The DUTCH test (dried urine test for comprehensive hormones) measures oestrogens, progesterone and androgen metabolites, a 4 point free cortisol curve, total metabolised cortisol and melatonin from four or five dried urine samples collected from one evening to the next morning. It shows how hormones are processed and cleared, which blood tests do not. It does not diagnose endocrine disease, and for menstruating clients timing matters: collect on days 19 to 22 of a 28 day cycle. Verified practitioners can order it through Vively from Nutripath.
| Test type | Measured in dried urine samples |
|---|---|
| Nutripath code | Shown in your practitioner account |
| Sample and collection | Dried urine kit collected at home from one evening to the next morning and posted to Nutripath |
| Preparation | No alcohol for 24 hours and limit caffeine and fluids on the day. Menstruating clients collect on days 19 to 22 of a 28 day cycle. Check hormone medicines and supplements with the prescriber first. |
| Turnaround | Shown in your practitioner account. |
| Available through | Nutripath test ordered through Vively. You need to be a verified practitioner to refer it. |
| Pricing | Pricing in your practitioner account |
| Results | PDF report from Nutripath, filed in your client’s record and app beside their blood results |
Only practitioners can order this test. Ask your naturopath, nutritionist or dietitian whether they use Vively.
What does the DUTCH test measure?
The client soaks filter paper strips with urine at set times from one evening to the next morning. Because urine carries hormones and their breakdown products, the test reports both how much hormone is being made and how it is being metabolised and cleared.
Oestrone, oestradiol and oestriol, plus the 2-OH, 4-OH and 16-OH pathways and methylation of the 2 and 4 catechols. Practitioners read the pattern alongside liver, gut and methylation support.
Pregnanediol as a marker of progesterone output, and testosterone, DHEA-S and their 5-alpha and 5-beta metabolites, which show which way androgens are being processed.
Free cortisol and cortisone at waking, 2 hours later, at dinner and at bedtime show the daily rhythm. Metabolised cortisol shows total production across the day, so a flat curve can be read against how much cortisol is being made.
6-sulfatoxymelatonin from the waking sample, and a few organic acids linked to B12, B6, glutathione and dopamine and noradrenaline breakdown.
How do you order a DUTCH test through Vively?
- Get verified. You need to be a verified practitioner to refer tests. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Build the order. Log in to the practitioner platform, choose the Nutripath test and add any blood tests or the $99 Baseline Health Check to the same order. Pricing shows in your account, and either your client or your practice can pay.
- Client collects at home. Nutripath sends your client the collection kit once the order is placed. Your client follows the kit instructions (four timed urine samples soaked onto filter paper strips, from dinner time one evening to 2 hours after waking the next morning, plus one overnight sample if your client wakes to urinate) and posts the sample back to Nutripath in the packaging provided.
- Review the report. Nutripath’s PDF report is filed in your client’s record and app, next to their blood results, ready for the follow-up consult.
See every Nutripath test you can order on the Nutripath tests page.
Order a DUTCH test with your client’s blood tests
Free access for verified naturopaths, nutritionists and dietitians. Order Nutripath tests and blood pathology in one place, and see every result in your client’s record.
What does a DUTCH result tell you, and what does it not?
DUTCH gives a detailed picture of hormone metabolism from one home collection. The evidence that acting on that picture improves outcomes is still limited, so treat it as a guide for the plan, not a diagnosis.
Published method studies show dried urine results track liquid urine and, for several hormones, serum levels reasonably well (Newman et al., 2019; Newman and Curran, 2021). Urine reflects what is excreted, so it is a different measure from a blood level.
Conditions such as Cushing’s syndrome, adrenal insufficiency and polycystic ovary syndrome are diagnosed with the tests set out in endocrine guidelines (Nieman et al., 2008; Teede et al., 2023). A DUTCH result that suggests one of these needs GP review.
Cycle day, sleep, caffeine, fluid intake and missed or late samples all change the pattern. One collection is a snapshot of one day, so a surprising result may need repeating.
Oral progesterone, hormone creams, DHEA and pregnenolone change urine metabolites a lot. Results on treatment need careful timing and are best discussed with the prescriber.
How does the DUTCH test fit with blood work?
Blood tests give the circulating level and are what GPs and specialists act on. DUTCH adds the metabolism and the daily pattern. Ordering both in one Vively order lets you read them side by side.
- ContextLow pregnanediol in the luteal phase with low serum progesterone
Two measures pointing the same way support low progesterone output for that cycle. Check cycle timing first, and refer if cycles are irregular or the client is trying to conceive.
- ReferHigh androgen metabolites with high free testosterone or irregular cycles
A pattern that can fit polycystic ovary syndrome. PCOS is diagnosed by a doctor, so refer with the results and the cycle history.
- ContextFlat cortisol curve with low DHEA-S
Often seen with long term stress, poor sleep or shift work. Address sleep and load first. Very low results with fatigue, weight loss or dizziness need GP review.
- CheckLow hormone output across the board in a client over 40
May reflect perimenopause or menopause. FSH and LH from a blood test help place it, and a GP can discuss options.
What can affect a DUTCH result?
- Collecting on the wrong cycle day, or in an irregular cycle
- Oral or topical progesterone, oestrogen, DHEA, pregnenolone and other hormone products
- Oral or inhaled glucocorticoids such as prednisone
- Caffeine, alcohol and drinking a lot of fluid on the collection day
- Late, missed or out of order samples, and a broken night of sleep
- Bananas, fava beans, creatine and supplements such as tyrosine or quercetin, which affect some organic acid markers
When should you refer the client to their GP?
- Cortisol results that are very high or very low, especially with weight change, high blood pressure, dizziness or easy bruising
- Missed periods, very heavy bleeding, or bleeding after menopause
- Signs of high androgens such as new facial hair, acne or hair loss with irregular cycles
- A client who wants to start, stop or change hormone therapy on the basis of the result
- Any result that conflicts with symptoms or with the client’s blood tests
How should a client prepare for a DUTCH test?
Copy or print this to send to your client. Follow the instructions in the Nutripath kit if they differ.
Preparing for your DUTCH test
- If you have periods, collect on days 19 to 22 of a 28 day cycle, counting day 1 as the first day of bleeding. If your cycle is longer or shorter, ask your practitioner which days to use.
- Don’t drink alcohol for 24 hours before or on the collection day. Keep caffeine to one cup on the day.
- Don’t drink anything in the 2 hours before each sample, and keep your total fluids to about 1.2 litres on the collection day.
- Collect four samples, starting in the evening: at dinner time, at bedtime, within 10 minutes of waking the next morning and 2 hours after waking. If you wake in the night to urinate, collect that once as well.
- If you take hormone medicines or supplements such as progesterone, oestrogen, DHEA, pregnenolone or cortisone tablets, ask your practitioner and prescriber about timing before you collect. Don’t stop prescribed medicines without asking.
- Let the strips dry as the kit describes, label each one with the time, and post the kit back in the packaging provided.
- Your practitioner will receive the report and go through it with you.
How do practitioners use the DUTCH test with clients?
It is most useful when blood tests have not explained cycle symptoms, perimenopause changes, low libido or a stress and sleep picture, and the question is how hormones are being processed. Pin down cycle timing and medicines before ordering, add blood oestradiol, progesterone, testosterone, SHBG and DHEA-S to the same order, and use a repeat collection on the same cycle day to show change. Results that point towards an endocrine condition go to the GP with the report.
DUTCH test FAQs
Can a naturopath, nutritionist or dietitian order a DUTCH test through Vively?
Yes. You need to be a verified practitioner to refer it. Add the DUTCH test to an order in the Vively practitioner platform, on its own or with blood tests. Pricing shows in your account. No account yet? Request free access.
What does a DUTCH test show that a blood test doesn’t?
Blood tests give the level of a hormone at one point in time. DUTCH shows how oestrogens, progesterone and androgens are being broken down, plus a 4 point cortisol curve across the day. It complements blood tests rather than replacing them.
When should a DUTCH test be done in the cycle?
For a 28 day cycle, on days 19 to 22, which is about 6 to 9 days before the next period is due. Clients with longer or shorter cycles adjust the day. Postmenopausal clients and men can collect on any day.
Can clients do a DUTCH test on hormone therapy?
Yes, but the timing matters. Oral progesterone, creams and gels, DHEA and pregnenolone all change urine results, so check timing with the prescriber and note every product on the request.
How long do DUTCH results take?
The expected turnaround shows in your practitioner account when you add the test. Allow extra time for postage.
References
- Newman M, Pratt SM, Curran DA, Stanczyk FZ. Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry (GC-MS/MS). BMC Chemistry. 2019.
- Newman M, Curran DA. Reliability of a dried urine test for comprehensive assessment of urine hormones and metabolites. BMC Chemistry. 2021.
- Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2008.
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2023.
- Precision Analytical. DUTCH Complete collection instructions. dutchtest.com. 2025.