What Does the DUTCH Test Measure?

The DUTCH test is a dried-urine hormone panel that measures your sex hormones, how your body breaks them down, and your cortisol pattern across a day. It is a legitimate laboratory test, and it answers questions a single blood draw cannot. It is also more than most women need for routine menopause care, which is why we use it selectively: Golden Leaf can order and interpret DUTCH testing when it will change a plan, and we can review results you already have, but we don’t currently sell the kit online.

This guide covers what the test measures, how it differs from blood testing, when it earns its cost, and when it doesn’t.

What is the DUTCH test?

DUTCH stands for Dried Urine Test for Comprehensive Hormones. Instead of one blood draw, you collect four or five small urine samples on filter paper over the course of a day, let them dry, and mail them to the laboratory. Because the samples are spread across the day, the test can show patterns, such as how cortisol rises and falls, that a single sample can’t.

There are a few versions. DUTCH Complete is the standard panel. DUTCH Plus adds salivary cortisol at waking. DUTCH Cycle Mapping tracks estrogen and progesterone across a full menstrual cycle, which is used for women who still have cycles.

What does the DUTCH test measure?

• Estrogens and their metabolites. Estradiol, estrone and estriol, plus the pathways your body uses to break estrogen down (2-hydroxy, 4-hydroxy and 16-hydroxy), and how well the next step, methylation, is working.
• Progesterone metabolites. The breakdown products that reflect progesterone production.
• Androgens. Testosterone, DHEA-S, androstenedione and their metabolites, including the pathway that produces the more potent DHT.
• Cortisol and cortisone. Four or five readings across the day, plus their metabolites, which together show both the daily rhythm and the total amount produced.
• Other markers. Melatonin, 8-OHdG (a marker of oxidative stress), and some markers related to B-vitamin status and to the breakdown of dopamine, norepinephrine and serotonin.

It is a long list, and the report runs to many pages. What matters is whether any of it changes what you and your clinician would do.

How is it different from a blood test?

A blood test measures the hormone circulating at the moment of the draw. That is exactly what you want when the question is “how much estradiol is getting into my system on this dose”, and it is the measurement that dosing guidance is built on.

DUTCH measures what has passed through and been processed. That makes it better at two things: showing patterns over a day (cortisol) and showing how a hormone is metabolised (estrogen pathways). It is worse at telling you your current level, and for some hormone therapy forms, especially transdermal estradiol, urine results don’t reflect what is in the blood well.

So the two tests answer different questions. Neither replaces the other; DUTCH vs blood test compares them, and saliva, question by question.

Is the DUTCH test legitimate?

Yes, in the sense that matters: it is performed by a CLIA-certified laboratory, the measurements are real, and the method has been published and compared against blood and saliva testing. Many integrative and naturopathic clinicians use it.

The fair criticism is about usefulness rather than accuracy. Menopause guidelines from the major societies don’t recommend urine or saliva hormone testing to diagnose menopause or to guide hormone therapy dosing, because symptoms and, where needed, blood levels do that job. Some of the markers on the panel, particularly the estrogen-metabolism ratios, are interesting but their value for day-to-day decisions is still being researched. A test that produces a long report can also lead to treating numbers rather than the person.

Our view: DUTCH is a legitimate tool with a narrow set of jobs. It is not a routine test, and it is not a prerequisite for hormone therapy.

When the DUTCH test helps

• A cortisol question. Wired-but-tired, 3 a.m. waking, or stress symptoms where a daily cortisol pattern would change the plan.
• An estrogen-metabolism question. For example, a history that makes a clinician want to see which breakdown pathways are favoured before or during treatment.
• Cycle mapping. For women still cycling, where a single-day sample would miss the pattern. See DUTCH Cycle Mapping, explained.
• Reviewing results you already have. Many patients arrive with a DUTCH report from another practice and want it explained. We do that, and our guide to reading DUTCH results walks through each section.

When it doesn’t

• Deciding whether you are in perimenopause or menopause. Symptoms and age do that; a hormone level on one day often misleads.
• Setting or adjusting a hormone therapy dose. Symptoms first, blood levels when needed.
• As a general “check my hormones” screen. The report is long, and most of it won’t change anything.

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.

How Golden Leaf uses DUTCH today

We can order and interpret DUTCH testing when a clinician believes it will change your plan, and we’re glad to go through results you already have. We don’t currently sell the DUTCH kit through our website; that may return. Lab prices depend on what is tested, and your provider will tell you what they recommend and why before anything is ordered, so the price is in front of you when you decide. Our guide to hormone tests covers the blood panel we use most often and when testing is useful at all.

What to ask before any hormone test

• What question will this test answer that my symptoms don’t?
• Would a blood test answer it?
• What would we do differently depending on the result?
• What does it cost, and is that covered by anything?

If the answers are vague, the test probably isn’t needed yet.

Golden Leaf’s care team treats perimenopause and menopause by video in the states we serve. Book a first visit if you’d like your symptoms, and any results you already have, looked at as a whole.

Sources: Precision Analytical, the DUTCH test (laboratory’s own description of the panel); The Menopause Society, hormone therapy position statement; National Institute on Aging, What is menopause?.