What Does DUTCH Test? 4 Groups of Hormones, Metabolites, & Other Biomarkers

One of the top questions we get asked is ‘’What does DUTCH (Dried Urine Test for Comprehensive Hormones) test’? See below for further information as to “what” and “why”!

Precision Analytical exists to make it easier for patients and their healthcare providers to find answers to complex clinical questions which affect their everyday lives. Our unique hormone testing and reporting methods create better tools for healthcare providers to explore hormone issues with their patients. We do this by testing four distinct groups of hormones, metabolites, and other biomarkers.


In their active form, hormones act as chemical messengers to control, facilitate, or trigger various processes in the body. As active hormones complete their work and new hormones are produced, active hormones need to be cleared from the body via the urine. Because steroid hormones do not dissolve well in water, they cannot pass straight into the urine. Instead, they must be broken down in the liver and kidneys to form smaller, water-soluble particles (known as metabolites) which can be excreted. Certain metabolites can be harmful if they are produced in excess, which is one important reason to test.

Metabolites are sometimes difficult to detect with traditional methods but can be extremely important indicators for certain conditions. Urine testing is the best method for testing reproductive hormone metabolites. Testing these metabolites can give healthcare practitioners an in-depth picture of why their patient’s overall hormones are elevated, lacking, or point toward specific symptoms.

DUTCH tests 10 Estrogen metabolites derived from E1, E2, and E3 and 2 Progesterone metabolites, b-Pregnanediol and a-Pregnanediol. The 8 Androgen metabolites tested by DUTCH include DHEA-S, Androsterone, Etiocholanolone, Testosterone, 5a-DHT, 5a-Androstanediol, 5b-Androstanediol, and Epi-Testosterone. The metabolite levels of estrogen show estrogen phase 1, also known as hydroxylation, and estrogen phase 2 detoxification, also known as methylation.

Understanding both estrogen and progesterone in the body can help providers understand estrogen-related cancer risk, autoimmunity, PMS, and fertility issues in their patients. Knowing these pathways can also assist the practitioner with potential suggestions for diet and lifestyle modification, supplementation, or hormone replacement therapy. The androgen metabolites help determine the activity of 5a and 5b-reductase. The more androgenic 5a-pathway can be useful to understand when working with men who experience male pattern baldness, cystic acne, and prostate issues. Women might experience cystic acne, female pattern baldness, hirsutism and PCOS. Check out this video for more information on testing reproductive sex hormones and their metabolites with DUTCH.


DUTCH Adrenal testing includes many more important markers than tested in blood or saliva. The DUTCH Complete™ includes 8 to 10 daily free cortisol and cortisone points taken throughout the day as well as a metabolized cortisol total. The DUTCH Plus® is our combination saliva/urine test which also includes the cortisol awakening response (CAR) by adding 10-12 daily free cortisol and cortisone points taken throughout the day.

Free cortisol is the active form of the hormone which binds to receptors and turns them on. Testing free cortisol helps understand the circadian rhythm and answers questions such as “Why am I tired?” “Why can I not sleep?” “Why do I crash in the afternoon?” etc. The metabolized cortisol is an indication of total cortisol production and metabolized through the liver in one day. This marker is specific to urine testing and cannot be found in blood or saliva testing. We include it because it can be greatly influenced by cases of hypothyroidism, hyperthyroidism, long-term stress, inflammation, insulin resistance, infection, poor liver function, anorexia, critical illness, and more. Cortisone is the inactive form of cortisol. Testing this hormone provides a secondary look at the circadian rhythm. It is also helpful to understand as some people are more prone to the deactivation of cortisol into cortisone which can further their symptoms of fatigue.

By looking at the entire adrenal picture in DUTCH testing, healthcare practitioners have a much more comprehensive look into the health of their patient’s cortisol production and response to help them achieve their goals.

We also report melatonin due to its influence on proper sleep and inverse relationship with cortisol. Melatonin is made in the evening and continued through the night. It is affected by factors like high cortisol and bright screens at night. If a patient reports trouble falling asleep, understanding cortisol and melatonin can help provide answers. Click here for more information on testing adrenal hormones and their metabolites with DUTCH.


8-OHdG is a marker for estimating DNA damage due to oxidative stress. It is considered pro-mutagenic and is a biomarker for various cancer and degenerative disease initiation. It can be increased by chronic inflammation, increased cell turnover, chronic stress, hypertension, hyperglycemia/pre-diabetes/diabetes, kidney disease, IBD, chronic skin conditions (psoriasis/eczema), depression, atherosclerosis, chronic liver disease, Parkinson’s (increasing levels with worsening stages), Diabetic neuropathy, COPD, bladder cancer, insomnia, and more. Studies have shown higher levels of 8-OHdG in patients with breast and prostate cancers.

Addressing the cause and adjusting treatments and dietary/lifestyle factors to minimize oxidative stress and creation of 8-OHdG is a necessary step toward health and longevity. DUTCH includes this marker as an added benefit of the DUTCH Complete™, DUTCH Plus®, and the DUTCH Cycle Mapping™ Plus panel results at no additional cost. To learn more about how 8-OHdG is a great compliment to a comprehensive hormone overview like DUTCH, please visit this page.


The last biomarkers DUTCH tests are organic acids, or what we like to call the DUTCH OATS, which are 6 additional nutrition and neurotransmitter metabolites. 4 of these build up in the urine when there is a vitamin or nutrient deficiency. Specifically, xanthurenate, kynurenate, methylmalonate, and pyroglutamate elevations serve as markers for vitamin B6, B12, and glutathione deficiencies, respectively. In addition, 2 neurotransmitter metabolites are included. While they are not direct measurements of dopamine and norepinephrine/epinephrine in the nervous system, their metabolites provide insight when correlated with symptoms such as fatigue, anxiety, insomnia, depression, motivation, libido, estrogen dominance, and stress. These symptoms may be influenced by dysfunction in the patient’s hormones or organic acids.

Testing organic acids gives healthcare practitioners an even more comprehensive understanding into the hormone and adrenal picture, and are available in the DUTCH Complete™, DUTCH Plus®, and DUTCH Cycle Mapping™ Plus panels. Check out this page to learn more about DUTCH OATs and see how these markers make DUTCH testing the most comprehensive overview of patient health available in one test!