InstalabDUTCH Complete
Should you take a DUTCH Complete test?
This test is most useful if any of these apply to you.
53 biomarkers included
- Kidney4
- Creatinine (U1 Waking)A concentration yardstick for the waking sample, correcting for how dilute or concentrated that urine was.An off value warns that hydration, not hormones, may be shifting your waking readings.
- Creatinine (U2 +2 Hours)The concentration yardstick for the mid-morning sample used to judge the early cortisol decline.It keeps the +2 hour hormone values from being distorted by how much you drank.
- Creatinine (U3 Dinner)The concentration yardstick for the evening sample.Heavy fluid intake at dinner can dilute this sample, which this marker corrects for.
- Creatinine (U4 Bedtime)The concentration yardstick for the bedtime sample taken at the daily cortisol low.It flags whether over-hydration before bed is distorting your trough readings.
- Hormonal25
- b-PregnanediolThe main urinary breakdown product of progesterone, a stand-in for how much progesterone you produced.Low levels in the second half of a cycle suggest weak or absent ovulation.
- a-PregnanediolA companion progesterone metabolite that rounds out the progesterone estimate.Read with its partner, it strengthens the read on progesterone output and cycle quality.
- Estrone (E1)A secondary estrogen and the main raw material your body hydroxylates into the metabolites this panel maps.Estrone sets the size of the pool then routed down the 2, 4, and 16 pathways.
- Estradiol (E2)The most potent of your three estrogens and the main driver of estrogen's effects on tissue.Low levels align with menopausal-type symptoms; high levels add to your total estrogen load.
- Estriol (E3)The weakest of the three estrogens, more prominent in urine and during pregnancy.It rounds out the estrogen picture but carries less of estrogen's strong tissue effect.
- 2-OHE1Estrone sent down the 2-hydroxy route, generally regarded as the lower-activity way to process estrogen.More estrogen moving this way is the pattern researchers link to lower estrogen-related risk.
- 4-OH-E1Estrone sent down the 4-hydroxy route, a pathway of mechanistic interest because its products can react with DNA.A pathway worth watching, though human evidence for it as a stand-alone risk marker is limited.
- 16-OH-E1Estrone sent down the 16-hydroxy route, whose products keep more estrogen-like activity.More estrogen routed here, relative to the 2 route, is the balance tied to higher risk in some studies.
- 2-Methoxy-E1A 2-pathway metabolite after your body caps it with a methyl group, a neutralizing finishing step.Good methylation here suggests estrogen metabolites are being safely deactivated for removal.
- 2-OH-E2Estradiol processed down the same lower-activity 2-hydroxy route as its estrone counterpart.It adds to the share of estrogen moving down the generally favorable 2 pathway.
- 4-OH-E2Estradiol processed down the 4-hydroxy route, the catechol pathway of most mechanistic concern.Elevated 4-hydroxy products prompt attention to how well your body neutralizes them, an exploratory read.
- Total EstrogenThe combined pool of your estrogens, a single figure for overall estrogen exposure.Higher total estrogen has been tied to greater breast cancer risk in postmenopausal cohort studies.
- 2-OH / 16-OH-E1 BalanceThe classic ratio weighing the lower-activity 2 route against the more estrogen-like 16 route.A higher ratio shows mixed, mostly favorable signals; the individual ratio alone is not a validated risk test.
- 2-OH / 4-OH-E1 BalanceWeighs the favorable 2 route against the DNA-reactive 4 route.A tilt toward the 4 route is a discussion point about detoxification support, not a diagnosis.
- 2-Methoxy / 2-OH BalanceShows how completely your body finishes and neutralizes its 2-pathway estrogen metabolites.A low ratio suggests the methylation step that deactivates these catechol estrogens may be sluggish.
- DHEA-SThe main adrenal androgen precursor (DHEA in its stored, sulfated form), a marker of adrenal reserve.Low levels can accompany aging or a depleted adrenal picture; high levels point to adrenal androgen excess.
- AndrosteroneA major 5-alpha androgen breakdown product and a well-established marker of 5-alpha-reductase activity.High androsterone signals androgens are being pushed toward the potent DHT-forming route.
- EtiocholanoloneThe matching 5-beta androgen breakdown product, an inactivation route with no androgen effect.Its balance against androsterone shows which way your body prefers to process androgens.
- TestosteroneYour main androgen, measured here as the urinary output reflecting production and metabolism over the day.Read with its metabolites, it shows not just how much you make but where it goes next.
- 5a-DHTA more potent androgen called DHT that your body makes from testosterone through the 5-alpha route.Higher DHT-route activity is linked to acne, scalp hair loss, and unwanted hair growth.
- 5a-AndrostanediolA downstream 5-alpha metabolite that tracks activity of the potent androgen pathway.Elevated levels reinforce a picture of stronger androgen signaling, relevant to skin and hair symptoms.
- 5b-AndrostanediolThe 5-beta counterpart, part of the inactivation side of androgen metabolism.A rise here favors the quieter, non-activating route for handling androgens.
- Epi-TestosteroneA near-twin of testosterone with no androgen activity, useful as an internal reference point.Its ratio to testosterone helps flag outside testosterone use and puts your own output in context.
- DHEA-SThe main adrenal androgen precursor (DHEA in its stored, sulfated form), a marker of adrenal reserve.Low levels can accompany aging or a depleted adrenal picture; high levels point to adrenal androgen excess.
- 6-OH-Melatonin-SulfateThe main breakdown product of melatonin, your overnight sleep-timing hormone; a single morning sample gauges total overnight output, not precise timing.The best-validated of the extra markers, it tracks your body's own nighttime melatonin output.
- Nutrients5
- MethylmalonateA functional marker of vitamin B12 status that rises when B12 runs short inside cells.An elevated value suggests a functional B12 shortfall worth confirming with a blood test, though reduced kidney function can also raise it.
- XanthurenateA byproduct that builds up when vitamin B6 runs low, making it a functional B6 marker.A high value points toward a functional B6 insufficiency, an exploratory read best confirmed separately.
- KynurenateA tryptophan-pathway byproduct that also reflects vitamin B6-dependent steps.Read with xanthurenate, it supports a picture of B6 status and tryptophan handling.
- b-HydroxyisovalerateA byproduct that rises when biotin, one of the B vitamins, is in short supply.An elevated value suggests functional biotin insufficiency; note biotin supplements can skew immunoassay-based lab tests.
- PyroglutamateA marker tied to demand on glutathione, the body's main built-in antioxidant.A high value suggests your antioxidant system is being drawn down, an exploratory signal.
- Stress & Recovery15
- Cortisol (U1 Waking)Your morning cortisol peak from the brain-and-adrenal stress axis (the HPA axis), the surge meant to wake you and mobilize energy.A low waking value suggests a blunted morning rise; a very high one points to an over-firing stress axis.
- Cortisol (U2 +2 Hours)Cortisol about two hours after waking, showing how quickly the morning peak begins to fall.Staying high here suggests your expected mid-morning decline is running late.
- Cortisol (U3 Dinner)Evening cortisol, which should sit well below your morning value as the day winds down.An elevated dinner value suggests a rhythm shifted late, often tied to stress or irregular routines.
- Cortisol (U4 Bedtime)Your cortisol at bedtime, when levels should sit near their daily low as your body prepares for sleep.A high bedtime value is the reading most likely to explain trouble falling asleep or staying asleep.
- Cortisone (U1 Waking)The inactive form of cortisol at waking; tissues convert cortisol to cortisone to control its strength.Paired with waking cortisol, it keeps the morning active-hormone estimate from being overstated.
- Cortisone (U2 +2 Hours)Inactive cortisone two hours after waking, tracking the on-and-off switch through mid-morning.Cortisol falling while cortisone holds suggests tissues are actively dialing the hormone down.
- Cortisone (U3 Dinner)Evening cortisone, mirroring active cortisol as the day's output tapers.Evening cortisone that stays high echoes a rhythm that has not settled for the night.
- Cortisone (U4 Bedtime)Bedtime cortisone at the daily low, completing the day-long active-plus-inactive picture.It confirms whether your whole cortisol system has reached its nightly floor.
- 24 Hour Free CortisolThe unbound, active cortisol excreted across the whole day, a running total of active hormone exposure.A high day-long total is the classic screen for cortisol excess and warrants medical follow-up.
- 24 Hour Free CortisoneThe day's total of cortisol's inactive partner, read next to free cortisol to keep the active estimate honest.The cortisol-to-cortisone comparison hints at how tissues are switching the hormone on and off.
- a-TetrahydrocortisolA major cortisol breakdown product (a-tetrahydrocortisol) that feeds the total-production estimate.With the other breakdown products, it captures output that the free-cortisol curve alone can miss.
- b-TetrahydrocortisolA second cortisol breakdown product (b-tetrahydrocortisol) used to gauge total cortisol turnover.Its balance against the cortisone breakdown product reflects an enzyme that switches cortisol on and off.
- b-TetrahydrocortisoneThe main breakdown product of cortisone (b-tetrahydrocortisone), the inactive side of the ledger.The cortisol-metabolite to cortisone-metabolite ratio flags whether that on-off enzyme is over- or under-working.
- Metabolized CortisolThe total of cortisol's breakdown products, the best single estimate of how much cortisol your body actually made across the day.Low total production can hide behind a normal-looking curve; a high total points to genuine cortisol excess.
- Cortisol Clearance RateHow fast your body clears cortisol, comparing breakdown products against the free cortisol left in urine.Fast clearance can make free cortisol look low even when production is normal, and slow clearance the reverse.
- Gastrointestinal1
- IndicanA byproduct of gut bacteria fermenting protein, used as a rough marker of gut imbalance.Elevated indican hints at bacterial overgrowth or protein malabsorption; treat it as a screening clue only.
- Neurological3
- HomovanillateA breakdown product of dopamine (called HVA), included as a rough marker of dopamine turnover.It reflects mostly body-wide, not brain, dopamine handling, so read it as exploratory context.
- VanilmandelateA breakdown product of adrenaline and noradrenaline (called VMA), a rough marker of stress-chemical turnover.Like its dopamine counterpart, it is largely peripheral and best treated as exploratory, not a stress diagnosis.
- QuinolinateA tryptophan-pathway metabolite studied as a marker of inflammatory tone in the nervous system.Interpret as exploratory context; it does not directly measure brain chemistry or diagnose anything.
About DUTCH Complete
Most hormone testing hands you a snapshot: one blood draw, one moment, one number for each hormone. Your body does not run on snapshots. Cortisol climbs and falls on a daily clock, and your liver constantly reshapes estrogen and testosterone into other compounds that carry effects of their own.
This panel works differently. From urine collected at four points across a single day, it maps how much of each hormone you make, the daily rhythm of your stress hormones, and the specific routes your body uses to break sex hormones down.
What This Panel Reveals
This is a pattern-based, exploratory panel used mainly in functional and preventive settings. Major medical societies do not endorse dried urine hormone panels for diagnosing hormone disease, and there are no validated cutoffs for popular ideas like 'adrenal fatigue.' What it offers is a wide, timed map you can track over time and bring to a clinician.
The first layer is production. The panel measures your three estrogens, markers of progesterone output, testosterone, and the main adrenal androgen supply. Together these describe your sex hormone levels, and for women still cycling, whether ovulation is generating enough progesterone.
The second layer, and the reason to use urine, is what happens next. Your body actively breaks hormones down, and the routes it chooses matter. This panel follows estrogen down its different breakdown pathways and cortisol through its full daily rhythm, information a single blood level cannot show.
Your Estrogen Breakdown Routes
After estrogen does its job, your body clears it down one of three routes, commonly called the 2, 4, and 16 pathways. The 2 route yields lower-activity products, the 16 route keeps more estrogen-like activity, and the 4 route produces compounds of mechanistic interest because they can react with DNA.
The panel reports each pathway plus balancing ratios between them. In postmenopausal cohort studies, a higher share of estrogen moving down the 2 pathway relative to the 16 pathway has generally tracked with lower breast cancer risk, while the total amount of estrogen has tracked with higher risk. The single 2-to-16 ratio on its own has been an inconsistent predictor, so read these as exploratory signals rather than a risk score.
Your Daily Cortisol Rhythm
Cortisol, run by the brain-and-adrenal stress axis (the HPA axis), should peak within an hour of waking and fall to a low at night. Four timed samples let you see that shape, and a flattened curve, with morning and night close together, is the pattern most consistently linked in research to poorer health and higher mortality.
Free cortisol at four points tells you about timing. Breakdown products add total production and clearance speed, which the daytime curve alone can miss. Someone can show normal free cortisol yet be making very little or clearing it unusually fast, and only the metabolites reveal that.
How to Read Your Results Together
Individual numbers matter less than the patterns between them. A few examples:
| Pattern You See | What It May Suggest |
|---|---|
| Cortisol high at waking, low at bedtime | A healthy daily rhythm, the shape tied to better outcomes in research. |
| Waking and bedtime cortisol close together | A flattened rhythm, the pattern most consistently linked to poorer health. |
| Normal free cortisol but low total breakdown products | Real production may be low despite a normal-looking curve, or you may be clearing cortisol fast. |
| Normal testosterone with high androsterone and 5-alpha metabolites | Androgens routed toward the potent DHT pathway, seen with acne, hair loss, and PCOS. |
For androgens, the panel shows whether testosterone is being pushed toward a more potent androgen called DHT (dihydrotestosterone). High androsterone and 5-alpha metabolites point that way, a pattern seen with acne, scalp hair loss, and polycystic ovary syndrome (PCOS), even when testosterone itself looks normal.
What to Do with Your Results
Use results as a map, not a verdict. A flattened cortisol curve or a high day-long cortisol total is worth confirming, and a very high total warrants medical follow-up. Estrogen routing and androgen patterns are best discussed with a clinician who can pair them with blood work and your symptoms.
Because these markers shift with sleep, stress, cycle phase, and hydration, single results are noisy. Retesting every three to six months after a change lets you watch the trend, which carries more meaning than any one draw. Where a firm diagnosis is the goal, standard blood tests and, for adrenal disease, validated urine or blood workups remain the reference.
When Results Can Be Misleading
Some confounders hit the whole panel at once. Every marker is adjusted for urine concentration using creatinine, and in single-timepoint samples that correction is imperfect, so hydration can nudge many values together. Collection timing, illness, and hard exercise in the prior day can also shift steroid output broadly.
Medications matter across the board. Hormone therapy, birth control, and steroid creams or pills change the hormone readings directly, melatonin supplements distort that marker, and reduced kidney function alters how hormones are cleared into urine. Biotin supplements mainly interfere with immunoassay-based lab tests rather than the lab method this panel uses to measure its steroid markers, so their effect here is limited. Interpretation also depends on sex, age, and, for women, where you are in your cycle.