DUTCH test: a closer look at hormone breakdown and cortisol rhythm

How DUTCH Test (Dried Urine Hormone Panel) works

You urinate onto filter-paper strips at several set times across about a day, starting with the evening and including the moment you wake and the next morning. The strips dry, and you mail them to the lab. The lab measures sex hormones, their metabolites, and cortisol and cortisone at each time point, then reports patterns along with reference ranges.

Who it’s for, and who it isn’t

What’s included

• Clinician order and personalized collection instructions
• At-home kit with prepaid return to a CLIA-certified laboratory
• Clinician review of your report alongside your history and blood work
• Online visit to discuss results and next steps
• No membership fee

Possible side effects

• No physical side effects; collection is non-invasive
• Mistimed samples or missed collections can produce misleading results
• Borderline or unusual findings can cause worry or lead to unnecessary follow-up

This isn’t a complete list. Your clinician reviews risks, interactions and warnings with you before prescribing. In an emergency, call 911.

What the evidence says

Urinary hormone measurement is an established laboratory technique, and timed cortisol samples are used in medicine. However, interpreting estrogen metabolite ratios and many organic acid markers for routine care is debated, reference ranges are less established than for blood tests, and the test has not been reviewed by the FDA. The Menopause Society notes that optimal hormone levels for postmenopausal women have not been established.

What the DUTCH test measures

DUTCH stands for Dried Urine Test for Comprehensive Hormones. Instead of a single blood sample, you collect several urine samples on filter paper over roughly 24 hours. That allows the lab to look at patterns rather than one moment.

• Sex hormones: estrogens, progesterone metabolites, testosterone and DHEA
• Hormone metabolites: how estrogen and androgens are being broken down and cleared
• Cortisol and cortisone at several points in the day, including the rise after waking
• Some organic acid markers that relate to B vitamin status and neurotransmitter breakdown

When it can add something useful

A blood test tells you how much of a hormone is circulating at the moment of the draw. The DUTCH test adds information about how hormones are metabolized and how cortisol changes across a day. That can help in specific situations: symptoms that don't fit normal blood results, suspected disruption of the daily cortisol pattern, or questions about how a person on hormone therapy is processing it.

Your clinician decides whether those questions apply to you. If the answer would not change your care, the test is usually not worth the cost.

What it cannot tell you

It cannot diagnose menopause, low testosterone or adrenal disease. Conditions such as Cushing's syndrome or Addison disease are diagnosed with specific blood, urine or saliva protocols interpreted by a clinician. The Endocrine Society states that adrenal fatigue is not a recognized medical condition and that no test can detect it.

It also does not screen for cancer, replace mammograms or other screening, or set your hormone dose by itself. The Menopause Society advises that symptom response is the most reliable guide to hormone therapy doses, because hormone levels shift through the day and optimal levels have not been established.

DUTCH, saliva and blood compared

Blood tests are the standard for diagnosing hormone conditions and for safety monitoring, such as checking estradiol, testosterone, hematocrit or thyroid function. They are inexpensive, widely available and backed by established reference ranges.

Saliva hormone tests are often marketed alongside custom-compounded hormones. The Menopause Society says saliva testing is unnecessary and has not been proven accurate or reliable for this purpose. Dried urine sits between the two: it captures metabolites and several time points, but its role in everyday decisions is still being worked out. That is why your clinician treats it as a supplement to blood work, never a replacement.

How collection works

You receive a kit with labeled strips and a timing sheet. Typical collection points are late afternoon, bedtime, waking and two hours after waking, with a few extra waking samples for cortisol. Each strip dries before you package it for return.

Timing is everything. A sample taken an hour late or a missed waking sample can look like a real change in cortisol. Your instructions will also explain what to do about caffeine, alcohol, supplements and hormone doses on collection day; do not stop any prescribed treatment unless your clinician tells you to.

If you are on hormone therapy

The route you use matters. Vaginal estrogen, creams, patches and capsules are absorbed and processed differently, and urine metabolites may not mirror blood levels in a simple way. Your clinician will tell you when to collect relative to your dose.

Results are read as one piece of a larger picture that includes your symptoms, blood work and safety factors such as clot or breast cancer risk. A metabolite ratio alone is not a reason to start, stop or change therapy.

Regulatory status and price

The DUTCH test is a laboratory-developed test, designed and run within a single CLIA-certified lab. It has not been cleared or approved by the FDA. In September 2025 the FDA reverted its regulation after a court vacated the agency's 2024 rule that would have expanded oversight of these tests.

The price is $449, one-time, confirmed during your eligibility review. It is usually not covered by insurance. There is no membership fee.

Go deeper on DUTCH Test (Dried Urine Hormone Panel)