DUTCH Test Explained: Hormones, Cortisol & What to Do

Most guides to the DUTCH test give you a glossary of hormone names and leave you to figure out the rest. This article does something different: it maps every major DUTCH test marker — from your cortisol awakening response to oestrogen metabolites — to the specific nutritional or lifestyle lever most likely to move it. The result is a practical action plan, not a biology textbook.

The DUTCH test (Dried Urine Test for Comprehensive Hormones) has become one of the most popular functional hormone panels in 2026, and for good reason. It tracks cortisol, sex hormones, melatonin, and their metabolites across a full day — giving you a far richer picture than a single morning blood draw. Below, I'll explain what each section of your results actually means, where the science is strong, and where honest uncertainty remains.

What Is the DUTCH Test and How Does It Work?

The DUTCH test is a dried urine panel that collects four to five samples over 24 hours to measure how your body produces, uses, and clears hormones. Unlike a blood test — which gives a single snapshot — the DUTCH test captures your cortisol curve, sex hormone metabolites, and organic acid markers that reflect nutrient status.

You collect samples on filter-paper strips at specific times: waking, two hours after waking, afternoon, evening, and (optionally) overnight. The strips dry at room temperature and are posted to the laboratory. Results typically arrive in 10–15 business days.

The test was developed by Precision Analytical in the United States and is now ordered by functional medicine practitioners worldwide, including across the UK and Europe.

What Does a DUTCH Test Measure?

The DUTCH Complete panel — the most commonly ordered version — covers five categories of markers. Here's what each category tells you and why it matters.

1. Cortisol and Cortisol Metabolites

This is the section most people order the DUTCH test for. It measures free cortisol at each collection point, total cortisol metabolites (reflecting 24-hour production), and the cortisol awakening response (CAR) — the natural spike that should occur within 30 minutes of waking.

A flat CAR may indicate chronic stress or HPA-axis dysregulation. Elevated total cortisol metabolites with normal free cortisol can suggest your body is producing too much cortisol but clearing it quickly — a pattern blood tests miss entirely.

A 2021 review in Psychoneuroendocrinology confirmed that the cortisol awakening response is a reliable biomarker of HPA-axis function when measured via dried urine samples, consistent with salivary cortisol data [1].

2. Sex Hormones: Oestrogen, Progesterone, Testosterone

The DUTCH test measures not just total levels of oestradiol, progesterone, and testosterone, but their metabolites — the downstream products your body creates when processing these hormones.

For oestrogen, the three key metabolites are 2-OH, 4-OH, and 16-OH oestrone. A higher ratio of 2-OH to 16-OH is generally considered more favourable, though the clinical significance of these ratios remains an active area of research [2].

3. DHEA and Androgen Metabolites

DHEA-S is your body's most abundant steroid hormone and a precursor to both testosterone and oestrogen. Low DHEA-S on a DUTCH test often appears alongside high cortisol — a pattern sometimes called "cortisol steal," where chronic stress shifts hormone production away from DHEA.

4. Melatonin (6-OH Melatonin Sulphate)

The DUTCH test measures melatonin's primary metabolite from the overnight urine sample. Low levels may indicate poor sleep quality, excess blue-light exposure, or insufficient melatonin production — all of which can compound cortisol dysfunction.

5. Organic Acids: B12, B6, Glutathione, and Dopamine Markers

This is where the DUTCH test goes beyond a standard hormone panel. Organic acid markers like methylmalonate (B12 status), xanthurenate (B6 status), and pyroglutamate (glutathione demand) give indirect insight into nutrient cofactors your body needs to metabolise hormones properly.

Low B vitamin status, for instance, can impair methylation — a biochemical process critical for clearing used oestrogen from the body.

How to Read Your DUTCH Test Results: Marker by Marker

The most useful way to read your DUTCH test results is not marker by marker in isolation, but by looking for patterns across categories. Here are the three most common patterns practitioners identify — and what each one suggests.

Pattern 1: High Free Cortisol + Low DHEA-S

This combination suggests chronic stress is dominant and your adrenal output has shifted towards cortisol at the expense of DHEA. You may feel wired but exhausted, sleep poorly, and struggle with afternoon brain fog.

Action levers: Stress-management practices (breathwork, sleep hygiene), adaptogenic herbs like ashwagandha which may help support healthy cortisol metabolism*, and B-vitamin optimisation.

Pattern 2: Low Free Cortisol + Low Cortisol Metabolites

Often mislabelled "adrenal fatigue" (a term not recognised by mainstream endocrinology), this pattern may reflect HPA-axis down-regulation after prolonged stress. Morning energy is typically very low, and the cortisol awakening response is flat.

Action levers: Prioritise sleep quality, morning sunlight within 30 minutes of waking, and consider nutrients that may help support adrenal function such as vitamin C and pantothenic acid (B5).*

Pattern 3: Elevated 4-OH Oestrone Metabolite

The 4-OH oestrogen pathway is considered less favourable because its metabolites can form reactive quinones. A 2006 paper in The Journal of the National Cancer Institute explored the potential implications of oestrogen metabolite ratios, though clinical cut-offs remain debated [2].

Action levers: Cruciferous vegetables (broccoli, cauliflower) contain indole-3-carbinol, which may help support favourable oestrogen metabolism.* Adequate methylation — dependent on folate, B12, and B6 — is also important for clearing oestrogen metabolites.

DUTCH Test vs. Blood Test: When to Use Each

The DUTCH test and blood tests are complementary, not competing. Each excels at different things. Here's a direct comparison:

For a comprehensive picture, many functional medicine practitioners recommend running a blood panel for thyroid, fasting insulin, and iron alongside a DUTCH test for cortisol and sex hormones. The NHS blood test guide covers what standard panels include.

What to Do After You Get Your DUTCH Test Results

A DUTCH test is only as useful as the actions you take afterwards. Here is a practical checklist based on the most common findings:

• Flat cortisol awakening response → Get 10+ minutes of outdoor light within 30 minutes of waking. This is one of the strongest evidence-based interventions for resetting your circadian cortisol rhythm [3].
• Elevated evening cortisol → Implement a screen-free wind-down routine 90 minutes before bed. L-theanine (200 mg) may help promote relaxation and support the transition to sleep.*
• Low B6 or B12 organic acid markers → Optimise dietary intake or consider a B-vitamin complex. Noobru Advantage includes a full B-vitamin complex alongside cognitive-support ingredients.*
• High cortisol metabolites with low DHEA → Address chronic stress as a root cause. Ashwagandha (KSM-66, 600 mg daily) may help support healthy cortisol levels over 4–8 weeks, according to a 2019 RCT [4].*
• Unfavourable oestrogen metabolite ratios → Increase cruciferous vegetable intake and ensure adequate methylation cofactors (folate, B12, B6).

Important: Always review your DUTCH test results with a qualified practitioner. The markers are complex, and self-interpretation without clinical context can lead to unnecessary interventions.

Summary: Key Takeaways from Your DUTCH Test

• The DUTCH test is a 24-hour dried urine panel that measures cortisol patterns, sex hormones and their metabolites, melatonin, and organic acid nutrient markers — far more detail than a single blood draw provides.
• Cortisol patterns matter more than single readings. A flat cortisol awakening response or elevated evening cortisol points to HPA-axis dysregulation, not a simple "high" or "low" cortisol problem.
• Hormone metabolites reveal processing issues that total hormone levels miss — particularly for oestrogen clearance and methylation capacity.
• Organic acid markers link hormones to nutrients. Low B6, B12, or glutathione markers on a DUTCH test can explain why your hormones aren't metabolising optimally.
• Action beats information. Every DUTCH test pattern maps to specific, evidence-based lifestyle and nutritional interventions — from morning light exposure to B-vitamin optimisation.
• The DUTCH test complements, not replaces, blood work. Use it alongside standard blood panels for thyroid, iron, and metabolic markers.

Frequently Asked Questions About the DUTCH Test

What is a DUTCH test and what does it stand for?

DUTCH stands for Dried Urine Test for Comprehensive Hormones. It collects four to five dried urine samples over 24 hours to measure cortisol patterns, sex hormones, melatonin, and key hormone metabolites — providing a more detailed picture than a standard blood test.

How much does a DUTCH test cost in the UK?

A DUTCH Complete test typically costs between £250 and £400 in the UK, depending on the practitioner. Some clinics bundle the cost with a consultation; others charge separately for interpretation.

Is the DUTCH test better than a blood test for hormones?

It depends on what you're testing. The DUTCH test excels at mapping cortisol curves and hormone metabolite pathways across a full day. Blood tests remain the gold standard for thyroid hormones, fasting glucose, and iron. Ideally, use both.

How long does it take to get DUTCH test results?

Results typically arrive within 10 to 15 business days after the laboratory receives your samples. Your practitioner will then schedule a follow-up to walk through findings and recommendations.

Can supplements help support cortisol levels shown on a DUTCH test?

Certain nutrients — including B vitamins, magnesium, and adaptogenic herbs like ashwagandha — may help support healthy cortisol metabolism when combined with sleep and stress-management practices.* Always discuss supplement use with the practitioner reviewing your results.

References

1. Stalder T, et al. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414–432. PubMed
2. Muti P, et al. Estrogen metabolism and risk of breast cancer: a prospective study. J Natl Cancer Inst. 2000;92(7):563–569. PubMed
3. Blume C, et al. Effects of light on human circadian rhythms, sleep and mood. Somnologie. 2019;23(3):147–156. PubMed
4. Lopresti AL, et al. An investigation into the stress-relieving and pharmacological actions of an ashwagandha extract. Medicine. 2019;98(37):e17186. PubMed

*These statements have not been evaluated by the Food and Drug Administration or MHRA. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting any supplement regimen.