DUTCH test: what it measures and what the evidence shows

The DUTCH test is a mail-in hormone panel that uses dried urine. You collect urine on filter paper at set times of day, post it to a lab, and get a report on cortisol, its breakdown products, sex hormone metabolites and more. The name stands for Dried Urine Test for Comprehensive Hormones.

If you are trying to decide whether it is worth ordering, the short version is this: the lab method has been checked against other urine methods in small studies, and those studies were written by people at the company that sells the test. The published work listed on this page doesn’t test whether the results diagnose a condition or improve treatment. That is a gap in the evidence. It is not proof that the test is wrong.

Cortisol

One blood draw for one cortisol result. It can’t diagnose or rule out an adrenal condition by itself.

$109

This is a standard blood cortisol test, not a DUTCH test. Check the order details to see whether it reports total or free cortisol, and follow the instructions on your lab order.

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Price checked November 2026. Not available in ND, RI, NY, NJ, MD and HI. We earn a commission on sales.

What the DUTCH test is

In the 2021 validation study, the four dried urine samples were:

1. The first urine of the day.
2. A sample 2 hours after waking.
3. An afternoon sample, around 4 p.m.
4. A sample before bed, around 10 p.m.

Participants soaked a strip of filter paper with urine and let it dry for 24 hours. The lab then extracted the hormones from the paper and measured them by mass spectrometry, a method that can tell closely related molecules apart, and adjusted each result for how concentrated the urine was (creatinine). Your own kit may use different times, so follow its instructions.

According to the study authors, the method is designed to report:

• Free cortisol, cortisone and cortisol metabolites.
• Estrogen, progesterone and androgen metabolites.
• A metabolite of melatonin.
• A set of organic acids (in the 2021 study, the melatonin metabolite and organic acids came from the first-morning sample only).

The point of four samples is to catch the daily rise and fall. The 2021 authors say single first-morning urine samples often agree poorly with a 24-hour collection. For how that rhythm looks in blood, see when cortisol is highest.

What the research shows

Study	What was compared	Result	Limits
BMC Chemistry, 2019	Dried urine against blood levels of estradiol and progesterone in 12 women; four-spot against 24-hour urine in 26 people; dried against liquid urine in 18 of them	Dried urine was a good stand-in for blood. Agreement for the collection comparisons was 0.94 or higher (a score where 1.0 is perfect).	Covers only estrogen and progesterone metabolites. Only four women were followed through a menstrual cycle. Healthy adults.
BMC Chemistry, 2021	Dried against liquid urine in 18 people. Four-spot against 24-hour urine in 26 people. Organic acids in 20 people.	Dried against liquid urine: above 0.90 for the reproductive hormones, 0.75 to 0.99 for the organic acids. Four-spot against 24-hour urine: above 0.90 for 14 of 17 metabolites, and 0.78 to 0.85 for the other three.	Healthy volunteers who reported no medical problems. The analysis left out cortisol because the authors say it was validated in earlier papers from the same group.

These papers answer one question well: does dried urine give the same numbers as liquid urine, and do four samples match a full day’s collection? For the hormones tested, the answer was yes, in small groups.

What the studies don’t show

• They are written by the lab that sells the test. In the 2021 paper the two authors are the company’s founder and an employee, and the paper’s competing-interests note says the company is a commercial lab selling hormone testing. The 2019 paper has two company authors and two from outside it, one at a university. Both papers say the statistics were done by an independent agent. A company can run careful studies. It is still worth knowing who ran them.
• They compare methods, not diagnoses. Agreement with a 24-hour urine collection doesn’t show that a result identifies a disease or tells you which treatment to choose. The 2019 authors write that further validation is still needed for additional hormones and metabolites. None of the sources on this page shows that acting on DUTCH results improves health.
• Reference ranges are lab-specific. The 2021 authors write that reference ranges for the method are laboratory-specific and not standardized.
• Medicines weren’t tested. The 2021 study did not exclude people using hormonal medicines, because its only goal was to compare collection methods. It doesn’t tell you how those medicines change a DUTCH report.
• The wider field is early. The 2024 Endocrine Reviews paper on assessing glucocorticoid status lists the urinary steroid profile among novel markers and marks the evidence as “limited data.” It describes research on 24-hour urine from people with adrenal tumors, where the pattern of urinary steroids shifted step by step, and says such an approach “could be used” to help assess hormone status. That is a research direction, not a settled test.

None of this says DUTCH kits are unreliable. It says the evidence we can use answers a narrower question than most buyers are asking.

How it compares with standard tests

Question	Tests NIDDK names	Where DUTCH fits
Too much cortisol (Cushing’s syndrome)	Usually two of: 24-hour urinary free cortisol, late-night salivary cortisol, low-dose dexamethasone suppression test. NIDDK says no single test is perfect.	Not on NIDDK’s list.
Too little cortisol (adrenal insufficiency)	The ACTH stimulation test is used most often, with insulin tolerance and CRH tests in some cases.	Not on NIDDK’s list.

A clinician arranges those tests, and the results are read against the lab’s own ranges. MedlinePlus notes that urine and saliva can estimate blood cortisol, and that a cortisol test alone can’t identify the cause of an abnormal level. For how urine, saliva and hair testing differ, see saliva, urine and hair cortisol tests and free and total cortisol.

DUTCH and “adrenal fatigue”

DUTCH is often marketed to people who feel exhausted and suspect “adrenal fatigue.” That is not a recognized diagnosis. A 2024 paper in the Journal of the Endocrine Society says it has never been scientifically proven to exist, and that the salivary cortisol profiles sold to diagnose it have never been validated. That paper is about salivary profiles and does not name dried urine tests. What can fairly be said is that none of the sources here validates a dried urine profile as a way to diagnose adrenal fatigue, and the condition itself isn’t established. See adrenal fatigue.

Before you order a DUTCH test

• Tell a clinician what you take. MedlinePlus says birth control pills and other medicines can affect cortisol results, and that the most common cause of abnormal cortisol levels is taking steroid medicines for a long time or stopping them suddenly. The effect on a dried urine report isn’t covered by the studies above. Never stop a medicine to prepare for a test unless your prescriber says so.
• Know who will read the result. The FDA describes direct-to-consumer tests as tests marketed without a health care provider. MedlinePlus says at-home tests are not a replacement for a provider, and that you should follow up with one whatever the result.
• Ask whether the test is FDA-approved or authorized. MedlinePlus advises using only such tests. None of the sources used here says whether any DUTCH product has FDA clearance, so ask the lab or your clinician directly.
• Check cost and coverage first. Prices and insurance coverage vary, and we don’t list either. Ask your insurer and the lab before you order.

Questions people ask

Is the DUTCH test accurate?

For the narrow job of giving the same numbers from dried urine as from liquid urine or a 24-hour collection, the published studies say yes, in small groups of healthy people. Whether its results are accurate for diagnosing a condition hasn’t been shown in the sources on this page.

Can the DUTCH test diagnose Cushing’s or Addison’s disease?

No source here says so. NIDDK names different tests for each, and a diagnosis comes from a clinician working through them.

Is DUTCH better than a blood cortisol test?

The sources here don’t compare the two. They answer different questions: a morning blood cortisol shows one moment, while a four-spot profile tries to show a day’s pattern. Which is more useful depends on what a clinician is trying to find out. If your question is whether your cortisol is low, see the cortisol test guide and at-home or lab testing.

Can I order one without a doctor?

Direct-to-consumer tests exist, according to the FDA, but whether a given DUTCH order can be placed that way depends on the lab or seller, so check. If you do, take the report to a clinician rather than acting on it alone.

Keep reading

• Saliva, urine and hair cortisol tests

  How the other sample types compare.

• Free and total cortisol

  What each measurement means.

• Adrenal fatigue

  The evidence on a label that is not a recognized diagnosis.

• All adrenal and related tests

  ACTH, DHEA-S, aldosterone and more.