What is DUTCH testing?

One hormone test explained and compared to conventional methods

As an endocrinologist, the main part of my job is to test hormone levels and interpret the results. It sounds straightforward, but the nuance comes in deciding which hormones to test based on a patient’s symptoms. How we interpret those hormone levels is not just based on “normal” or “not normal,” but the pattern of results within the context of the patient's health. More tests of more hormones is not always helpful.

At least once a week, a new patient comes in my office with a ream of test results with a colorful logo on the top left corner. The results show multiple hormone levels across the 24 hours of a day, plotted on graphs with trend lines. The graphs are accompanied by circular icons that look like the volume dial on an old TV. If the dial is pointing to the sweet spot, it is marked by stars. The hormone level is indicated with a green triangle. Patients are hoping I can review these results and then explain why they aren’t feeling well.

The results that I described are from a type of test called DUTCH testing. DUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. Since its introduction in 2012, it has become popular because it claims to offer a more comprehensive picture of a person’s hormones than traditional blood testing. But what exactly is DUTCH testing? What does the data say about the results?

What is DUTCH testing?

Offered by a single lab, Precision Analytical, Inc., a DUTCH test is essentially a kit that a person uses at home to collect urine samples on special filter paper. When the filter paper dries, the hormones, peptides, and electrolytes are left on the paper. The paper is then sent to the lab where it is reliquefied. From there, the reconstituted urine is tested for over 35 different hormones.

In most cases the kits require sending samples from four specific times of day in an effort to measure how that hormone fluctuates over the course of a full day. In many cases it tests for metabolites of the target hormone in addition to the hormone itself. For example, it tests cortisol levels but also cortisol metabolites. Some of the other hormones tested include various forms of estrogen, progesterone, cortisol, testosterone, and DHEA, just to name a few.

Is DUTCH testing accurate?

In general, when we want to know if a test is accurate, we like to compare it to a gold standard test. For example, when we want to use a new test for thyroid stimulating hormone (TSH) in the blood we draw blood, typically from thousands of participants, and we test their blood for TSH using the new test and the old test and then we compare. We then look at how close the new test results come to the results from the old test. We want them to be within a specific range above or below the old gold standard test. We also have several different labs use the old test and the new test side by side, to make sure that many different lab technicians using the new test on many different machines get the same results.

DUTCH test has undergone some of this type of accuracy testing. There is some data comparing blood levels of some hormones to urine levels of those hormones (here, and here are two examples), but these studies are all quite small, often with fewer than 50 participants. It is important to note that this data isn’t comparing blood testing to DUTCH testing specifically. It just compared the levels of some hormones in blood to measures of those same hormones in the urine using a typical urine test. (So, comparing what fluid is tested, but not the specific DUTCH method of measuring it.) These studies also don’t compare blood testing to urine testing at different times of day. So, it is unclear how closely urine levels of hormones follow the rise and fall that we see in blood levels of those same hormones over a 24-hour period.

Precision Analytical has conducted some research into how DUTCH testing compares to urine testing with urine that has not been dried. In the same study they also compared how the four spot urine tests compare to 24-hour urine collection (this is exactly what it sounds like, collecting your urine in a jug for a full 24-hour period). In both cases they found that the DUTCH testing did approximate both the typical urine test and the 24-hour urine collection, but again the study was very small. It included just 20 participants in one group and 26 participants in the other group.

There are a few hormones for which there are validated normal ranges for 24-hour urine collections. In particular, we have a lot of data on what the level of cortisol should be over a 24-hour urine collection period. We do not have the same kind of data for cortisol metabolites, or various forms of estrogen and progesterone. We would also like to see the data comparing DUTCH testing to other types of urine testing confirmed by labs other than Precision Analytical itself.

What, if anything, does DUTCH testing tell us?

Currently, DUTCH testing does seem to accurately reflect the levels of the hormone measured in the urine at the time the urine was collected. But that is about all it tells us. Even here we would like more data, including data from other labs replicating the Precision Analytical findings. Ultimately, this leaves us with a big question. How to compare DUTCH testing to validated blood levels of the hormones that DUTCH testing measures? The short answer right now is that we can’t.

Because there is still so much that we don’t know about how to interpret DUTCH testing, it is considered experimental. As a result, it is not covered by most health insurance. Depending on the specific test, DUTCH testing can cost anywhere from $300 to $700 per kit. In my practice I don’t find that the results change my clinical thinking or what I recommend for my patients. I don’t offer the test in my practice. Instead, I rely on blood, urine, and saliva testing validated with much more extensive research and that is most often paid for by my patients’ medical insurance.

The Savvy Short:

· DUTCH testing is a way of testing hormone levels from urine collected on special filter paper and dried before it is sent to the lab.

· There are studies comparing urine hormone levels to blood hormone levels. There are also studies comparing traditional urine testing to DUTCH testing, but in all these cases the studies are quite small—enrolling fewer than 50 patients.

· We don’t have good data telling us how to compare DUTCH testing to blood hormone levels, making the results difficult to interpret.

· DUTCH testing is considered experimental and as such is not covered by most medical insurance plans.