Four hormone systems, one collection
The DUTCH Plus maps your sex hormone production, adrenal hormone output, and melatonin from a series of dried urine strips collected across a single day. Each system connects to the next.
Total oestrogen is only part of the picture
Standard blood tests measure total or free oestradiol. They do not measure what happens to oestrogen after it is made. The metabolic pathway your body uses is clinically significant — and directly influenced by gut health, methylation status, and toxic load.
→ 2-MeOE1 (favourable)
→ estriol (weaker, longer-acting)
→ quinones if impaired
The 2:16 ratio and 2-MeOE1 conversion are specific markers that blood tests cannot provide. They directly inform decisions about I3C / DIM support, methylation cofactors, and gut barrier restoration — interventions which change the ratio rather than simply suppressing oestrogen production.
Questions the DUTCH answers that blood tests cannot
Is my cortisol pattern suppressed, elevated, or dysregulated?
The 4-point diurnal curve shows whether the problem is morning output, afternoon crash, evening elevation, or a flat pattern throughout — each has different clinical implications and different causes.
Why is my 9am cortisol normal but I'm exhausted?
A single morning cortisol serum test misses the CAR, the afternoon dip, and evening cortisol. DUTCH captures the pattern that explains the functional picture even when the snapshot looks normal.
Is my body making enough progesterone?
Urinary progesterone metabolites give a fuller picture of total luteal phase output than serum day-21 progesterone, which is highly time-sensitive and often measured incorrectly.
Is oestrogen dominance from overproduction or poor clearance?
You can have normal serum oestrogen with impaired clearance, leading to symptomatic dominance. DUTCH separates production from metabolic pathway choice from gut recycling (enterohepatic circulation).
Why has my DHEA fallen over the past few years?
DHEA-S decline with age is normal — but chronic cortisol demand accelerates it. The relationship between cortisol output and DHEA-S on DUTCH maps the pregnenolone steal pattern in real data.
Is poor sleep a cortisol problem, a melatonin problem, or both?
Melatonin (6-OHMS) on DUTCH combined with evening cortisol separates the sleep architecture drivers: elevated evening cortisol suppresses melatonin onset; low melatonin with normal cortisol is a different problem requiring a different approach.
The CAR — not captured by any other test
The cortisol awakening response is a distinct, neurologically-regulated spike in cortisol in the 30 minutes after waking. It reflects hypothalamic-pituitary axis sensitivity — separate from the rest of the diurnal cortisol pattern. It blunts in chronic stress and fatigue states before the diurnal curve shows abnormality.
Interpretation requires both values — waking and +30-minute — because the absolute cortisol level at 30 minutes is less clinically meaningful than the magnitude of the rise from baseline. A blunted CAR with otherwise normal diurnal cortisol is a distinct pattern associated with burnout, atopic conditions, and immune dysregulation.
Clinical presentations the DUTCH addresses
Perimenopause and menopause
Fluctuating oestrogen with or without HRT, identifying whether symptoms are driven by production decline, metabolic pathway shifts, or progesterone insufficiency. Essential for monitoring HRT dose appropriateness.
Chronic fatigue and burnout
Blunted CAR, flat diurnal curve, and low DHEA-S are the biochemical footprint of exhausted HPA function. Distinguishes Stage 2 resistance (elevated cortisol, low DHEA) from Stage 3–4 burnout (both low).
PMS, PMDD, and cycle irregularity
Inadequate progesterone in the luteal phase, oestrogen dominance relative to progesterone, and poor oestrogen clearance all present as worsening premenstrual symptoms. Blood tests at the wrong cycle phase miss this entirely.
Poor sleep and fatigue despite adequate hours
Evening cortisol elevation suppressing melatonin onset, low melatonin production, or a blunted CAR preventing functional morning arousal — three separate sleep architecture drivers that require different interventions.
Unexplained weight gain, especially abdominal
Elevated cortisol drives visceral adipose deposition and blocks fat oxidation. Cortisol-insulin interaction explains why clients who are eating well and exercising cannot lose the mid-section weight.
Anxiety, low mood, and irritability
Oestrogen supports serotonin receptor sensitivity; progesterone supports GABA tone; DHEA has direct neuroprotective effects. The hormonal contribution to mood is often missed when mental health presentations are treated in isolation from the endocrine picture.
How DUTCH testing works
Dried urine testing is significantly more comprehensive than serum for hormones — it captures free fractions, metabolites, and the full diurnal pattern that a blood draw at a single time point cannot provide.
Complete from collection to protocol
Test & laboratory
Clinical interpretation
DUTCH Plus — £495
What is covered
What you receive
What blood tests for hormones can and cannot show
Blood tests for hormones have clinical value — they are the right tool for certain questions. DUTCH answers the questions that serum cannot.
| Clinical Question | Serum Blood Test | DUTCH Plus |
|---|---|---|
| Total oestradiol level | ✓ Yes (single point) | ✓ Yes (plus metabolites) |
| Oestrogen metabolic pathway (2-OH, 4-OH, 16-OH) | ✗ Not measurable in serum | ✓ Full pathway mapping |
| Progesterone level | ✓ Yes (extremely time-sensitive) | ✓ Metabolites give fuller picture |
| 4-point diurnal cortisol curve | ✗ Single-point only | ✓ Full diurnal map |
| Cortisol awakening response | ✗ Not captured | ✓ Waking + 30-minute CAR |
| Total cortisol production rate | ✗ Free cortisol only | ✓ Metabolites (a-THF, b-THF, THE) |
| Melatonin output | ✗ Not standard | ✓ 6-OHMS first morning urine |
| DHEA-S | ✓ Yes | ✓ Yes plus androgen metabolites |
Tests that work alongside DUTCH
Hormones do not operate in isolation. The DUTCH often raises questions that other tests are positioned to answer.
GI-MAP — gut health and oestrogen clearance
Beta-glucuronidase on GI-MAP directly measures the enzyme that recirculates conjugated oestrogen back into circulation. Elevated beta-glucuronidase explains oestrogen dominance even where DUTCH oestrogen production is normal. The gut-hormone axis requires both tests to fully investigate.
HTMA — adrenal mineral patterns
The sodium-to-potassium (Na/K) ratio on HTMA maps adrenal mineral activity; the calcium-to-magnesium ratio maps the adrenal stress response at the cellular level. HTMA and DUTCH together give both functional and biochemical adrenal assessment.
Blood chemistry — thyroid and metabolic context
Cortisol elevation suppresses TSH and reduces T4-to-T3 conversion. Understanding the thyroid picture alongside the cortisol pattern on DUTCH often explains thyroid presentations that are biochemically borderline but symptomatically significant.