DUTCH Plus

Your hormones do not hold still. Cortisol climbs within minutes of waking and fades by night, estrogen gets broken down through several different routes, and testosterone is constantly converted into stronger or weaker forms. A single blood draw catches one frozen frame of that motion.

This panel takes a different approach. Over one day it collects several urine and saliva samples to map not just how much of each hormone you make, but how your body processes and clears it. Treat it as a functional survey used mainly in wellness and functional-medicine settings, not a diagnostic test used to rule in a disease.

What This Panel Reveals

The value here is the combination. On their own, these markers are snapshots. Read together, they sketch how your endocrine system behaves over a full day and where the hand-offs between making, activating, and clearing hormones may be shifting.

Your Daily Cortisol Rhythm

The saliva samples track cortisol and its inactive partner cortisone from waking through bedtime. A healthy pattern rises sharply in the first hour, then declines steadily. The dried-urine cortisol breakdown products add a second layer: the total amount of cortisol your body produced and cleared, which can stay normal even when free saliva levels look low because you are clearing it quickly. Cortisone often reads more reliably than cortisol at the low concentrations found overnight.

How You Process Estrogen

Estrogen is not one thing. Your body converts it down three main routes that behave differently: a 2-pathway associated in large cohort studies with lower estrogen activity, a 4-pathway that can form DNA-reactive compounds unless they are neutralized by a chemical tag called methylation, and a 16-pathway that keeps estrogen signaling switched on longer. The panel measures the parent estrogens and these breakdown products, then reports balance ratios. In postmenopausal cohorts, a higher share of the 2-pathway relative to parent estrogens has been linked to lower breast cancer risk, though this is an emerging research pattern, not a validated risk test to act on alone.

Androgens and Their Routing

Testosterone can be pushed toward its most potent form, DHT (a stronger androgen), by an enzyme called 5-alpha-reductase, or defused down an inactivating route. The panel captures both by weighing androsterone (the potent-route marker) against etiocholanolone (the inactivating-route marker). Higher activity of the potent route shows up on average in women with polycystic ovary syndrome (PCOS, a common hormonal and metabolic condition) and tracks with insulin resistance.

Functional Markers Beyond Hormones

The panel adds a short set of urinary organic acids, everyday chemical byproducts that hint at nutrient status and other systems. Some tryptophan-pathway byproducts rise when vitamin B6 is functionally low, methylmalonate rises when vitamin B12 is functionally low, and a melatonin breakdown product estimates your overnight melatonin. These give functional context around the hormone data, though the strength of evidence varies marker by marker.

How to Read Your Results Together

No single value carries the story. These interpretation patterns show why the combination matters.

Because the cortisol rhythm, and especially the surge in the first hour after waking, varies substantially from one day to the next, treat a striking single-day result as a lead to confirm, not a verdict.

What to Do with Your Results

Use this panel as a starting map, then confirm anything meaningful with validated testing. For adrenal concerns, the reference-standard tests remain a morning blood cortisol or a stimulation test, not urine or saliva profiling alone. Waking salivary cortisone, though, has performed well as a screen for true adrenal insufficiency in recent studies.

If androgens look high, serum testosterone, SHBG (the protein that binds sex hormones), and metabolic labs sharpen the picture. If estrogen routing looks skewed, review it with a clinician rather than acting on the ratio itself, because major oncology guidelines rely on tumor tissue testing, not urinary metabolites, to judge estrogen-related cancer risk.

For tracking, the panel is most useful repeated under similar conditions: the same phase of the menstrual cycle for those who cycle, the same sampling routine, and at least a couple of months between draws so real change can separate from day-to-day noise.

When Results Can Be Misleading

Several factors move many markers at once. Collection timing is the big one: cortisol values depend heavily on sampling the exact moment you wake and the minutes after, so a delayed first sample distorts the whole morning curve.

Hormonal birth control, hormone therapy, and recent corticosteroid use (including inhalers and skin creams) shift steroid readings across the board. Hydration changes urine concentration, which is why creatinine is measured in every urine sample to correct for it. And the dried-urine and saliva methods themselves have less independent validation than established blood, 24-hour urine, and lab-based saliva testing, so read the numbers as a pattern rather than precise absolutes.