DUTCH Hormone Test New Zealand: A Comprehensive Clinical Guide
The DUTCH hormone test represents one of the most detailed methods available for evaluating hormonal health, offering clinicians and patients a multidimensional view of hormone production, metabolism, and clearance that conventional blood testing cannot provide. For individuals in New Zealand seeking advanced hormonal assessment, the DUTCH test has emerged as a sophisticated diagnostic tool that maps the complex interplay between cortisol rhythms, sex hormone metabolites, melatonin production, and key organic acid markers.
What is the DUTCH test?
The Dried Urine Test for Comprehensive Hormones — abbreviated as DUTCH — is a proprietary hormone panel developed by Precision Analytical, Inc. (Oregon, USA) that utilises dried urine samples collected on filter paper at specific intervals across a 24-hour period. Unlike a single-point serum blood draw or a saliva collection, the DUTCH protocol captures hormonal output at multiple time points throughout the day and overnight, enabling assessment of both total hormone production and the circadian pattern of cortisol secretion.
The test measures a broad array of analytes that fall into several categories: adrenal hormones (cortisol and cortisone and their metabolites), sex hormones (oestrogen, progesterone, testosterone, and DHEA along with their downstream metabolites), melatonin (via its primary urinary metabolite 6-hydroxymelatonin sulphate), and a select panel of organic acids relevant to neurotransmitter metabolism and nutritional status. By capturing metabolites rather than solely parent hormones, the DUTCH test provides insight into how the body processes and clears hormones — a dimension of hormonal health that serum testing largely omits.
The standard DUTCH panel is designated the DUTCH Complete. Additional configurations include the DUTCH Plus (which adds salivary cortisol awakening response measurements to the dried urine collections), the DUTCH Cycle Mapping panel (designed for premenopausal women to track oestrogen and progesterone across an entire menstrual cycle), and the DUTCH Sex Hormone Metabolites panel.
How it works
COLLECTION METHODOLOGY
The DUTCH test requires the collection of four to five dried urine samples across a single 24-hour window. The individual saturates small filter paper strips with urine at designated times: typically upon waking, two hours after waking, in the afternoon, at bedtime, and optionally during the night. Each sample is air-dried and posted to Precision Analytical's laboratory in the United States for processing. In New Zealand, practitioners order the test kits through authorised distributors, and completed samples are returned internationally via courier.
ANALYTICAL TECHNIQUE
The laboratory employs liquid chromatography–tandem mass spectrometry (LC-MS/MS) and gas chromatography–mass spectrometry (GC-MS) to quantify hormone levels and their metabolites in dried urine. These methods are considered gold-standard analytical techniques in clinical chemistry, offering high sensitivity and specificity for steroid hormone measurement (Keevil, 2016). The use of dried specimens on filter paper — a methodology with precedent in newborn metabolic screening programmes — offers practical advantages in specimen stability and transport compared to liquid urine.
PHYSIOLOGICAL BASIS
Steroid hormones are synthesised from cholesterol through a series of enzymatic conversions. Once produced, they circulate in serum (largely bound to carrier proteins such as sex hormone–binding globulin and cortisol-binding globulin), exert their biological effects at target tissues, and are subsequently metabolised — primarily in the liver — through phase I hydroxylation (cytochrome P450 enzymes) and phase II conjugation (glucuronidation and sulphation). These water-soluble metabolites are then excreted in urine.
The DUTCH test captures both the free (unconjugated) fraction and the conjugated metabolites. This is clinically meaningful because it reveals not only how much hormone is produced but also which metabolic pathways predominate. For example, oestrogen metabolism proceeds through three primary hydroxylation pathways — 2-hydroxy, 4-hydroxy, and 16-hydroxy — each with different implications. The 2-hydroxy pathway is generally considered more favourable, while elevated 4-hydroxyoestrone has been associated with oxidative DNA damage and may carry genotoxic potential (Cavalieri & Rogan, 2011). By quantifying these individual metabolites, the DUTCH test provides a level of resolution that serum oestradiol measurement alone cannot achieve.
The evidence
DRIED URINE VERSUS SERUM AND SALIVA TESTING
Serum (blood) hormone testing remains the standard of care in conventional endocrinology and is the basis for most clinical guidelines, including those referenced by BPAC NZ for thyroid, reproductive, and adrenal hormone assessment (BPAC NZ, 2013). Serum testing measures total and, in some cases, free hormone concentrations at a single point in time. It is well validated, widely available in New Zealand through community laboratories, and the reference ranges are established from large population datasets.
However, serum testing has recognised limitations. A single blood draw captures hormone levels at one moment, which may not reflect diurnal variation — a critical consideration for cortisol, which follows a well-characterised circadian rhythm peaking in the early morning and declining through the evening (Debono et al., 2009). Serum cortisol also predominantly measures the protein-bound fraction, whereas the biologically active free cortisol represents only approximately 5–10% of circulating levels.
Saliva testing measures free (unbound) hormone concentrations and is established in research settings for cortisol profiling. The cortisol awakening response (CAR) — the physiological surge in cortisol occurring 30–45 minutes after waking — is best captured via multiple salivary samples and has been extensively studied as a marker of hypothalamic-pituitary-adrenal (HPA) axis function (Stalder et al., 2016). Salivary testing is endorsed for late-night cortisol measurement in the investigation of Cushing syndrome by the Endocrine Society (Nieman et al., 2008).
The DUTCH test occupies a distinct position by combining the metabolite information available through urine testing with the convenience and stability of dried specimen collection. A 24-hour urine collection has long been used in clinical endocrinology to assess total cortisol output (urinary free cortisol), but patient compliance with liquid 24-hour collections is notoriously poor. The dried urine format addresses this practical limitation while offering additional metabolite data not routinely available through standard laboratory urinalysis.
It should be noted that the DUTCH test is not a replacement for conventional endocrine investigation. Conditions such as Cushing syndrome, Addison disease, congenital adrenal hyperplasia, and hypogonadism require assessment through established diagnostic pathways as outlined by Medsafe NZ–approved laboratory protocols and specialist endocrinological evaluation. The DUTCH test is best understood as a complementary functional assessment tool that may provide additional clinical nuance in appropriate contexts.
RESEARCH CONSIDERATIONS
Peer-reviewed literature specifically validating the DUTCH test as a diagnostic instrument remains limited compared to the extensive validation underpinning serum and 24-hour urinary free cortisol methodologies. The analytical validity of LC-MS/MS for urinary steroid profiling is well established (Krone et al., 2010), and the clinical utility of urinary steroid metabolite profiling has been demonstrated in research on adrenal disorders and oestrogen metabolism (Eisenhofer et al., 2017). However, much of the interpretive framework applied to DUTCH results is drawn from broader steroid metabolism literature rather than from direct clinical outcome studies using the DUTCH platform itself. Clinicians and patients should be aware of this distinction when interpreting results.
Who may benefit
The DUTCH hormone test may be appropriate for individuals experiencing symptoms suggestive of hormonal imbalance where conventional testing has been unrevealing or where greater metabolic detail is desired. Populations that may benefit include:
Premenopausal women with menstrual irregularities— The DUTCH Cycle Mapping panel may provide insight into oestrogen and progesterone fluctuations across the menstrual cycle, which single-point serum testing may miss. This may be relevant for individuals investigating unexplained cycle irregularity, perimenstrual symptoms, or difficulty conceiving.
Perimenopausal and postmenopausal women— Hormonal changes during the menopausal transition are complex. DUTCH testing may help characterise the pattern of oestrogen decline and the relative predominance of specific oestrogen metabolic pathways, potentially informing decisions about menopausal hormone therapy (MHT) or lifestyle interventions.
Individuals with symptoms of adrenal dysfunction— For those presenting with persistent fatigue, sleep disturbance, or impaired stress resilience, the cortisol diurnal pattern and cortisol metabolite data provided by DUTCH testing may offer a more detailed picture of HPA axis function than a single morning serum cortisol.
Men with suspected androgen imbalance— Testosterone and its metabolites (including 5α-dihydrotestosterone and the androgenic metabolites androsterone and etiocholanolone) are measured, potentially offering insight beyond total and free testosterone serum levels.
Individuals on hormone replacement therapy— DUTCH testing may assist in monitoring the metabolism of exogenous hormones, particularly for individuals using transdermal or oral oestrogen, progesterone, or testosterone, where serum levels may not fully reflect tissue-level hormone activity.
Those seeking assessment of melatonin status— The test measures 6-hydroxymelatonin sulphate, the primary urinary metabolite of melatonin, which may be relevant for individuals with circadian rhythm disruption or chronic sleep disturbance.
It is important to emphasise that DUTCH test results do not constitute a diagnosis. Results must be interpreted within the full clinical context by a qualified health practitioner.
What to expect
BEFORE THE TEST
A practitioner consultation is conducted prior to ordering the test. This clinical assessment reviews current symptoms, medical history, medications, and supplementation — all of which may influence hormonal levels and must be considered in result interpretation. Certain medications, including oral contraceptives, corticosteroids, and bioidentical hormone preparations, may need to be discussed regarding their impact on testing accuracy.
DURING COLLECTION
The DUTCH Complete kit contains filter paper collection strips, a requisition form, and detailed instructions. Collections are made at home at the designated times across approximately 24 hours. Each sample involves saturating the filter paper strip with urine, then allowing it to air-dry completely before packaging. The process is straightforward and non-invasive, requiring no venipuncture.
For the DUTCH Plus variant, additional salivary samples are collected upon waking and at 30-minute and 60-minute intervals post-waking to capture the cortisol awakening response.
Premenopausal women are typically advised to collect samples on specific cycle days (usually days 19–22 of a standard 28-day cycle, or approximately 5–7 days after ovulation) to capture the luteal phase progesterone peak.
AFTER COLLECTION
Completed samples are posted to Precision Analytical in the United States. Turnaround time is generally 10–15 business days from laboratory receipt. Results are returned to the ordering practitioner in a detailed report format that includes graphical representations of cortisol rhythm, metabolite pathways, and individual analyte values with reference ranges.
RESULTS INTERPRETATION
The report is extensive and requires clinical expertise to interpret. Key components include:
Cortisol and cortisone diurnal pattern — graphed across the collection time points, indicating whether the expected morning peak and evening nadir are present or disrupted.
Total cortisol metabolites — reflecting overall cortisol production, which may differ from free cortisol levels.
Oestrogen metabolites — including 2-OH-E1, 4-OH-E1, 16-OH-E1, and methylation activity (2-methoxyoestrone), which may indicate whether oestrogen is being metabolised through favourable or less favourable pathways.
Progesterone metabolites — including α-pregnanediol and β-pregnanediol.
Androgen metabolites — including DHEA-S, testosterone, 5α-DHT, 5α-androsterone, 5β-androsterone, and etiocholanolone.
Melatonin (6-OH-melatonin sulphate) — reflecting overnight melatonin production.
Organic acids — including methylmalonate (a marker of vitamin B12 status), xanthurenate (a marker of vitamin B6 status), pyroglutamate (related to glutathione status), and homovanillate and vanilmandelate (dopamine and noradrenaline metabolites, respectively).
A follow-up consultation with the ordering practitioner is essential to contextualise results against symptoms, medical history, and any concurrent laboratory findings.
Considerations and safety
The DUTCH test is a non-invasive specimen collection with no direct physical risks. However, several clinical considerations are pertinent:
Regulatory context in New Zealand— The DUTCH test is not processed by New Zealand–based laboratories and is not funded through the public health system. It sits outside the standard laboratory test menu available through Te Whatu Ora–funded community laboratories. Results are not automatically integrated into the NZ electronic health record. This does not diminish the test's analytical validity but does mean it exists as a complementary rather than first-line investigation.
Medication and supplement interactions— Exogenous hormones (including oral contraceptives, MHT, anabolic steroids, and DHEA supplements), corticosteroids (inhaled, topical, or oral), and melatonin supplements will directly influence measured analytes. Biotin supplementation may interfere with certain immunoassays but is less of a concern with mass spectrometry–based methods. All current medications and supplements should be disclosed during the pre-test clinical assessment.
Hydration status— Because results are normalised to creatinine to account for urine concentration, significant dehydration or overhydration may affect accuracy. Standardised hydration is recommended during the collection period.
Clinical assessment requirement— All Drips services are nurse-administered and physician-supported. A clinical assessment precedes every appointment to ensure appropriateness and safety. DUTCH test results are reviewed in the context of individual health profiles, and any findings suggestive of endocrine pathology are referred to appropriate medical specialists for further evaluation.
Limitations— The DUTCH test does not measure thyroid hormones, insulin, HbA1c, or inflammatory markers. It is not a screening tool for endocrine malignancy. It should not be used in isolation to diagnose or exclude clinically significant endocrine conditions. Its greatest utility lies in providing detailed metabolic context that complements — rather than replaces — conventional hormonal assessment.
SCHEDULE A 20 MINS DOCTOR CONSULTATION
Our doctor will review your symptoms, medical history, and any previous test results to determine if this testing pathway makes sense for you.
Questions? Contact us at drips.nz/contact
REFERENCES
BPAC NZ. Investigating tired all the time. Best Practice Journal. 2013. Available from: https://bpac.org.nz [citation needed for specific article URL].
Cavalieri EL, Rogan EG. Unbalanced metabolism of endogenous estrogens in the etiology and prevention of human cancer. J Steroid Biochem Mol Biol. 2011;125(3-5):169-180. PMID: 21397019.
Debono M, Ghobadi C, Rostami-Hodjegan A, et al. Modified-release hydrocortisone to provide circadian cortisol profiles. J Clin Endocrinol Metab. 2009;94(5):1548-1554. PMID: 19223520.
Eisenhofer G, Peitzsch M, Kaden D, et al. Reference intervals for LC-MS/MS measurements of plasma free, urinary free and urinary acid-hydrolyzed deconjugated normetanephrine, metanephrine and methoxytyramine. Clin Chim Acta. 2017;468:172-177. PMID: 28235482.
Keevil BG. LC-MS/MS analysis of steroids in the clinical laboratory. Clin Biochem. 2016;49(13-14):989-997. PMID: 27343561.
Krone N, Hughes BA, Lavery GG, Stewart PM, Arlt W, Shackleton CH. Gas chromatography/mass spectrometry (GC/MS) remains a pre-eminent discovery tool in clinical steroid investigations even in the era of fast liquid chromatography tandem mass spectrometry (LC/MS/MS). J Steroid Biochem Mol Biol. 2010;121(3-5):496-504. PMID: 20417277.
Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540. PMID: 18334580.
Stalder T, Kirschbaum C, Kudielka BM, et al. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414-432. PMID: 26563991.
This article is intended for educational purposes only and does not constitute medical advice. Individual health needs vary. All Drips services are delivered by registered health professionals and are preceded by a clinical assessment to determine suitability.
