DUTCH Hormone Test: A Dietitian’s Unbiased Review

Lots of women with PCOS and hormone issues have felt dismissed or hurt by the traditional healthcare system. As a result, many people are turning to functional medicine providers for answers. This is especially true when it comes to hormone health.

One tool that is gaining popularity in the complementary and alternative world is the DUTCH hormone test. 

The DUTCH hormone test is used by many naturopathic providers and dietitians to get down to the “root cause” of your hormone problems. 

But is it legit?

In today’s article, we are going to provide an unbiased look at the DUTCH test. We do not sell the DUTCH test, but are hear to provide you with information and insight to empower you to make the best choices for your hormone health. 

Let’s dive in!

What is the DUTCH test?

DUTCH test stands for Dried Urine Test for Comprehensive Hormones. 

And it is exactly what it sounds like. The DUTCH test is a hormone panel sold by the company Precision Analytics. They claim to measure levels of sex hormones and adrenal hormones based on a series of several urine tests throughout the day. 

Precision Analytics sells several variations of DUTCH testing. 

DUTCH Complete

The DUTCH Complete test claims to measure the following hormone levels in your urine:

• Progesterone metabolites
• Estrogen metabolites
• Androgen metabolites
• Creatinine
• Daily free cortisol and cortisone (through saliva)
• Cortisone metabolites and DHEA-S
• Nutritional Organic Acids – vitamin B12 marker, vitamin B6 markers, biotin marker, glutathione marker, gut marker
• Neuro-related markers – dopamine metabolite, norepinephrine/epinephrine metabolite, neuroinflammation marker
• Melatonin
• Oxidative Stress/DNA damage

DUTCH Plus

The DUTCH Plus test claims to measure all of the metabolites from the DUTCH Complete as well as a testing for your cortisol awakening response and an optional insomnia sample.

DUTCH Cycle Mapping

This testing claims to measure levels of estrogen and progesterone metabolites throughout the course of a menstrual cycle. These hormone levels naturally change throughout the course of a cycle. 

DUTCH Cycle Mapping claims to be able to better identify hormonal imbalances since it is measure throughout the entire cycle (verses just a one-time blood or saliva test). 

This test involves collecting 25 dried urine samples over the course of 22 days. 

Typically, progesterone levels are low until just after ovulation. After ovulation, progesterone levels increase and then lower again in the few days before menstruation begins. 

Reversly, estrogen increases in days leading up to ovulation. Estrogen then decreases at the time of ovulation and will mildly increase again in the days before menstruation.

The potential benefits of the DUTCH Cycle Mapping is that it could help idenify abnormalities in your hormone changes over the course of your cycle rather than at one point in time. 

Who May Benefit from the DUTCH Hormone Test?

There are several reasons that someone may want to look into DUTCH testing. The DUTCH test is designed people who are concerned about hormonal imbalances. This testing has been used for many of the following purposes:

PCOS or Fertility Problems

Women with PCOS often have elevated androgen levels, such as testosterone and DHEAS. Many people with PCOS also have elevated cortisol and adrenal involvement, which is included in the DUTCH panel.

Estrogen Metabolism 

Estrogen is metabolized (broken down) into two primary pathways: 2-hydroxyestrone and16- hydroxyestrone. The first, 2-hydroxyestrone, tend to protect against cell growth and possibly protect against cancer.

The second pathway, 16-hydroxyestrone, is associated with inflammation and promotes cell growth. https://www.va.gov/WHOLEHEALTHLIBRARY/tools/estrogen-dominance.asp

Understanding the pathway by which estrogen is broken down can help identify you health risks and root causes of your symptoms. This can help create more individualized, targeted interventions for your hormone issues.

Estrogen Dominance

Estrogen is a necessary sex hormone for both men and women. However, the amount of estrogen can grow out of proportion to the amount of progesterone in your body. This can cause symptoms like irregular periods, heavy periods, decreased sex drive, and breast tenderness.

Estrogen dominance has also been associated with gynecological cancer, PCOS, and endometriosis. Hormone testing can help identity any abnormalities in your estrogen and progesterone levels. 

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is often used to correct low hormone levels, which is especially common in menopause. DUTCH claims that their dried urine test can help monitor use of oral progesterone and vaginal hormones.

MTHFR Gene Variant

This gene is involved in the break down of nutrients, including folate (vitamin B9). As vitamin B9 is broken down, it is converted to a form of folate that help convert the the amino acid homocysteine into another amino acid, methionine. 

If someone has one or both versions of this gene variant, this may mean that they have difficulty clearing homocysteine (an inflammatory amino acid). 

The MTHFR genes help regulate homocysteine clearance. Variations in this gene can result in a genetic predisposition of higher homocysteine levels, which can lead to increased inflammation.

Also, folate (vitamin B9) is in the same metabolic pathway as vitamin B12. Low folate levels may in turn lead to low vitamin B12 levels.

DUTCH testing does not analyze for the MTHFR gene variant. However, it may play a role in the methylation of B vitamins. 

The DUTCH hormone test does claim to measure a vitamin B12 marker within the dried urine sample, which could be helpful for those with this gene variation to check for deficiencies.  

Insomnia, chronic fatigue, and low energy 

Cortisol is well-known as the hormone involved in stress, and imbalances in cortisol levels may affect sleep and energy levels. The DUTCH hormone test include both free cortisol and metabolized cortisol levels. 

The company claims that it is important to measure metabolized cortisol levels through dried urine samples to identify not only how much cortisol is in your body, but also how the cortisol is being broken down. 

Adrenal Fatigue  

Cortisol is is a hormone involved in blood sugar regulation, sleep, and managing inflammation. 

As discussed above, increased physical or psychological stress can increase cortisol levels, which are measures as metabolites in the dried urine samples.

DUTCH Test Vs. Blood Test

Blood tests are one of the most common way to check your hormones. 

With traditional medicine, the hormone testing labs are ordered by your primary care provider or an endocrinologist. The blood test shows the levels of each hormone that is in your blood stream at the time of the test. Some doctors may also order a 24 hour urine test.

The DUTCH hormone test measures hormone metabolites, which is what is left after your body has processed and excreted the hormone remnants. The DUTCH test is used primarily by alternative medicine practitioners. 

How Much Does It Cost?

The costs for the hormone testing kits below were as of January 2023. Keep in mind that you will want to review results with your healthcare provider, so be sure to factor that cost in as well. 

DUTCH Test Complete Cost

The DUTCH Test Complete is normally $499, but was on sale at $399 at the time this article was written. 

DUTCH Test Plus Cost

The Dutch Test Plus is normally $650, but was also on sale for $499 when this article was written.

How Do you Take a DUTCH Test?

The DUTCH test provides detailed instructions with the test, but we’ll give your a quick overview.

The DUTCH test isn’t hard, but does require attention to detail. Essentially, you urinate on the paper from the kit at four specific times over a 24 hour period. 

Then you leave the urine-saturated papers out to dry, place them in a plastic bag, and then mail the dried urine samples back to the company for testing.

DUTCH Test Results

You DUTCH test results will be sent to you as a lab report.

The report is several pages and pretty overwhelming to look at, so it is usually recommended to have results reviewed by a trained professional. 

From there, you and your provider can create a personalized plan based on your results.

DUTCH Test: What Does Research Show?

Honestly, the DUTCH test is really controversial. Hormones are extremely complex, and we just don’t have a lot of research on the use of urine metabolites in clinical practice. 

There have been some studies conducted, but most were conducted by the company that sells the test. 

This isn’t necessarily bad; we want lab companies to be testing their methods and technology. But it does introduce bias into the research, so I would like to see more third-party testing.

Disadvantages of the DUTCH Hormone Test

1. The DUTCH Hormone Test is Expensive

Will the DUTCH test hurt you?

Probably not. It’s just information. But with limited research on the test, it may lead misleading conclusions about your health that:

1. Scares your unnecessarily
2. Leads you to buy supplements that are expensive, unnecessary, and may have their own risks and side effects

Not to mention, you’re out a lot of money that could have been used for evidence-based treatments.

    2. Risk for Inaccurate or Unreliable Results

This is a two-fold concern. 

First of all, we aren’t even confident that the results of the DUTCH test based. Just because one of your metabolite levels comes back abnormal doesn’t necessarily mean that this is the “root cause” of your problems.

Secondly, we need to address the issue of training.

There are a lot of dietitians using the DUTCH test in their practices. I am a dietitian myself, so I can speak to our training. Dietitians are extremely skilled in implementing diet changes for medical issues.

But we have ZERO training in school for these types of hormone lab results. Instead, dietitians learn how to interpret the results of the DUTCH hormone test from the company that sells it. 

There are lots of other providers who use the DUTCH hormone test besides dietitians. But as far as I can tell, the primary way for anyone to get training on interpreting lab results is through the company that sells the test.

For me, that’s a red flag.

Advantages of the DUTCH Hormone Test

1. The DUTCH Test Claims to Measure Hormone Metabolites

Blood and saliva hormone testing will not measure metabolites. The dried urine testing may provide a measurement of the broken down or “processed” hormones. With more third-party research, it’s possible that this could provide some merit.

2. You May Have Improvement in Your Symptoms

After you take the DUTCH test and work with your practitioner to implement some diet and lifestyle changes, you may feel better.

But here’s the thing: there are lots of holistic changes that can be made to support your hormone health without the DUTCH hormone test, such as N-acetyl cysteine supplementation, addressing insulin resistance, and adrenal support.

With all of that being said, I’m not here to invalidate the experience of anyone who feels like the DUTCH test helped them. Their results may have lead them to a change that improved their symptoms.

Instead, this information is here to help guide women who are considering using the DUTCH test as the next step in their hormone health journey.

Final Thoughts: Is the DUTCH Test Legit?

So, is the DUTCH test legit?

We really don’t know because the research isn’t there yet. That doesn’t mean that there isn’t value to the test, but we also just don’t have a lot of evidence to show its benefit.

The studies that have been conducted were conducted by the company that sells the test, which runs the risk of bias.

On top of that, the price of the test plus the cost of working with a practitioner for interpretation of results could easily rack up to +$1,000 dollars.

And honestly, the results of the hormone testing won’t significantly change how we approach your health concerns from a nutrition perspective. 

I personally wouldn’t spend that kind of money on a test with little validation, nor would I recommend it to my clients. 

Instead, I would recommend working with a women’s health dietitian to find nutrition and lifestyle changes based on your symptoms and individualized needs.