DUTCH® Test
An advanced dried-urine panel mapping hormones and their metabolites.
- Hormone metabolites — what your body does with a hormone, which a blood level can't show
- The daily cortisol rhythm, which a single morning draw reduces to one number
- Estrogen clearance pathways, where a specific question has come up
An additional layer, not a foundation. It does not diagnose a hormone deficiency and should not start or stop hormone therapy on its own.
Indicative price · confirmed after eligibility · prescription treatment
What the DUTCH test measures
A standard blood panel tells you how much of a hormone is circulating at the moment the needle went in. That's useful, and for most decisions it's enough.
What it doesn't tell you is what your body is *doing* with that hormone — which pathways it's being broken down through, and what it's being converted into. Two people with identical estradiol on a blood test can be metabolizing it quite differently, and in some situations that difference matters more than the level itself.
That's the gap the DUTCH® test is designed to fill. It's also a test with real debate around it, which we'd rather cover honestly than skip.
The DUTCH® test — Dried Urine Test for Comprehensive Hormones, from Precision Analytical — uses dried urine samples collected at home across a day. That collection method is the point: because it captures multiple samples rather than one, it can show the daily pattern of hormones that vary through the day — cortisol most importantly, which follows a pronounced rhythm that a single morning blood draw reduces to one number. The panel covers sex hormones and their metabolites (estrogens, progesterone, testosterone, DHEA, and the downstream products they are converted into); estrogen metabolism pathways, meaning which route your body favors when clearing estrogen; cortisol and cortisone across the day, giving the free cortisol rhythm plus metabolites indicating overall production; and organic acid markers, including some relating to B vitamin status and neurotransmitter metabolism.
How it works here
Every plan follows one path. Each step feeds the next. See the All Treatments approach.
- 01
Measure
We baseline your labs, history, and goals.
- 02
Plan
A clinician decides whether this fits — and what else might serve you.
- 03
Act
If appropriate, you start with clear guidance and high-touch support.
- 04
Track
We monitor how you respond on a defined cadence.
- 05
Adjust
Protocols are refined over time. Guided care, not a kit in the mail.
How it compares to the alternatives
| DUTCH® Test | Comprehensive Blood Panel | Saliva Hormone Test | |
|---|---|---|---|
| Sample type | Dried urine, multiple collections across a day | Single blood draw | Saliva, multiple collections |
| Shows hormone levels | Yes | Yes — the clinical standard | Free fraction only |
| Shows hormone metabolites | Yes — its main advantage | No | No |
| Shows daily cortisol rhythm | Yes | No — single time point | Yes |
| Accepted for treatment decisions in conventional practice | Contested | Yes — the standard | Contested |
| Useful for diagnosing a hormone deficiency | Not the right tool | Yes | Limited |
| Useful for understanding metabolism and rhythm | Yes | No | Partly |
| Collected at home | Yes | Usually a draw site | Yes |
| Relative cost | Higher | Baseline | Middle |
Scroll the table sideways to compare →
The honest summary: this isn't a choice between the DUTCH test and blood work. Blood work is the foundation and diagnoses the deficiency; the DUTCH test is an optional second layer that answers a different question. Anyone offering the DUTCH test *instead of* standard labs is using it wrong.
When it's genuinely worth adding
The DUTCH test tends to earn its cost in a few specific situations.
Symptoms and standard labs disagree. Your blood work looks unremarkable but you feel distinctly unwell. Metabolism and rhythm are one plausible place the explanation could hide.
Fatigue with a suspected cortisol rhythm problem. A single morning cortisol can look normal while the pattern across the day is not. This is probably the strongest use case.
You're already on hormone therapy and something isn't adding up. Metabolite data can add context about how you're processing what you're taking.
Perimenopause with a confusing picture. Fluctuating hormones are hard to capture in one draw, and the fuller map sometimes helps. See menopause and perimenopause care.
Situations where we'd generally say don't bother: you haven't had standard lab work yet, you're feeling well and simply curious, or your question is straightforwardly “is my testosterone low” — which serum answers better and less expensively.
What it can't tell you
Worth stating plainly, because the marketing around this category tends to imply otherwise. It cannot diagnose a hormone deficiency in place of serum testing. It cannot detect or rule out cancer, including hormone-sensitive cancers. It cannot tell you what dose of anything you need. It cannot substitute for imaging, examination or guideline-recommended screening. And it cannot definitively predict your risk from a metabolite ratio, whatever the report's color coding suggests.
Delivery
An at-home dried-urine collection kit; results are reviewed with your clinician. Collection involves saturating filter paper at set points across a day, drying the samples and mailing them to the lab. It's straightforward, but timing matters for the rhythm data, and the instructions are worth following exactly — a mistimed collection produces a pattern that looks like a finding.
Is it right for you?
The DUTCH® test fits adults already engaged in hormone or perimenopause care who have a specific unanswered question, and who understand it's an additional layer rather than a foundation. If you're starting out, begin with a comprehensive blood panel — that's what establishes your baseline and drives the actual treatment decisions. If gut symptoms are part of the picture, gut biome analysis may be the more productive next test. And if you're unsure, that's a reasonable thing to decide with a clinician rather than by ordering more panels.
Often considered alongside
Comprehensive Lab Panel
A comprehensive blood panel establishing your baseline across key health markers.
View treatmentGut Biome Analysis
Lab-developed testA microbiome analysis profiling your gut bacteria to inform your plan.
View treatmentProducts marked Compounded are prepared by a licensed compounding pharmacy under a prescription written for you. Compounded medications are not FDA-approved and are not equivalent to or interchangeable with any branded product.
An honest word on the evidence
Here is where we differ from most pages selling this panel. The DUTCH test is widely used in functional and integrative medicine, and practitioners who use it regularly find the metabolite and rhythm data genuinely informative. That experience is real. It is also true that mainstream endocrinology does not consider dried-urine metabolite testing validated for guiding hormone treatment decisions. Serum testing remains the reference standard, and the clinical significance of many metabolite patterns — including the estrogen pathway ratios the test is best known for — is still debated rather than settled. Reference ranges for this kind of testing are less firmly established than for standard blood work. Our position: the DUTCH test is a useful additional input for a specific set of questions. It should not diagnose anything on its own, it should not be the basis for starting or stopping hormone therapy by itself, and it isn't necessary for most people. Where it earns its place, it's because a specific question came up that blood work couldn't answer — not because more data is automatically better. If a practitioner presents DUTCH results as definitive, or builds an entire treatment plan on metabolite ratios alone, that's a reason for caution rather than confidence.
Frequently asked questions
At home, via dried-urine samples collected at set points across a day, then mailed to the lab for analysis. Timing matters for the cortisol rhythm data, so following the instructions precisely affects whether the result means anything.
Neither is better — they answer different questions. Blood testing is the standard for measuring hormone levels and diagnosing deficiency. The DUTCH test adds metabolite and daily-rhythm information that blood can't show. It complements standard labs rather than replacing them.
It depends entirely on the question you're trying to answer. If standard labs and your symptoms disagree, or a cortisol rhythm problem is suspected, it can add real insight. If you haven't had standard blood work yet, or you're simply curious, it usually isn't the right next step.
The laboratory methodology is well regarded. The debated part is interpretation — how much clinical meaning to assign to particular metabolite patterns. Mainstream endocrinology does not consider dried-urine metabolite testing validated for guiding treatment decisions, which is why we treat it as an additional input rather than a decision-maker.
Generally no. Specialty panels of this kind are typically out of pocket. Your indicative price is confirmed at eligibility.
“Adrenal fatigue” isn't a recognized medical diagnosis. The DUTCH test can show that your cortisol rhythm differs from the expected pattern, which is a real and sometimes useful finding — but a pattern is not a diagnosis, and interpreting it requires the wider clinical picture.
That's a clinical decision, and it depends on what question you're trying to answer. Sometimes testing while on therapy is exactly the point. Discuss it before collecting rather than after.
A clinician reviews them with you in the context of your symptoms, history and standard labs. Results are interpreted alongside everything else — not read in isolation, and not used on their own to start or stop treatment.
See if DUTCH® Test fits your plan
The right plan begins with knowing where you are. Start with a short eligibility check and a baseline — and we'll tell you, honestly, what fits.
We measure first. Then we act.
ACT 2 Health provides clinician-led care. Treatments described are available only to eligible patients following clinical evaluation and within applicable regulations. This page is educational and is not medical advice. Individual results vary.