The DUTCH Hormone Test: The New Frontier in Hormonal Testing

Simple and effective, the DUTCH hormone test can help improve the balance and function of hormones in your body.

The Dried Urine Test for Comprehensive Hormones (DUTCH) test is a urine-based test that provides a comprehensive assessment of key hormones and metabolites1, informing clinicians about:

  • 24-hour cortisol production;
  • diurnal free cortisol;
  • free cortisone rhythms;
  • cortisol metabolites (indicating rate of cortisol metabolism);
  • Dehydroepiandrosterone;
  • Melatonin
  • Six organic acids, and
  • Sex hormones include Estradiol, Estrone, Estriol, Progesterone, Testosterone, DHEA estrogens, estrogen metabolites, progesterone metabolites, and androgens.

    The DUTCH hormone test requires collecting a small amount of urine on filtered paper four times a day. This allows for the detection of changes in hormone levels throughout the day. An advantage of the DUTCH hormone test is how easily the sample is collected by urinating directly on a filter paper (no blood draw, no spitting into tubes, nor 24-hour urine collection).

Who created the DUTCH hormone test?

Precision Analytical developed the DUTCH hormone test, a laboratory certified by the Clinical Laboratory Improvement Amendments or CLIA. This regulatory standard applies to all clinical laboratory testing performed on humans in the United States, except for clinical trials and basic research.

Precision Analytical, founded by Mark Newman in 2012, is run by a team of healthcare practitioners with extensive experience in performing laboratory tests and developing novel testing methods.

Why use a DUTCH hormone test?

The DUTCH hormone test can help identify the hormonal deficiencies or malfunctions, which can be the leading cause behind various chronic health issues. Alterations to the optimal levels of circulating hormones like cortisol or sex hormones and hormone metabolites2.

In Australia, hormone testing is commonly done by a blood test, and sometimes through saliva or urine test. But none of these tests measures variations cortisol levels, estrogen metabolism or changes in the function of other hormones.

Why measure hormone metabolites?

When hormones are metabolised, they leave behind small molecules called metabolites. From a testing perspective, measuring hormone metabolites provides an additional layer of information that informs about previous hormonal levels3. For any hormone, like cortisol, measuring both circulating cortisol levels and the number of cortisol metabolites provides a complete picture of a patient’s cortisol status.

Data obtained from the DUTCH hormone test can inform our clinicians about the underlying conditions causing your symptoms and help design personalised treatments that target the problems behind the symptoms you are experiencing4-6.

DUTCH hormone test and the HPA axis

Our body has a complex system to deal with real or perceived stress, involving multiple organs, hormones and cells. The ultimate goal of this system is to maintain homeostasis within the body and preserve life. This is accomplished through a complex autoregulatory process involving neural and hormonal systems closely associated with central and peripheral biological clocks.


The hypothalamic-pituitary-adrenal (HPA) axis is a part of the endocrine system and a key regulatory pathway in maintaining homeostatic processes, influencing immune function and our response to chronic stress7-8. The HPA axis consists of the hypothalamus, the pituitary gland, and the adrenal glands. These three organs interact and form a communication pathway used by the body to respond to stressful stimuli. When actual or perceived stress occurs, the HPA axis is activated, and the ultimate product of this system is cortisol. Cortisol is responsible for increasing blood glucose levels, enhancing the brain’s use of glucose, promoting more efficient tissue repair and reducing inflammation9-10.


Altered cortisol levels can lead to multiple health problems, such as weight gain, acne, chronic tiredness, nausea, and many others. Balanced cortisol levels are important to maintain optimal blood sugar levels, metabolism, sleep, energy and inflammation levels11-12.

For more information on the role of cortisol, see our recent article.

DUTCH hormone test and HPA Axis Dysregulation

Malfunction of the HPA axis can lead to abnormal production of essential hormones that regulate multiple functions in the body. Some conditions associated with HPA dysfunction include metabolic and cardiovascular disease, hypertension, obesity, osteoporosis, altered gastrointestinal and immune function, sleep disturbances, and affective disorders13-14.

The DUTCH Complete Hormone Profile is the most thorough and preferred option for testing hypothalamic-pituitary-adrenal (HPA) axis function.

DUTCH hormone test and Hormonal imbalance

Symptoms of hormonal imbalance can be mild or can progress to more complicated and potentially dangerous conditions15-18.

Symptoms of hormonal imbalance in women include:

  • Fatigue
  • Depression
  • Mood swings
  • Weight gain
  • Thinning hair
  • Vaginal dryness
  • Low libido
  • Menstrual cycle changes

Symptoms of hormonal imbalance in men include:

  • Lack of energy
  • Mood swings
  • Weight changes
  • Loss of muscle mass
  • Hair loss
  • Low libido
  • Erectile dysfunction

DUTCH hormone test and abnormal melatonin levels

Melatonin is produced in the Pineal gland and many other sites, such as the gastrointestinal tract, parts of the central nervous system and various leukocytes. Melatonin plays a vital role in regulating our sleep/wake cycle, as well as regulating, and it is important to maintain optimal levels19-21.

Melatonin deficiency has been associated with altered sleep/wake cycles. For this reason, people having trouble sleeping sometimes seek melatonin supplements22. Melatonin deficiency is associated with:

  • Some forms of dementia;
  • Mood disorders;
  • Severe pain;
  • Some cancers and
  • Type 2 diabetes.
  • Alterations of the normal functioning of circadian rhythms

DUTCH hormone test and Fertility problems

Suppose you suffer from a condition like Premenstrual syndrome (PMS), fibroids, irregular periods, painful periods, anxiety, moodiness and endometriosis; the DUTCH hormone test may help. These conditions can be associated with imbalances in adrenal and reproductive hormones, which can be detected with the
DUTCH hormone test23-26.

DUTCH hormone test and DHEA levels

Dehydroepiandrosterone (DHEA) is a key precursor hormone used by our body to produce other hormones, like testosterone and estrogen. DHEA is associated with aging, depression, osteoporosis and vaginal atrophy27-30. The DUTCH hormone test can detect levels of DHEA and DHEA-S, an alternative form of the hormone, which can help reveal evidence of inflammation in the body.

DUTCH hormone test and Estrogen dominance

Estrogen dominance is a form of hormonal imbalance that can affect women. It involves abnormally high estrogen levels, possibly due to a malfunction in the production of progesterone31-32. Potential symptoms of this condition include:

  • Endometriosis;
  • PMS;
  • Painful periods;
  • Fibrous breasts;
  • Fibroids
  • Tender breasts;

The DUTCH hormone test can detect abnormal levels of estrogen and progesterone, helping your health care provider identify the cause of your symptoms.

DUTCH hormone test and Estrogen metabolism

Alterations in the normal metabolic pathways for estrogen can lead to health problems, including estrogen dominance and certain cancers such as breast, cervical and uterine cancers33-35. The DUTCH hormone test can detect levels of estrogen, as well as the estrogen methylation pathway. This information can potentially help clinicians identify instances of nutrient deficiencies or genetic mutations associated with your symptoms.

DUTCH hormone test and thyroid or insulin resistance

The DUTCH hormone test does not test for levels of thyroid hormones or insulin. Still, it can detect free cortisol levels, informing clinicians about the need to do further testing to understand thyroid function better. The DUTCH hormone test can also detect high levels of metabolised vs free cortisol, which can indicate insulin resistance36. At AUSCFM, we complement the DUTCH hormone test with a comprehensive blood panel test to assess insulin resistance, including a full thyroid panel or glucose and insulin markers.

DUTCH hormone test and pregnancy

Hormonal dysfunction may be associated with difficulties conceiving37-39. The DUTCH hormone test can detect all sex hormones for optimal reproductive function in women. The DUTCH hormone test can identify various hormonal imbalances that could be associated with your difficulties conceiving. Consult with our AUSCFM staff for further details on how the DUTCH hormone test can help you.

Modern and evidence-based Functional Medicine: complete a DUTCH test with us

At the Australian Centre for Functional Medicine, we follow an evidence-based approach to all treatments we develop. In addition, each patient is provided with a personalised assessment and treatment. Our evidence-based approach to diagnosis and treatment aims to identify the biological problems behind the symptoms experienced by the patient.

For patients suffering from certain symptoms, like chronic fatigue, brain fog, anxiety, body aches, nervousness, sleep disturbances and digestive problems, we may recommend the DUTCH test, as this provides a comprehensive overview of relevant hormones. This urine-based test accurately measures hormone levels, including sex and adrenal steroid hormones, hormone metabolites, diurnal free cortisol and melatonin.

With these results at hand, we will be able to gain a better understanding of the potential mechanisms driving your symptoms and design a personalised treatment plan.

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  1. Newman M, Curran DA. Reliability of a dried urine test for a comprehensive assessment of urine hormones and metabolites. BMC chemistry. 2021 Dec;15(1):1-3. Read it!
  2. Berczi I. Pituitary malfunction and immune abnormalities. InPituitary function and immunity 2019 Jun 4 (pp. 41-48). CRC Press. Read it!
  3. Aguiar-Oliveira MH, Bartke A. Growth hormone deficiency: health and longevity. Endocrine reviews. 2019 Apr;40(2):575-601. Read it!
  4. Fujii H. Association between parathyroid hormone and cardiovascular disease. Therapeutic Apheresis and Dialysis. 2018 Jun;22(3):236-41. Read it!
  5. Azizi F, Amouzegar A, Tohidi M, Hedayati M, Cheraghi L, Mehrabi Y. Systemic thyroid hormone status in treated graves’ disease. International journal of endocrinology and metabolism. 2019 Oct;17(4). Read it!
  6. Ouanes S, Popp J. High cortisol and the risk of dementia and Alzheimer’s disease: a review of the literature. Frontiers in aging neuroscience. 2019 Mar 1;11:43. Read it!
  7. Maniam J, Antoniadis C, Morris MJ. Early-life stress, HPA axis adaptation, and mechanisms contributing to later health outcomes. Frontiers in endocrinology. 2014 May 13;5:73. Read it!
  8. DeMorrow S. Role of the hypothalamic–pituitary–adrenal axis in health and disease. Read it!
  9. Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L. The cortisol awakening response: more than a measure of HPA axis function. Neuroscience & Biobehavioral Reviews. 2010 Sep 1;35(1):97-103. Read it!
  10. Faravelli C, Lo Sauro C, Lelli L, Pietrini F, Lazzeretti L, Godini L, Benni L, Fioravanti G, Alina Talamba G, Castellini G, Ricca V. The role of life events and HPA axis in anxiety disorders: a review. Current pharmaceutical design. 2012 Dec 1;18(35):5663. Read it!
  11. Iob E, Steptoe A. Cardiovascular disease and hair cortisol: a novel biomarker of chronic stress. Current cardiology reports. 2019 Oct;21(10):1-1. Read it!
  12. DeSantis AS, DiezRoux AV, Hajat A, Aiello AE, Golden SH, Jenny NS, Seeman TE, Shea S. Associations of salivary cortisol levels with inflammatory markers: the Multi-Ethnic Study of Atherosclerosis. Psychoneuroendocrinology. 2012 Jul 1;37(7):1009-18. Read it!
  13. Ceruso A, Martínez-Cengotitabengoa M, Peters-Corbett A, Diaz-Gutierrez MJ, Martínez-Cengotitabengoa M. Alterations of the HPA axis observed in patients with major depressive disorder and their relation to early life stress: a systematic review. Neuropsychobiology. 2020;79(6):417-27. Read it!
  14. van Dalfsen JH, Markus CR. The influence of sleep on human hypothalamic–pituitary–adrenal (HPA) axis reactivity: A systematic review. Sleep medicine reviews. 2018 Jun 1;39:187-94. Read it!
  15. Stanikova D, Zsido RG, Luck T, Pabst A, Enzenbach C, Bae YJ, Thiery J, Ceglarek U, Engel C, Wirkner K, Stanik J. Testosterone imbalance may link depression and increased body weight in premenopausal women. Translational psychiatry. 2019 Jun 7;9(1):1-2. Read it!
  16. Ahmed RG. Dysfunction of maternal thyroid hormones and psychiatric symptoms. American Research Journal of Endocrinology. 2018;2(1):1-6. Read it!
  17. Monteagudo PT, Falcão AA, Verreschi IT, Zanella MT. The imbalance of sex-hormones related to depressive symptoms in obese men. The Aging Male. 2016 Jan 2;19(1):20-6. Read it!
  18. Pereira Jr JC, Pradella-Hallinan M, Pessoa HD. Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis. Clinics. 2010;65:547-54. Read it!
  19. Almughrabi OM, Marzouk KM, Hasanato RM, Shafik SS. Melatonin levels in periodontal health and disease. Journal of periodontal research. 2013 Jun;48(3):315-21. Read it!
  20. de Almeida Chuffa LG, Lupi LA, Cucielo MS, Silveira HS, Reiter RJ, Seiva FR. Melatonin promotes uterine and placental health: potential molecular mechanisms. International journal of molecular sciences. 2020 Jan;21(1):300. Read it!
  21. Hsu CN, Huang LT, Tain YL. Perinatal use of melatonin for offspring health: Focus on cardiovascular and neurological diseases. International journal of molecular sciences. 2019 Jan;20(22):5681. Read it!
  22. Olcese J, Jockers R. Melatonin in Health and Disease. Frontiers in Endocrinology. 2020;11. Read it!
  23. Sonigo C, Beau I, Binart N, Grynberg M. Anti-Müllerian hormone in fertility preservation: Clinical and therapeutic applications. Clinical Medicine Insights: Reproductive Health. 2019 Jun;13:1179558119854755. Read it!
  24. Wesevich V, Kellen AN, Pal L. Recent advances in understanding primary ovarian insufficiency. F1000Research. 2020;9. Read it!
  25. Abbasihormozi S, Babapour V. Stress hormone and oxidative stress biomarkers link obesity and diabetes with reduced fertility potential. Cell Journal (Yakhteh). 2019;21(3):307. Read it!
  26. Lee JH, Choi YS. The role of gonadotropin-releasing hormone agonists in female fertility preservation. Clinical and Experimental Reproductive Medicine. 2021 Mar;48(1):11. Read it!
  27. Narkwichean A, Maalouf W, Baumgarten M, Polanski L, Raine-Fenning N, Campbell B, Jayaprakasan K. Efficacy of dehydroepiandrosterone (DHEA) to overcome the effect of ovarian ageing (DITTO): a proof of principle double blinded randomized placebo controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017 Nov 1;218:39-48. Read it!
  28. Sonnenblick Y, Taler M, Bachner YG, Strous RD. Exercise, Dehydroepiandrosterone (DHEA), and Mood Change: A Rationale for the” Runners High”?. The Israel Medical Association Journal: IMAJ. 2018 Jun 1;20(6):335-9. Read it!
  29. Hough CM, Lindqvist D, Epel ES, Denis MS, Reus VI, Bersani FS, Rosser R, Mahan L, Burke HM, Wolkowitz OM, Mellon SH. Higher serum DHEA concentrations before and after SSRI treatment are associated with remission of major depression. Psychoneuroendocrinology. 2017 Mar 1;77:122-30. Read it!
  30. van Dammen L, de Rooij SR, Behnsen PM, Huizink AC. Sex-specific associations between person and environment-related childhood adverse events and levels of cortisol and DHEA in adolescence. PloS one. 2020 Jun 4;15(6):e0233718. Read it!
  31. Tauseef K, Zaffar H, Usman A, Niaz A. Morphological Spectrum of Endometrial Lesions. International Journal of Pathology. 2018 Nov 21:145-8. Read it!
  32. Patel S, Homaei A, Raju AB, Meher BR. Estrogen: The necessary evil for human health, and ways to tame it. Biomedicine & Pharmacotherapy. 2018 Jun 1;102:403-11. Read it!
  33. Sampson JN, Falk RT, Schairer C, Moore SC, Fuhrman BJ, Dallal CM, Bauer DC, Dorgan JF, Shu XO, Zheng W, Brinton LA. Association of estrogen metabolism with breast cancer risk in different cohorts of postmenopausal women. Cancer research. 2017 Feb 15;77(4):918-25. Read it!
  34. Słowikowski BK, Lianeri M, Jagodziński PP. Exploring estrogenic activity in lung cancer. Molecular biology reports. 2017 Feb;44(1):35-50. Read it!
  35. Cornel KM, Bongers MY, Kruitwagen RP, Romano A. Local estrogen metabolism (intracrinology) in endometrial cancer: a systematic review. Molecular and cellular endocrinology. 2019 Jun 1;489:45-65. Read it!
  36. Petersen KF, Shulman GI. Etiology of insulin resistance. The American journal of medicine. 2006 May 1;119(5):S10-6. Read it!
  37. Sauer UG, Asiimwe A, Botham PA, Charlton A, Hallmark N, Jacobi S, Marty S, Melching-Kollmuss S, Palha JA, Strauss V, van Ravenzwaay B. Toward a science-based testing strategy to identify maternal thyroid hormone imbalance and neurodevelopmental effects in the progeny–part I: which parameters from human studies are most relevant for toxicological assessments?. Critical Reviews in Toxicology. 2020 Dec 10:1-24. Read it!
  38. Napso T, Yong HE, Lopez-Tello J, Sferruzzi-Perri AN. The role of placental hormones in mediating maternal adaptations to support pregnancy and lactation. Frontiers in physiology. 2018 Aug 17;9:1091. Read it!
  39. Noyola-Martínez N, Halhali A, Barrera D. Steroid hormones and pregnancy. Gynecological Endocrinology. 2019 May 4;35(5):376-84. Read it!