DUTCH Hormone Test
A dried urine hormone test that looks at cortisol patterns, sex hormones and their metabolites. Useful for understanding stress responses, PMS, perimenopause, sleep issues, low energy and mood changes from a functional perspective.
Hormones and metabolites assessed in a DUTCH test
Depending on the specific DUTCH panel used, this test may assess:
Cortisol production over the day - including morning rise, daytime levels and night-time clearance
Cortisone and cortisol metabolites - giving a fuller picture of stress hormone output and metabolism
Oestrogen levels and metabolites - including how your body is processing and clearing oestrogen
Progesterone markers - which can be relevant for PMS-like symptoms and cycle changes
Androgens (such as DHEA and testosterone) - which can influence energy, mood, skin and hair
Melatonin - sometimes included, giving insight into sleep–wake rhythm
Additional markers related to oxidative stress and nutrient needs may be included in some panels
The test is designed to provide a comprehensive view of hormone production, metabolism and daily rhythm, which can be helpful when symptoms span multiple areas (for example, fatigue, mood, sleep, cycles and stress resilience).
How to complete the dried urine test at home
The DUTCH test is completed at home over the course of one day. You collect four urine samples: one before bed, one during the night (if you wake to use the bathroom), one upon waking and one two hours after waking. Each sample is applied to a special filter paper strip and left to dry. Once dry, the strips are packaged securely and sent to the laboratory using the prepaid packaging provided.
Some laboratories may recommend pausing certain supplements or medications before testing, particularly high-dose nutrients that could affect results. This will be discussed with you beforehand so the test is both safe and meaningful. Research has shown that dried urine samples are stable, accurate and correlate well with liquid urine samples, making them a practical alternative to 24-hour urine collections or multiple saliva samples.
Hormone-related symptoms where DUTCH may be considered
A DUTCH test may be worth considering if you are experiencing:
Persistent fatigue, particularly if it follows a pattern (for example, feeling wired at night but exhausted during the day).
Sleep disturbances, difficulty falling asleep, waking frequently or feeling unrefreshed despite adequate sleep.
Mood changes, anxiety, low mood or feeling easily overwhelmed by stress.
Irregular, heavy, painful or absent periods.
Symptoms of perimenopause or menopause (for example, hot flushes, night sweats, mood swings, low libido).
Hormonal acne or skin changes that seem to fluctuate with your cycle or stress levels.[52]
Low libido or sexual dysfunction.
Weight changes, particularly around the abdomen, that do not respond to diet or exercise.
Symptoms that suggest both sex hormone and stress hormone involvement, making it difficult to know which area to focus on first.
The DUTCH test can be particularly useful when standard blood tests for hormones (such as a day 21 progesterone or a single morning cortisol) have come back normal, but you still feel that hormones are playing a role in how you feel.
How DUTCH testing differs from GP hormone bloods
NHS hormone testing is designed to diagnose clear medical conditions, such as thyroid disease, polycystic ovary syndrome (PCOS), premature ovarian insufficiency or Addison's disease (adrenal failure). GP hormone tests typically measure hormones in blood at a single point in time, which is appropriate for diagnosing conditions that involve very high or very low hormone levels. For example, a single blood test can identify whether your thyroid is underactive or whether you are in menopause.
The DUTCH test, by contrast, is a functional test that looks at hormone patterns over time (the cortisol diurnal rhythm, for example, which cannot be assessed from a single blood sample) as well as how hormones are being metabolised and broken down, not just their circulating levels. It can help identify smaller shifts and imbalances that may contribute to symptoms but do not meet the threshold for a medical diagnosis.
For these reasons, the DUTCH test sits outside the scope of NHS testing. It provides additional context and detail that can be helpful for guiding nutrition, lifestyle and sometimes supplement or bioidentical hormone strategies, but it is not used to diagnose hormone-related diseases.
In this way, functional hormone testing is best seen as complementary to, not a replacement for, GP care.
What hormone patterns from the DUTCH test may indicate
DUTCH test results do not diagnose conditions, but they can highlight patterns such as:
Low or blunted cortisol output, which may be associated with chronic stress, burnout or feeling wired but tired.
High or elevated cortisol, particularly in the evening, which may relate to difficulty winding down or falling asleep.
Flattened cortisol rhythm (little variation across the day), which is sometimes seen in long-term stress or fatigue-related conditions.
Low progesterone relative to oestrogen, which may contribute to symptoms such as heavy periods, PMS, mood swings or sleep disturbances.
Oestrogen dominance patterns (high oestrogen or unfavourable oestrogen metabolite ratios), which some practitioners link to symptoms such as breast tenderness, water retention, mood swings or hormonal acne, although evidence for specific metabolite pathways remains limited.
Low DHEA, which may suggest low adrenal reserve or chronic stress.
Low melatonin metabolite, which may relate to poor sleep quality or circadian rhythm disruption.
Elevated oxidative stress marker (8-OHdG), which may indicate increased cellular stress or inflammation.
These findings are always interpreted in context, not in isolation, and they are used to guide strategies rather than to make firm diagnoses. The aim is not to label you, but to understand where your hormone picture may be drifting away from what feels balanced for you, and how that might relate to your day-to-day experience.
Using hormone patterns to guide nutrition, sleep and stress support
When DUTCH results are reviewed, they are always considered alongside your symptoms, cycle history, stress levels, sleep quality, diet, exercise, medications and any other relevant health information. Depending on the patterns that emerge, the focus may include:
Nutrition strategies to support blood sugar balance, which directly affects cortisol and progesterone production (for example, regular balanced meals with adequate protein, healthy fats and fibre).
Foods that support hormone production and metabolism, such as cruciferous vegetables (for oestrogen metabolism), zinc-rich foods (for progesterone and testosterone), healthy fats (for overall hormone production) and fibre (for oestrogen clearance).
Stress management and nervous system support, such as breathwork, gentle movement, time in nature, boundaries around work and screen time, and practices that support parasympathetic activation.
Sleep hygiene strategies, including light exposure, evening wind-down routines, bedroom environment and managing stimulants (caffeine, alcohol, screen time).
Movement and exercise that supports hormone balance without over-stressing the body, particularly if cortisol is high or adrenal reserve is low.
Where appropriate, targeted nutrients or herbs that support specific hormone pathways, although food and lifestyle changes are always the foundation.
Hormone symptoms and results that need medical assessment
You should speak to your GP if you experience:
Severe or rapidly worsening fatigue, particularly if accompanied by dizziness, low blood pressure or darkening of the skin (which may suggest adrenal insufficiency).
Very heavy periods with clots, flooding or bleeding that soaks through pads or tampons within an hour.
Postmenopausal bleeding (any bleeding after periods have stopped for 12 months or more).
Severe mood changes, suicidal thoughts or thoughts of self-harm.
New or worsening symptoms that significantly affect your quality of life or ability to function.
If DUTCH results suggest a pattern that could relate to a medical condition (for example, very low cortisol suggesting adrenal insufficiency, or very high androgens suggesting PCOS), you will be encouraged to share the report with your GP so that appropriate NHS investigations or referrals can be arranged.
Let's talk about your hormones
If you’re experiencing hormonal or stress-related symptoms and are unsure what the next step should be, we can start with a conversation. Together we can explore your symptoms, history and goals, and then decide whether a DUTCH test - or any testing at all - is likely to be helpful, or whether it makes more sense to begin with nutrition and lifestyle changes alone.
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