DUTCH Comprehensive Hormone Testing for Optimizing Wellness

Dr. Leah Hassall, ND

When hormones are in balance, they help the body to thrive. When out of balance, they significantly affect our quality of life. The degree of hormonal imbalance exists on a continuum: When one or more hormone is significantly out of physiological ranges, we can see serious disease. When one or more hormones is just slightly outside of optimal ranges, we may see sleep issues, mood changes, menstrual irregularities, migraines and PMS symptoms, frequent cold and flu and weight changes. Hormones are chemical messengers in the body that are produced in one part of the body and then travel to another part of the body where they exert some effect. Hormones control most functions in the body including sleep, mood, reproduction, blood sugar regulation, hunger, body temperature, heart rate and metabolism to name a few.

One tool that naturopathic physicians use to detect hormone imbalance is the DUTCH PLUSTMtest. DUTCH stands for: “Dried Urine Test for Comprehensive Hormones”. The test uses dried urine and saliva samples that are easily collected at home over the course of one day. The DUTCH PLUSTMtest looks at:

  • Basic hormones and metabolites
  • Androgens and metabolites
  • Cortisol metabolites
  • Free cortisol patterns
  • Organic acids

Basic Hormones

DUTCH PLUSTMlooks at progesterone and all three types of estrogen (E1, E2 and E3). Imbalances in these hormones often lead to cycle irregularities or an absence of a cycle (amenorrhea), heavy menstrual bleeding, spotting between periods, PMS symptoms, intense cramping, migraines, hot flushes and vaginal dryness. Sex hormones are part of a complex web of pathways where they are constantly being converted into different metabolites. DUTCH PLUSTMlooks at those levels of metabolites in the urine to determine if your body is preferentially converting a hormone into a less active metabolite.


Androgens refer to the “male hormones” DHEA-S, testosterone and androsterone. Both males and females have androgens and imbalances can look like decreased sex drive, hair loss or hair growth in women (chin and chest), muscle loss and decreased energy. Androgens (and other sex hormones) are often out of balance in people with PCOS (polycystic ovarian syndrome) or androgen sensitivity.

Cortisol Metabolites and Free Cortisol Patterns

When we wake in the morning, our cortisol levels naturally rise and peak about 30-60 minutes after waking (termed the cortisol awakening response). After this point, they begin to decline. The magnitude of the difference between peak morning cortisol and the decline can be used as an indicator of adrenal gland function. Under chronic stress conditions (psychological burnout, PTSD, poor sleep, SAD, chronic fatigue, autoimmune disease and functional GI issues), the cortisol awakening response can be blunted. The cortisol awakening response can also be elevated in work-related stress, blood sugar dysregulation, general depression and chronic pain.

Organic Acids

DUTCH PLUSTMmeasures norepinephrine/epinephrine, serotonin, melatonin and a marker of DNA damage (8-OHdG). When out of balance, many of these chemicals are implicated in chronic fatigue, mood changes (anxiety and depression), seasonal affective disorder (SAD) and sleep disorders.

Melatonin levels change throughout the day, increasing after dark to trigger the responses that cause sleep. It is also thought to be involved in upregulating the immune system to prevent seasonal cold and flu as well as being anti-inflammatory.

DUTCH PLUSTMis an excellent testing choice if you think that you may be experiencing hormonal imbalances, especially if you have a history of chronic stress or disease. It is one of the most comprehensive hormone testing panels and is quickly becoming a favourite among physicians who test for sub-clinical hormone imbalances.


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Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L. (2010). The cortisol awakening response: more than a measure of HPA axis function. Neurosci Biobehav Rev.35(1):97-103.

DUTCH PlusTM: Complete with Cortisol Awakening Response (2018). Retrieved September 4, 2018, from https://dutchtest.com/

Prior, J. (2018). Ovulation and menstrual cycles. Retrieved September 4, 2018, from http://www.cemcor.ubc.ca/resources/topics/ovulation-and-menstrual-cycles