How to Read Your DUTCH Test Results

A DUTCH report is long, colourful and mostly gauges, and the first time you see yours you’ll want to know which of the thirty-odd markers matter. The honest answer is that a handful might change what you and your clinician do, several are interesting context, and some are research-stage markers that look more decisive on the page than they are in the evidence. This guide walks through each section of a DUTCH Complete in plain English, says what a high or low result usually means, and flags the ones not to over-read.

It assumes you know what the test is; if not, start with what the DUTCH test measures. And it is general information: your own report should be read with the clinician who ordered it, against your symptoms and history.

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. Two further cautions: if you use estrogen through the skin or vagina, urine doesn’t reflect it well, and oral progesterone inflates the progesterone metabolites, so results on hormone therapy need an expert reading.

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. 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 are a reasonable prompt for the lifestyle advice you’d get anyway, and sometimes for a conversation about which hormone therapy form to use. They are not a reason to buy a “estrogen detox” supplement.

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.

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 occasionally add a clue; they are not the reason to do the test, and a supplement protocol built on them is building on sand.

Which results actually change a plan

In our experience, 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.

The ones that rarely do: the organic acids, the pathway ratios on their own, and any single marker in a woman who feels well.

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:

• 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.
• A flattened or late-peaking cortisol curve points to the sleep and stress work on our fatigue and sleep pages, and sometimes to treating the night sweats that are driving it.
• Androgen pathway findings inform the options for hair thinning and low libido.

The test explains; the care is the same conversation either way, and it starts with a $99 video visit, with pricing published. Already have a DUTCH report? Bring it to your first visit and a clinician will go through it with you, section by section, as part of the visit.

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. 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.

Sources: Precision Analytical, DUTCH test; The Menopause Society; Mayo Clinic, Menopause diagnosis.