The cortisol curve
Can change a planSection 4
A cortisol curve that explains a sleep or stress pattern and points at a specific intervention.
Section 4: the cortisol curveHow to Read Your DUTCH Test Results
A DUTCH report can contain thirty-odd markers, but only a handful might change what you and your clinician do. Several provide context, and some are research-stage markers that look more decisive on the page than they are in the evidence.
Which part of your report?
Pick a sectionPick a section to see whether it tends to change a plan.
Progesterone
Can change a planSection 2
A progesterone section that confirms non-ovulatory perimenopausal cycles when bleeding, mood or sleep are the complaint.
Section 2: progesterone metabolitesHormone therapy at Golden Leaf HealthEstrogen pathways
Can change a planSection 1
An estrogen-metabolism picture that nudges the choice of hormone therapy form or prompts lifestyle changes you'd benefit from anyway.
Section 1: estrogensHormone therapy at Golden Leaf HealthAndrogens
Can change a planSection 3
An androgen pathway picture that explains hair or skin changes.
Section 3: androgensOrganic acids
Rarely changes a planSection 5
These are supporting markers that may add a clue, but they are not the reason to do the test.
Section 5: the organic acidsMy blood test doesn't match
Not a contradictionDifferent quantities
They're different quantities in different units, so a "low estrogen" on DUTCH and a "normal estradiol" in blood are not a contradiction.
Why the numbers won't matchI'm on hormone therapy
Needs an expert readingTwo cautions
If you use estrogen through the skin or vagina, urine doesn't reflect it well. Oral progesterone inflates the progesterone metabolites, so results on hormone therapy need an expert reading.
Why the numbers won't matchSix things worth knowing.
- Only a handful of the markers on a DUTCH report might change what you and your clinician do.
- DUTCH measures hormone metabolites in dried urine, so its numbers won't match a blood test.
- No guideline recommends treating on the basis of the estrogen pathway ratios.
- In a cycling woman tested about a week before her period, good progesterone levels confirm ovulation.
- Low free cortisol with normal total cortisol usually means fast clearance, not exhausted glands. 'Adrenal fatigue' isn't a recognised diagnosis.
- The organic acids are supporting markers that may add a clue, but they are not the reason to do the test.
First, why the numbers won't match a blood test
DUTCH measures hormone metabolites in dried urine: what your body made and processed over the hours before each sample. A blood test measures the hormone circulating at one moment. They're different quantities in different units, so a "low estrogen" on DUTCH and a "normal estradiol" in blood are not a contradiction.
The reference ranges on the report are the laboratory's own, built from its population, and they're shown as gauges rather than numbers for a reason: the position within the range is a rough guide, not a diagnosis.
There are two further cautions.
Estrogen through the skin or vagina
If you use estrogen through the skin or vagina, urine doesn't reflect it well.
Oral progesterone
Oral progesterone inflates the progesterone metabolites, so results on hormone therapy need an expert reading.
If you are new to the test, start with what the DUTCH test measures.
Section 1: estrogens and how you metabolise them
What's measured
Estrone (E1), estradiol (E2) and estriol (E3), and then the pathways your liver uses to break estrogen down: the 2-hydroxy, 4-hydroxy and 16-hydroxy routes, followed by methylation, the step that neutralises the 2- and 4-hydroxy forms.
What it usually means
Total estrogens low in a woman past menopause is expected. Estrogens high in a cycling woman in the second half of her cycle, especially with low progesterone metabolites, fits the erratic cycles of perimenopause and may explain mood swings, breast tenderness and bloating; see estrogen overload for the symptom side. This is the one section where timing matters most: a sample taken on day 5 and one on day 21 tell different stories.
Don't over-read
Be careful with the pathway ratios. A preference for the 4-hydroxy route and poor methylation have been studied in relation to breast cancer risk, and the report presents them prominently, but no guideline recommends treating on their basis. The research is observational, and diet, weight, alcohol and exercise all shift them. They may prompt lifestyle advice or a conversation about which hormone therapy form to use. They are not a reason to buy an "estrogen detox" supplement.
Where estrogen goes next.
The pathwaysEstrogenEstradiol, estrone and estriol
- Pathway 12-hydroxy
- Pathway 24-hydroxy
- Pathway 316-hydroxy
MethylationThe step that neutralises the 2‑ and 4‑hydroxy forms.
Section 2: progesterone metabolites
What's measured
Two breakdown products of progesterone, called a-pregnanediol and b-pregnanediol, which together reflect how much progesterone you produced in the days before the sample.
What it usually means
In a cycling woman tested about a week before her period, good levels confirm ovulation; low levels suggest a cycle without ovulation or a short, weak luteal phase, both common in perimenopause and both plausible causes of heavy or erratic periods, PMS and poor sleep. After menopause, low is normal. The b-form is the one associated with the calming effect many women notice from progesterone; a relatively low b-to-a ratio sometimes explains why someone on progesterone doesn't feel its sedative benefit.
Don't over-read
Results on oral micronised progesterone, which produces large amounts of these metabolites without saying much about tissue effect. And a single cycle: if the question is the cycle, cycle mapping is the right tool.
Section 3: androgens
What's measured
Testosterone, DHEA-S, androstenedione and their metabolites, including whether your body prefers the 5-alpha pathway, which produces the more potent DHT, or the 5-beta pathway.
What it usually means
Low DHEA-S is normal with age and doesn't by itself mean anything to treat; see our DHEA post for when supplementing is and isn't reasonable. Low testosterone with low desire after menopause is a prompt for the conversation on our low libido page, though a blood level is what's used to monitor any treatment. A strong 5-alpha preference with acne, hair thinning or facial hair fits the picture of androgen sensitivity at the follicle and can inform treatment choices.
Don't over-read
Testosterone from urine as a basis for dosing testosterone therapy; blood is the standard, and the goal of any treatment is a level within the female range.
Section 4: the cortisol curve
What's measured
Free cortisol and cortisone at four or five points, waking, half an hour to an hour after waking, afternoon and bedtime, which gives the daily rhythm, plus the metabolised cortisol, which reflects total production over the day.
What it usually means
The expected curve is a sharp rise after waking and a steady fall to a low at bedtime. A flattened curve, a low waking rise, or a bedtime value that stays high correlate with stress, poor sleep, night-shift patterns and depression, and can explain "wired but tired". A high bedtime cortisol is a reasonable prompt for the sleep and stress work on this site.
Don't over-read
This is the section most often used to diagnose "adrenal fatigue", which isn't a recognised condition; see our fatigue page for why. Low free cortisol with normal metabolised cortisol usually means you clear cortisol quickly, not that your glands are exhausted. Very low total cortisol with symptoms is a reason for a doctor to test properly for adrenal insufficiency with blood tests, not a reason to take adrenal supplements. And the curve changes day to day; one day's pattern is a sketch.
Three shapes a cortisol curve can take.
IllustrationExpected. A sharp rise after waking and a steady fall to a low at bedtime.
Flattened. A flattened curve or a low waking rise correlates with stress, poor sleep, night-shift patterns and depression.
High at bedtime. A high bedtime cortisol is a reasonable prompt for the sleep and stress work on this site.
Section 5: the organic acids
What's measured
A melatonin metabolite (6-OH-melatonin-sulfate), 8-OHdG (a marker of oxidative DNA damage), markers related to vitamin B6 and B12 status, and the breakdown products of dopamine, norepinephrine, epinephrine and serotonin.
What it usually means
Low melatonin metabolite in someone who can't sleep is consistent and might support a low-dose melatonin trial. A B12 marker out of range is worth confirming with a blood test, which is cheaper and more specific. The neurotransmitter metabolites reflect what was made and broken down in the body as a whole, not in the brain, and their relationship to mood is loose.
Don't over-read
Almost all of it. These are supporting markers that may add a clue, but they are not the reason to do the test. A supplement protocol based on them is not well supported.
Which results can change a plan
In our experience, these are the ones that do.
- 1
A cortisol curve that explains a sleep or stress pattern and points at a specific intervention.
- 2
A progesterone section that confirms non-ovulatory perimenopausal cycles when bleeding, mood or sleep are the complaint.
- 3
An estrogen-metabolism picture that nudges the choice of hormone therapy form or prompts lifestyle changes you'd benefit from anyway.
- 4
An androgen pathway picture that explains hair or skin changes.
What happens after the results
Whatever a DUTCH report shows, it leads to a treatment conversation, and the treatments are the ones we already provide.
What brought you to the test?
Erratic estrogen with low progesterone in perimenopause
Opens the question of cyclic progesterone or hormone therapy for mood, sleep and bleeding.
Low estrogen after menopause
With symptoms is the ordinary case for hormone therapy, decided on how you feel, with blood levels as the check once you're on it.
Androgen pathway findings
Inform the options for hair thinning and low libido.
The test adds information, but care starts with the same conversation: a $99 video visit, with pricing published.
Wondering whether hormone therapy is right for you? See who should not take HRT.
Already have a DUTCH report?
Bring it to your first visit and a clinician will go through it with you, section by section.
Getting your report read
If you have a DUTCH report from another practice and nobody walked you through it, that's a common reason women come to Golden Leaf Health.
We interpret DUTCH results against your symptoms and history, say plainly which findings matter and which don't, and don't sell the kit online or build supplement protocols from the gauges. Book a first visit and upload the report.
Talk.
A one-on-one video visit about your symptoms, your history and what you want to feel like again. Your first visit is $99, refunded if you cancel at least 24 hours ahead.
Test.
If your provider thinks it will help, a hormone blood panel adds lab results to what you’ve told them. Not everyone needs this step.
Treat.
If treatment is right for you, your plan can include hormone prescriptions, non-hormonal options, lifestyle changes and optional supplements. Then two to three follow-up visits with a doctor and text check-ins through HIPAA-compliant messaging, included in membership at $49 a month, which begins one month after your first visit. Prescriptions and labs are priced separately.
Questions, answered plainly.
What does the DUTCH test show?
Your estrogens and how your body breaks them down, progesterone metabolites, testosterone and DHEA pathways, your cortisol pattern across a day and total production, and organic acid markers for melatonin, oxidative stress, B vitamins and neurotransmitter metabolites. All are measured in dried urine as metabolites, not blood levels.
What does the DUTCH test show about progesterone?
Two progesterone breakdown products reflect how much progesterone you made in the days before collection. In a cycling woman tested a week before her period, low values suggest a cycle without ovulation or a weak luteal phase. Oral progesterone inflates the values, so they need expert reading.
Are the estrogen metabolism ratios on the DUTCH test important?
The 2-hydroxy, 4-hydroxy and 16-hydroxy pathways and the methylation step are still being researched in relation to breast cancer risk. No guideline recommends treating on the basis of these ratios, and lifestyle factors shift them. They can inform a conversation but should not drive a prescription on their own.
Does the DUTCH test diagnose adrenal fatigue?
No. 'Adrenal fatigue' isn't a recognised diagnosis. The cortisol section shows your daily rhythm and total output, which stress and poor sleep can flatten. Low free cortisol with normal total cortisol usually means fast clearance, not exhausted glands. True adrenal insufficiency is diagnosed by blood tests, not DUTCH.
Is the DUTCH test worth it?
For a specific question, such as a cortisol pattern or an estrogen-metabolism concern, it can be. As a general hormone check, or to diagnose menopause or set a hormone therapy dose, it isn't, because symptoms and blood tests do those jobs.
Have your report read, and start treatment if it fits.
A $99 video visit with a clinician who treats perimenopause and menopause, in 33 states.
