reef ahead. It doesn't assess structural damage of the boat. It just shines a light and you have to do the rest. You have to navigate your way to dry land. Now in contrast, the medical model feels more like the Coast Guard. Its job is not to illuminate patterns per se.

Its job is to prevent you from getting shipwrecked. Its job is to prevent you from getting shipwrecked. Its tests scan for storms, for structural risk, for things that could genuinely harm you. Its perspective is from that radar level. It assesses probability, risk, and it takes its baselines

from population level data. So the lighthouse, AKA the Dutch test, thinks in illumination of patterns. The Coast Guard, AKA the medical model, thinks in risk management. So neither is wrong, but if you are the woman in the boat in the fog in that unknown territory, it can feel like you're caught between two authorities that don't

quite speak the same language. The lighthouse says, look at this pattern, you can do something about this. The coast guard says, be careful not to interpret that. The coast guard says, be careful not to overinterpret that signal as something absolute. And you're thinking, can someone just help me feel steady, please? That to me is menopause.

So this episode isn't about taking sides. It's not about saying the Dutch test is brilliant. It's not about saying the medical model is outdated. It's about understanding what each paradigm is actually saying and why the debate gets so heated. Because when you look underneath the surface, they're actually answering different questions. The Dutch model is asking, what patterns can we see in how

Sally (07:01.486)
the body has been adapting to stress over the years. And the medical model is asking, does this test result? it change diagnosis? Does it change treatment? Does it change risk? And those are not the same questions. And when women expect one authority, one test, one GP, one protocol to solve what is actually a multi-layered developmental

shift psychologically, something very interesting happens. And this is where I want to go next. Let's unpack what each side is really protecting and why menopause or women often feel sandwiched in the middle. So let's start with the Dutch paradigm first. What is the underlying worldview here? What is Dutch actually saying?

At its core, the Dutch model assumes that the body expresses lived experience through patterns. It's not particularly interested in a single snapshot blood value taken at 9 a.m. on a Tuesday. It's interested in rhythm, in flow, in metabolism, in pathways. It assumes that if we zoom out and look at how hormones are being produced, converted, and cleared,

over time, we might see something about how the system is adapting. And that word is important, adapting. The Dutch model isn't usually saying you're broken. It's saying your system is coping with stress in a particular way. It's coping with hormone metabolism in a particular way. If your cortisol curve is flatlined,

It doesn't say you have a disease. says your stress response looks blunted. I wonder why that's happening. If certain estrogen metabolites are high or low, it doesn't automatically say, this is a pathology. It says, this is the pathway your body seems to be favoring. It's pattern language. And psychologically that can feel

Sally (09:27.074)
very different from pathology language. Because instead of what's wrong with me, it becomes, well, how has my body been adapting? And there's a subtle but profound shift in perspective there. The Dutch test worldview also assumes that visibility changes behavior. If you can see a pattern, you might start to make different choices. I know this was my experience for sure.

If you see your cortisol dipping in the afternoon or your cortisone levels really high, you might start to prioritize rest because it's there in black and white. If you can see your melatonin metabolite is really low, you might want to look at sleep hygiene. You're way more motivated to look at it. If you see your detox pathways are under strain, you might look at stress load, nutrition, liver support, toxic load.

It's a model that assumes insight increases agency. And I really like that because it's very psychologically aligned with how humans change. don't usually, we don't usually change because someone tells us we should. We change because something clicks in our psyche. Something makes sense. Our perspective shifts. It's because something feels aligned and coherent in our body.

Now, another core assumption in this paradigm is that physiology reflects biography. That long-term stress, relational patterns, trauma, over-functioning, under-sleeping, too much caregiving, decades of pushing through, all those things don't just disappear. They leave biochemical fingerprints in the way you metabolize.

So when someone sees a cortisol curve that reflects exhaustion, it can feel like their history has finally been acknowledged. And even if the test isn't explicitly talking about trauma, it's simply saying, here's how your body is currently expressing the load it's under. Now does Dutch, now does the Dutch test diagnose disease?

Sally (11:54.817)
No, it doesn't. And that's a really important distinction. It measures metabolites. It measures output. It measures how hormones are being processed at this point in time. It doesn't measure causation. It doesn't measure central brain signaling. It doesn't tell you why the patterns exist, but within its own paradigm, that's not its primary goal. The goal is illumination.

And for many women, myself included in those early days, illumination felt like absolute relief. Because when you've been told everything is normal and you don't feel normal, seeing a pattern can restore your inner coherence. It stops you feeling like it's all in your head. It can make the fog feel less thick.

So when people defend the Dutch test strongly, what they're often defending isn't just the lab methodology. They're defending the experience of being seen, of having complexity acknowledged, of not being reduced to a single number. They're defending pattern over snapshots, context over dismissal, adaptation over defect. And that's

psychologically really powerful. Now that doesn't mean it's beyond critique and it doesn't mean it replaces medicine of course, but if we're going to understand why the debate is so charged, we have to understand what this model is actually offering. It's offering a lens with which to see our symptoms through. It's not offering a verdict, it's a lens. And for some women at midlife,

That lens feel like, and for some women at midlife, that lens feels like the first time their inner landscape has been mapped with any depth.

Sally (14:01.58)
And for some women at midlife, that lens feels like the first time their inner landscape has been mapped with any depth.

But here's where things get interesting because the medical model is operating from a completely different set of assumptions. And when you place those two paradigms side by side, pattern versus probability, illumination versus risk reduction, you can start to see why they don't agree.

Sally (14:39.33)
And when you start to place those two paradigms side by side, pattern versus probability, illumination versus risk reduction, you can start to see why they don't agree. They almost talk past each other. It's almost like they're both invisible from each other's perspectives. So let's look now at what the medical model is actually saying and why it's caution isn't stupidity or patriarchy or dismissal.

but something else entirely. So let's step into the medical model because if we're going to have this conversation properly, we have to understand what medicine is actually trying to do. It's not overtly trying to dismiss women, even though it feels like that sometimes. It's trying to prevent harm. That's its main focus. Medicine is built on population level thinking.

population level baselines. And that means when a doctor looks at a test, they're not just thinking about you as an individual, they're thinking about thousands of patients, millions even. They're thinking in terms of probability, safety and reproducibility. They're asking, does this test help us make a diagnosis? Does it help us define a treatment? Does it reduce risk?

Does it improve long-term outcomes? And if the answer is unclear, they become cautious. The medical model also assumes that correlation is dangerous and humans are meaning making creatures. We love a good correlation. We're really good at spotting patterns, sometimes too good. So when doctors see a metabolite that's a bit high or a cortisol curve that's a bit flat,

Their instinct isn't to build a story around it. Their instinct is to ask, is this within biological variation? Is this clinically significant? Does this predict disease? Because from their training, attaching meaning too quickly can create harm. If you tell someone their court is always broken, they may start to identify as broken.

Sally (17:05.42)
If you tell someone their estrogen metabolism is bad, they may develop anxiety around a normal variation. Medicine is very aware that labels change behavior. And sometimes labels create an illness identity where there wasn't actually disease. And that's a real concern in primary care.

Another core assumption in the medical paradigm is that a test must be actionable in a specific way. a number is high or low, what exactly are we doing differently here? Are we prescribing medication? Are we referring to a specialist? Are we monitoring for risk? If the likely recommendation is

Sally (18:01.494)
If the likely recommendation is something obvious like sleep more, reduce stress, move your body, eat regularly, then a doctor may reasonably think we didn't need to spend 300 pounds on a test to arrive there. From their perspective, that baseline lifestyle advice hasn't changed. It was always sleep more, reduce stress, move your body more, eat more regularly. So the cost...

benefit equation in the medical realm matters. It really matters to them. And there's also the issue of variability, right? So hormones fluctuate, cortisol fluctuates, estrogen fluctuates, perimenopause is by definition chaotic. So medicine asks, is this pattern predictable? Is it

Sally (19:01.752)
So medicine asks, is this pattern stable? Is it reproducible? Is it outside expected variations? If not, it may not meet the threshold for clinical intervention. And that doesn't mean the women's experience isn't real. It means the model requires a certain degree.

It means the model requires a certain degree of certainty before acting. And then there's something quieter underneath all of this. Medicine is structured around pathology. It's excellent for diagnosing disease. It's excellent at managing risk and excellent at preventing catastrophic outcomes. Menopause, however, is not a disease. It's a reproductive transition.

a developmental transition, you like. And these kinds of transitions don't always produce clean, diagnostable.

Sally (20:09.42)
And these transitions don't always produce clean, diagnosable pathology. They produce destabilization and destabilization is uncomfortable. Yes, of course, but it isn't necessarily pathological. So when a woman says, I feel like my whole system is unraveling, the medical model is scanning for anemia, thyroid dysfunction.

major depression, cardiovascular risk. And if those are ruled out, the system may say you are within normal limits. And from a statistical perspective, that may be true, but from a lived perspective, it can feel incredibly invalidating. So when doctors push back against the Dutch test, they're defending standards of evidence. They're defending

Sally (21:08.216)
They're defending patients from over-medicalization. They're defending the idea that not every fluctuation requires intervention. They're defending causation. And causation in medicine is not hostility, it's quite a responsibility.

Now, that mean the medical model captures the full experience of menopause? Not necessarily, but it was never designed to hold biography like the Dutch test was. It was designed to reduce morbidity and mortality. And I really think that distinction matters. So now we have two very, very different paradigms. One that says,

Let's look at patterns. Let's illuminate how you've had to, how.

Sally (22:08.332)
Let's look at patterns. Let's illuminate how you've had to adapt to cope. And one that says, let's protect against harm. Let's avoid over-interpret. Let's avoid over-interpretation. Neither is foolish or malicious. They are just both different. But when you're a woman in the middle, destabilised,

you are looking for steadiness. And the psychological tension between those models becomes very real and in a way destabilizes you further. And so that's where this debate stops being about metabolites and starts being about something much deeper. And that is what happens when we expect one authority to solve a multi-layered shift.

So let's take a breath.

Sally (23:11.586)
because here is where I think this gets really interesting. Beneath the lab values and the evidence hierarchies and all the arguments on Instagram, there's something very human happening. Menopause is destabilizing, not just hormonally, but identity-wise, nervous system-wise, relationally. Hormone buffering. Hormonal buffering shifts, sleep shifts, tolerance shifts.

Patience shifts, emotional material that's been quietly managed for decades can start to surface. And when a human being feels destabilized, the nervous system looks for something very specific. It looks for that certainty. It looks for authority. It looks for someone who knows. That's how we're wired.

And when we feel disorientated, we scan for steadiness outside of ourselves. Of course we do. We go to the GP or we order the test or we read the book or we follow the expert on Instagram because something in us wants to hear, this is what's happening and this is what you do. But now here is the psychological tension. Menopause is not a single layer problem.

It's endocrine, it's neurological, it's psychological, it's social, it's biographical, it's decades of adaptation meeting a reproductive shift. But when we approach it from a destabilized place, we often just want one clean answer, one authority, one explanation, one solution. And when that authority doesn't fully resolve the complexity,

Of course disappointment is going to creep in. If the GP says your bloods are normal and you still feel awful, that can feel like dismissal. And if the Dutch test shows patterns, but doesn't fix your anxiety or your rage or your insomnia, that can also feel like a false promise too. And the nervous system and the brain and the nervous system and the brain

Sally (25:32.067)
doesn't like ambiguity, it prefers certainty over complexity. So psychologically what can happen is we start oscillating between authorities. This one didn't fix it, maybe that one will, maybe this supplement, maybe this protocol, maybe another test. And it then becomes a search for the metaphorical stabilizing parent, if you will, the expert outside of ourselves who will hold the whole

thing for us. But I'm sure you're starting to see the bigger picture here. Menopause isn't a problem to be solved by a single lens, is it? It's a transition that exposes multiple layers at once. And expecting one professional, one test to contain all of that is almost guaranteed to create frustration and perhaps even more destabilization.

And this isn't because those tests are incompetent, far from it, but because we're asking them to do something for us that is larger than their remit. Because the deeper message of menopause is about moving us away from outsourcing authority to actually reclaiming it internally. tell me what's wrong with me to...

Help me understand what my system is doing here, please. It's a very, very different posture. One is seeking rescue, which of course is sometimes needed. And the other is building capacity, which is the longer game. Capacity to hold more nuance, to hold more uncertainty, to hold that destabilizing phase that we're going through.

And of course that shift doesn't happen overnight. And it often happens through this confusion, through trying one thing, then another, through feeling validated in one space and dismissed in another, until eventually something deeper starts to emerge and it stabilizes itself. And that stability doesn't come from certainty about every number.

Sally (27:55.201)
It comes from, as I said before, tolerance of complexity. And we spoke about this last week in our previous episode.

Sally (28:08.214)
So for me, this idea of expanding our capacity to tolerate more complexity and more uncertainty is where my new membership becoming sits. It's not an alternative to medicine. It's not an alternative to testing, but it's a space to increase your capacity to sit inside multi-layered change without collapsing into panic or outsourcing your power.

Because menopause isn't asking you to find the perfect authority or the perfect test. It's asking you to expand your internal steadiness. And that's developmental work. That's a healing journey. That's not diagnostic work actually.

Sally (29:00.866)
So if you're listening to this and thinking, I don't actually want another test. I don't want to fight with my GP. I don't want to live in constant optimization mode either. And I also don't want to feel lost in this transition. That's exactly why I created becoming. Becoming isn't about rejecting medicine. isn't about chasing functional fixes either.

and that constant optimization, can be exhausting. It's about building real inner capacity, capacity to sit with change, capacity to understand your nervous system, capacity to hold complexity without immediately needing to solve it. Because menopause isn't just a biochemical event. It's a huge developmental one. It's a transitional one.

And these type of transitional phases require space, space to metabolize what's surfacing, space to untangle what's hormonal from what's historical, space to strengthen your internal steadiness so you're not constantly scanning for the next authority. Becoming is that space, a place to practice.

is being with uncertainty without collapsing into it. A place to increase psychological and physiological resilience in real time. A place to learn how to listen to your system rather than panic about it. And if that resonates, the wait list is open for you to put your name down for when the doors open. And you can just go to sallygarozzo.com forward slash becoming to learn more.

So to close this episode, let's think about the image of you in that boat in the fog all at sea. The lighthouse is shining a beam across the water now. The coast guard scans for storms and danger. Both are doing their job. Both are operating from care. And you in the middle, you're trying to find your bearings. Maybe the question isn't which one is right. Maybe the question is,

Sally (31:24.96)
What helps you feel steady in the boat? Is it more illumination that you need? Is it more risk protection that you need? Is it more understanding of your own inner ecology? Or is it strengthening the part of you that can navigate even when the fog doesn't fully clear?

Menopause may not be asking you to choose a side. It might be asking you to become a steadier captain of your own ship. And that doesn't mean you don't use the lighthouse and it doesn't mean you ignore the coast guard or reject its help when you need it. It means that you develop the capacity to interpret both without losing yourself in the process. That to me is the deeper, more intelligent work of midlife.

And that's the conversation I'm most interested in continuing. Thank you for listening and I'll see you next time.