DUTCH Plus

A single blood draw captures hormone levels at one frozen moment. But hormones shift hour to hour, and the way your body breaks them down matters as much as how much it produces. The DUTCH Plus panel (Dried Urine Test for Comprehensive Hormones, Plus saliva collection) maps estrogen metabolism, androgen (male-type hormone) pathways, progesterone status, adrenal function, and cortisol rhythm across an entire day. It answers a question no single blood test can: are your hormones being produced in the right amounts and processed through safe, efficient pathways?

The "Plus" in this panel refers to the addition of saliva samples collected from mid-sleep through bedtime. These saliva samples capture something dried urine alone cannot: the cortisol awakening response, a burst of the stress hormone cortisol that normally surges within 30 to 60 minutes of waking. This rhythm is one of the most sensitive markers of how your stress system is actually functioning day to day.

What This Panel Reveals

The panel covers five distinct clinical domains from just four dried urine samples and six saliva samples, all collected at home over a single 24-hour period. Because these specimens span the full day, the results reflect how hormones behave in real life rather than at a single arbitrary moment.

Estrogen Production and Metabolism

Your body makes three forms of estrogen, and each one gets broken down through one of three main pathways. Two of those pathways produce relatively harmless byproducts. The third, called the 4-hydroxy pathway, generates byproducts that can directly damage DNA. Prospective studies have found that women with higher ratios of the protective 2-hydroxy pathway relative to other pathways had a lower risk of breast cancer. The panel measures all three estrogen types, all three breakdown pathways, and whether the protective methylation step (a detoxification process that neutralizes reactive estrogen byproducts) is keeping pace.

This matters because two women can have identical blood estrogen levels yet carry very different risks based on how their bodies process that estrogen. Standard blood tests measure only the parent hormones. They tell you nothing about which metabolic pathway is dominant or whether methylation is functioning well.

Progesterone Status

Rather than measuring progesterone directly (which fluctuates too rapidly for a spot measurement to be reliable), the panel measures its two main urinary breakdown products. These reflect total progesterone production over the collection period, giving a more stable and representative picture than a single blood value. Low levels can signal that ovulation did not occur, a weak second half of the menstrual cycle (called luteal phase deficiency), or declining ovarian function.

Androgen Production and Metabolism

The androgen section tracks testosterone and its downstream breakdown products, including the potent form called dihydrotestosterone (DHT) and several further derivatives. This reveals not just how much testosterone your body makes, but whether it is being converted preferentially toward DHT (linked to hair loss, acne, and prostate growth) or toward less active forms. It also measures DHEA-S (dehydroepiandrosterone sulfate), the most abundant adrenal hormone and a precursor to both testosterone and estrogen.

Cortisol: Production, Rhythm, and Clearance

This is where the DUTCH Plus differs most from other hormone panels. It combines two complementary measurement approaches. The dried urine samples capture total cortisol production and metabolism across the day, including how efficiently the body converts active cortisol to inactive cortisone and how quickly it clears cortisol through the liver. The saliva samples, collected at six time points from mid-sleep through bedtime, map the daily cortisol curve with enough resolution to calculate the cortisol awakening response (CAR).

The CAR is the sharp rise in cortisol that normally occurs 30 to 60 minutes after waking. A meta-analysis found that a blunted CAR is associated with fatigue and burnout, while an exaggerated CAR is linked to ongoing psychological stress. A large population-based study found that a flattened daily cortisol slope (meaning cortisol stays elevated into the evening rather than dropping) was associated with higher cardiovascular mortality. No single morning blood cortisol level can reveal these patterns.

Nutritional and Neurotransmitter Organic Acids

The panel includes several organic acid markers (small molecules produced during normal body chemistry) measured in the same urine samples. These serve as functional indicators of nutrient status and metabolic health. Methylmalonate rises when vitamin B12 is insufficient at the cellular level, even if blood B12 looks normal. Xanthurenate and kynurenate reflect vitamin B6 status and how the body handles tryptophan, a building block for the mood chemical serotonin. Homovanillate and vanilmandelate are breakdown products of dopamine and norepinephrine, offering a window into how actively these alertness and motivation chemicals are being produced and cleared. A melatonin breakdown product rounds out the picture by reflecting nighttime melatonin production, which connects sleep quality to hormonal health.

How to Read Your Results Together

The real power of this panel emerges when you read results in combination. Individual values matter less than the patterns they form across domains. Here are the most actionable interpretation patterns.

When Results Can Be Misleading

Oral contraceptives, hormone replacement therapy, and bioidentical hormones will all directly affect the results. If you are taking any form of supplemental hormones, your results will reflect that input, not your body's own production. Discuss timing and whether to pause supplementation with your provider before testing.

Hydration matters for the urine samples. The panel uses creatinine measurements at each collection point to correct for dilution, but extreme overhydration or dehydration can still affect accuracy. Biotin supplementation above 5 mg per day can interfere with some laboratory tests. Sleep disruption on the night of collection can flatten the cortisol awakening response independently of any underlying adrenal issue, so collect on a night with your typical sleep pattern.

Why Dried Urine and Saliva Together

Blood measures total and free hormone levels at a single point. Urine captures the cumulative output of hormones and, uniquely, their breakdown products over hours. Saliva captures the free (unbound, biologically active) fraction of cortisol and cortisone with enough time resolution to map the daily curve. No single specimen type can do all three jobs.

Studies comparing dried urine hormone measurements with traditional methods have shown strong correlation for major sex hormone metabolites and cortisol metabolites. The dried urine format eliminates the inconvenience of collecting all urine for 24 hours in a jug, making repeated testing practical.

Tracking Over Time

A single DUTCH Plus result is a snapshot of one day. Hormones fluctuate with your menstrual cycle, stress load, sleep quality, seasonal light exposure, and aging. The panel becomes far more valuable when repeated every 6 to 12 months, or 3 to 4 months after a targeted intervention like starting a supplement protocol, changing hormone therapy, or making significant lifestyle changes.

For premenopausal women, the timing within the menstrual cycle matters. The panel is typically collected during the mid-luteal phase (the second half of the cycle, roughly days 19 to 22 of a 28-day cycle) to capture peak progesterone production. Repeating at the same cycle phase each time allows meaningful comparison. For postmenopausal women and men, any day works, but consistency between collections improves trend accuracy.

What to Do with Your Results

Because this panel spans multiple clinical domains, different result patterns may point toward different specialists. Estrogen metabolism concerns warrant a conversation with a gynecologist or integrative medicine physician experienced in hormone health. Cortisol rhythm abnormalities may involve an endocrinologist, especially if the flattened curve is severe. Androgen patterns in women causing symptoms like acne or hair loss can be addressed by a reproductive endocrinologist or dermatologist.

The organic acid markers may flag functional nutrient insufficiencies. Elevated methylmalonate, for example, suggests a need for further B12 investigation with a blood test for methylmalonic acid or a trial of supplementation. Abnormal neurotransmitter breakdown products may warrant a broader look at mood, sleep, and nervous system function.

If your cortisol awakening response is absent or exaggerated, consider adding a sleep study or wearable sleep tracking to understand whether sleep architecture is contributing. If estrogen metabolism ratios are unfavorable, companion blood tests for methylation nutrients (folate, B12, homocysteine) can help identify the underlying bottleneck.