10 Reasons To Do a DUTCH Test

When a woman comes to see me with concerns about her weight, energy, libido, past history with breast cancer or even better, she proactively wants to optimize overall health, I almost always reccomend we start with the DUTCH hormone test.

Lab tests won’t “cure” you and in fact, sometimes even the best lab tests simply point to the need for further investigative testing, but the DUTCH is a great test for all women to do because of the richness of the data it provides when you seek to uncover the hidden causes behind health concerns instead of just covering up symptoms with drugs and supplements. (As an aside, I am not against supplements, but very often they can be used as a form of “green allopathy” where you simply treat the problem with a pill, albeit a holistic pill).

Why test hormones anyway though?

Hormones are chemical compounds present so sparsely in the blood that their concentration is usually measured on the level of a few parts per trillion. Yet they are tremendously powerful in coordinating the actions of our organs and glands – and affecting our quality of life! Steroid hormone imbalance can affect EVERY OTHER BODY SYSTEM and your specific lifestyle choices play a huge role in this outcome.

While it is possible to test hormones in blood or saliva and derive some useful data, these methods have drawbacks that limit their usefulness.

DUTCH is an acronym and it stands for “dried urine total complete hormones” from Precision Analytical lab in Oregon. Its an easy to do test that helps inform a plan of action. This test has you collecting 4 separate urine samples (using filter paper) over the course of 14 hours, to give you far more actionable data than using a salivary hormone panel.


Reason 1: It gives you a comprehensive look at cortisol production by your adrenal glands. Saliva adrenal testing only measures the free fraction of cortisol, which is around 1% of your production. The DUTCH test will measure both free and total (also called metabolized) cortisol for a better look at overall production. Metabolized cortisol comprises 80% of your total production and is a more accurate way of determining adrenal gland health. For more information on this, see my blog post “You Don’t Have Adrenal Fatigue”.

Why is this important? This is crucial for determining whether or not you have low cortisol. Far too many women have been told they’ve got low cortisol, or “adrenal fatigue” based on a saliva panel. 85% of these women have high metabolized cortisol (as seen on the DUTCH test) which means that although their free cortisol was low,overall production is just fine. Even worse, some of these women, (who were found to have low cortisol production via a saliva panel) were given hydrocortisone supplements. If they have high total cortisol and are given cortisol increasing medication or supplements, they will likely feel much worse.

Reason 2: The DUTCH test is easier to do than a saliva panel. I dont know about you, but working up a tube full of spit can be a challenge. With the DUTCH test, you just urinate on filter paper and put it aside to dry. Easy peasy!

Reason 3: It is only slightly more expensive than a saliva test. A leading lab charges $219 for their salivary adrenal and sex hormone panel. Although the DUTCH lab lists the price as $399 to consumers, when you work with a trained practitioner as myself, you can get the test for $250. For just $31 more, you get much more data that you can work with.

Reason 4: The DUTCH test can point a finger towards a concurrent thyroid problem. The DUTCH test is not a thyroid test but if you are hypothyroid, your adrenal values will likely show up as high free cortisol and low total cortisol.

Why is that?
Cortisol and thyroid hormone really interface with eachother. In hypothyroidism, the body experiences sluggish clearance of cortisol because the liver is not doing a good job at getting rid of it. So if you were to look at the free value (which is the only value you’d get if you’re doing an adrenal saliva profile) then you might think “this person is making too much cortisol” but its not because you’re making too much, its because it’s clearing the hypothyroid person’s system very slowly.

Reason 5: The DUTCH test gives you a total picture of DHEA production. The DUTCH test will show you your overall DHEA production (by combining the 3 most abundant metabolites of DHEA which are DHEA-S, etiocholanolone and androsterone). The sum total of these 3 metabolites gives you a good estimation of your overall production of DHEA, which is a vitality hormone that counterbalances the effects of too much cortisol. The difference between DHEA and DHEAS is that DHEA has an extra sulfate molecule attached to it and 90% of the DHEA in the body exists as DHEA-S. However, this sulfation of DHEA into DHEA-S is inhibited by iflammation. Therefore, If you have high total DHEA production but low DHEA-S, it could be due to inflammation.

Reason 6: It tells you how you are processing your estrogen. Estrogen should be a “use it and lose it” hormone. In order for us to be healthy, the body has to get rid of spent estrogen. It does this primarily through the liver which sends it to the colon for removal. There are two phases of estrogen metabolism. The first is the 2, 4 or 16 hydroxy estrone pathway. 70% of your estrogen should break down to 2-OH because this is the more protective estrogen metabolite.

Here’s a peek at one of my clients results, Carmen, who lives a very healthy lifestyle with lots of cruciferous vegetables and pasture raised meat. She also practices stress reduction and gets adequate sleep. Her 2-OH of over 70% (hers was 78.6%, which is awesome) is highly correlated with her healthy lifestyle. Its pretty awesome when you put so much effort into your health to see your labs reflect that effort. I know Carmen was happy to find out these results and it ifluences her to stay motivated with her healthy habits for the long run.


Reason 7: Don’t forget about 4-OH and 16-OH. Those are the more proliferative (and potentially cancer causing metabolites) of estrogen. We still need some, (they can never be zero), because the 4-OH metabolite helps maintain bone health….but they should not be too much over 10% and 20% respectively.

Reason 8: The DUTCH test tells you how well you are methylating your estrogen. Methylation of estrogen is the second step in the estrogen detoxification process. It is a protective step in which you turn your 2-Hydroxy estrone into a 2-Methoxy estrone. This takes place in the liver, so this test is a somewhat indirect measurement of liver health as well. I will be honest, many people fall a little short in this area….it seems that our methylation is collectively lacking. This seems to relfect the toxic times that we live in and all that our livers have to deal with these days. I do find a few people who are methylating their estrogen well, but in the 100 or so tests that Ive done, more than 60% of people show up as low methylators.

Here is an example of low methylation. The 2-Methoxy-E1 should be up around a 7 or 8, but its only a 4.3.

Low methylation


Reason 9: The DUTCH test tells you what type of testosterone metabolites your body favors. Testosterone can break down into 5a-DHT or 5b-DHT. 5a-DHT is more “androgenic” or potent metabolite of testosterone and is responsible for things like acne, thinning head hair, excess body hair and is correlated in PCOS. If you have these issues and have what is called high 5a reductase activity, there are specific things that can be done to reduce this metabolite of testosterone, but you need to test in urine, such as the DUTCH test, and not in saliva.

Reason 10: The DUTCH test can tell you if you are estrogen dominant. Estrogen dominance is one of the most damaging hormone imbalances that modern women face today.It means that you dont have enough progesterone to balance out your estrogen. Symptoms of estrogen dominance include PMS, migraines, heavy periods, moodiness. Estrogen dominance can sound a little misleading because it sounds as though you have too much estrogen. This is usually the case, but not always. You can actually be low estrogen and estrogen dominant and all that really means is that you have low estrogen and even lower progesterone. The DUTCH test can tell you both….what your total estrogen is and what your estrogen level relative to progesterone is. Both of these values are important in recovering from hormone imbalance.

Here is an example of estrogen dominance:

estrogen dominance

Science has advanced. Saliva testing has been replaced with dried urine testing. A hormone test such as the DUTCH test can help get you on the path to better health. I use this test exclusively in my Balance Your Hormones, Love Your Life online group program and with my 1:1 work with women all over the world.

If you have any questions about the test, please leave a comment below and I would be happy to answer them!

UPDATE: As of Jan 2018, the DUTCH complete test now includes markers for vitamin B6 and B12.


Let me help you get your weight and health to where it should be. This three-part video series is a great point to start!

36 Responses to 10 Reasons To Do a DUTCH Test

  1. Hi Maria, I am interested in this test. I have had a lumpectomy in the past, although everything was negative. My main issue is weight. I think I eat a pretty healthy diet, I exercise every day, but the weight keeps going up and up. I am so frustrated with this weight issue. Do you think this will help me get answers? Thank you.

    • Hi Patty: Absolutely. The test tells you what your body is doing with your estrogen. Not just the absolute level of estrogen.

  2. So the question remains, if you find out you have high total cortisol but low free cortisol, why? What causes increased cortisol turnover?

    • Hi Josh: First we have to ask why the total (metabolized) cortisol is high, meaning, why is the brain signaling the adrenals to make so much cortisol? Reasons for this can be stress, inflammation, infections, pain, obesity and insulin/glucose issues.
      But when metabolized cortisol is high and free is low, it could be a situation where the body may be choosing to lower cortisol availability to tissues by clearing it very quickly as a protective mechanism. Since the body is producing high amounts of cortisol in response to some stressor, it does its best to limit the damage from having high free cortisol by decreasing the hormones availability. High total, low free could indicate obesity, insulin resistance or hyper thyroidism or too much thyroid medication. The top reasons however are obesity and/or insulin resistance.

  3. Hello, I have been scouring the internet trying to find information regarding my cortisol results from the DUTCH test. My results show that my cortisol is low but the cortisone metabolites are high. This is confusing to me…the test results state that this could mean I actually have high overall cortisol it’s just being cleared quickly. My naturopath suggested I take an adrenal glandular supplement for a month; but I’m wondering if I really should be adding more cortisol. Do you have any thoughts on the subject?

    Also a bit of history I am hypothyroid; and am currently on 2 grains of naturethroid. All lab tests seem to indicate no problems with T3 conversion. Thanks for any help you can give me!

    • Jackie, are you referring to metabolized cortisol being high or that you favor inactive cortisone over active cortisol? They are two different things. Since I am unsure what you are referring to, I am unable to offer specific advice but I will tell you that the adrenal picture of hypothyroidism on this test is high FREE cortisol and low metabolized cortisol. Are you able to ask your naturopath for a more detailed understanding of your results? If not, I do 2nd opinions all the time for those who already have done a DUTCH test.

  4. Hi Maria. I would like to take the Dutch Test ASAP. Last year I took another hormone test that showed I was high in cortisol, progesterone, estradiol & low in testosterone. I also have a gene mutation: MTHFR ++.
    I have a insomnia issue, waking up every night in the early hours for 2-3 hrs.
    Other wise I’m in excellent health: diet. Excersice. Meditation. Mineable screen time(Emfs & blue light))
    Active. No stress…except for this imbalance. I need help, are you interested? If not, who can you recommend?
    Thank you. Alby

  5. Hi Maria, I have done a full hormone test at the clinic a few months back. My results came back normal however since up till date I haven’t found any cure nor the reason for my PMS I have recently visited an alternative medicine clinic. The doctor has advised me to do the DUTCH test as it is apparently much more thorough than the normal hormone tests. My questions is, would you recommend the DUTCH test to detemine the reasons for severe PMS? Thank you in advance.

    • Hi Tahera:
      I absolutely would recommend a DUTCH test for your PMS, and yes, it is fast becoming the gold standard of hormone testing and is much more thorough than any other hormone test out there. Find out how many tests your clinician has done as it is a high complexity lab. I’m sorry you are suffering from PMS, that used to be my issue too, so I can totally identify!

  6. Hi there! Thank you so much for all of this information. It is so helpful! I have recently had the DUTCH test done and have been scouring the Internet for how I can determine if I have estrogen dominance. Your post came up but I am not sure what you did to confirm that you were. I am extremely low in all of my hormones because my cortisol is so high. How did you know you were estrogen dominant? At this point I am just confident because of symptoms.

    My total estrogen is: 22.2
    Progesterone: 8.6
    E2: 1.1

    Thank you so much! 🙂

    • Hi Shelby–I know how to read the test, that is how I can confirm whether someone is estrogen dominant or not. Do you have a practitioner who can explain it to you or did you order it on your own? If your looking to have a thorough and full understanding of your results, I’d be happy to do an hour session with you. I’ve done well over 100 DUTCH tests on my clients!

    • A physician is not needed. I can order the DUTCH test and in most states in the USA, people can order directly from the lab’s website.

  7. Hi Maria 🙂
    I’m interested to know what you do with the test results. I work with holistic acne treatment, and my generalized program teaches people to clean up their diets/sleep/stress/movement etc as the baseline to improving the function of the whole body, and in turn the function of the hormones, and in turn reduce or eliminate acne.

    I completely understand what you’re saying about often times tests like this are just used for green allopathy (ie. oh progesterone is low? Let’s give you some natural progesterone). I’m totally guilty of doing this.

    It’s just that I find it difficult when I’ve already prescribed all the baseline lifestyle changes and — you know, the customer may or may not be doing them, I don’t know, as it’s an inexpensive group program — but then they want to know what the next step is, especially if they’ve been doing the baseline for a while. What supplements should they use, they want to know?

    I’ve tended to encourage them then to take a saliva hormone test, but then the results .. well… what do you do with them except give them a pill for their ill?? The test still doesn’t tell me WHY the hormones are out of balance, just that they are. I find this really frustrating because I know green allopathy isn’t really getting at the root, and I’m perpetuating the myth that there is a silver bullet out there. And if they’re already doing the lifestyle changes and I don’t have further tests to go on, what have I really learned to help them?

    So I’m really interested in what you do with the results of this one test 🙂 Since I’m in the acne niche, I’m curious, for example, what measures would you take if it showed that they were converting more towards 5a-DHT (that wouldn’t be considered just green allopathy).

    Thanks so much Maria! 🙂

    • Hi Tracy: it’s great to hear that you are coaching women w acne issues! As you may know, Im so not a fan of saliva testing because it leaves out a big piece of information. As far as results, it depends on a woman’s (or man’s) mix of hormone issues as shown by the DUTCH test. No test tells us the WHY of hormone imbalance; that is often a lifestyle issue, although there are other considerations. Sadly, I believe that just being alive in the 21st century will predispose far too many of us to hormone imbalances.

  8. Hi Maria,

    How does the DUTCH test compare to a 28 day hormone panel. Is it not better to see what’s happen over the whole period of your cycle?


    • Hi Jacqui:

      I think you are referring more to a cycle mapping test but I am not certain what you mean by a 28 day test. As far as I know, there are no tests that take a sample for every single day in the 28 day cycle. The DUTCH cycle mapping requires 11 samples over a 28 day cycle, I believe.

      But regarding these ‘mapping’ type tests, they are quite expensive and not everyone needs to get one. It depends on what your suspected hormone issues are. If fertility is an issue, then yes, I would say a cycle mapping type of test is good.

      But most people can do a DUTCH complete and get more than adequate information. Lab testing can really add up, and I always try to choose the best tests and have my clients spend their money wisely. Hope this helps!

  9. Hi Maria,
    Can I send you my results as a second opinion?
    I my cortisol seems to be almost flat lining I have a very high off the chart DHEA result high is 3000 but my result is 3700 range.
    Also a very high androsterone reading-

  10. I am 36 years old and just had a total hysterectomy with excision for endometriosis by a Nook doctor. In no longer have ovaries and will be thrown into surgical menopause. Is there anything this test can help me with? I need some sort of hormone replacement but would like to avoid synthetic route.

    • Hi Kelly
      Sure, this test can give you your post surgical baseline and it also looks at your adrenal health, which is so important to sex hormone balance and overall health.

  11. Hi how many times do you need to repeat this test ? Is there a more affordable retest? Can you domthiswith Lyme & coinfections please &. Thank u,, any help for us with limited or no incomes, or only if you can pay it all,,,,,

    • Hi Debbie

      How many times you need to repeat it depends on your progress. Yes, you can do this test with Lyme and co-infections.

  12. Hi Maria

    Can you do this from the UK? I’m 51 and still having periods. Thing is they are not regular. This year i had one after 6 weeks then one 2 weeks later. Isn’t DUTCH cycle day specific? I have M.E/ CFS after prolonged exposure to emotional stress. Chronically fatigued. Headaches. Brain fog. Nausea. Problems with light and sound etc. I’m a clean eater no alcohol, caffeine, refined sugar. Can no longer exercise or work. Struggling to carry out every day activities. Thank you.

  13. Hi Maria,

    Are you allowed to drink any alcohol at all during this testing process?
    I am about to embark on the Dutch cycle mapping and Dutch complete. (Over the month)
    Don’t want to muck up the result a bit am getting mixed answers.
    I really appreciate all the information above!
    Kind regards

  14. Hi Maria I’m in the uk, want to take this test, have you interpret the results and give me actual protocols to follow to balance..cfs/pms/PCOS here…🙄thanks kate x

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