The DUTCH Plus - The Ultimate Hormone Test

The DUTCH test is a cutting edge at home urine test offering a comprehensive insight into your hormone levels and how well they may or may not be functioning.

D = dried

U = urine

T = test

C = comprehensive

H = hormones

Taking hormone testing to a new level; alongside sex hormones and their metabolites, the DUTCH Plus looks at the overall diurnal pattern of free cortisol, and the total and distribution of cortisol metabolites. The inclusion of Cortisol Awakening Response (CAR) brings another important piece of the HPA axis into focus.

The addition of 6 organic acid markers turns the original DUTCH on its head - allowing for a more comprehensive understanding of the hormone and adrenal picture, especially when it comes to commonly reported symptoms such as fatigue, anxiety, insomnia, depression, motivation, sex drive, estrogen dominance, and stress.

Key Benefits:

Whilst a blood test offers a snapshot of hormone levels in time - the DUTCH test looks at the products of hormone metabolism which show how your body is processing hormones. This allows the doctor to see where there are imbalances - and even better can infer why - which allows us to tackle the root cause of health problems.

The DUTCH test is a urine steroid hormone profile that measures hormones and hormone metabolites (called conjugates) in a dried urine sample and is performed from the comfort of your home.

It's the most cutting-edge way to truly see what’s going on when it comes to your hormones.

Measuring both hormones and their by-products can give you & your practitioner a much better overall picture of hormone production. For example, a DUTCH urine steroid hormone profile on someone with low salivary cortisol could show normal cortisol production, but high levels of metabolites. In other words, this would indicate you're producing enough cortisol, but it’s just getting broken down into its metabolites very quickly.

With serum (blood) and saliva hormone spot-testing, it’s possible to track variations in hormone release throughout the day – and this is a great way to measure how your hormones change during a 24-hour period (your circadian rhythm). In contrast, a standard 24-hour urine collection many physicians use reflects your total hormone output in a 24-hour period.

But by using the DUTCH urine steroid test, you get the best of all worlds: blood, saliva and urinary results with just a urine collection.

Do note that the results from the DUTCH are complex and do require skilled interpretation.

The DUTCH test traditionally measures the following:

Free cortisol

Free cortisone






Progesterone metabolites (a-pregnanediol, b-pregnanediol)

Androgen metabolites (DHEAS, etiocholanolone, androsterone, testosterone, 5a-DHT, 5a-androstanediol, 5b-androstanediol, epi-testosterone)

Estrogen metabolites (estrone, estradiol, estriol, 2-OH-estrone, 4-OH-estrone, 16-OH-estrone, 2-Methoxy-estrone, 2-OH-estradiol)


The New Dutch PLUS now measures:

CAR: Cortisol Awakening Response.

6 Organic Acids.

The DUTCH Gives A More Comprehensive Look At Your

You may have heard of ‘adrenal fatigue’ - the ‘condition’ whereby years of chronic stress - from whatever cause - results in ‘b u r n o u t’. Where the adrenal glands simply give up producing cortisol - the main adrenal hormone responsible for keeping us energised and responsive to daily stressors.

Cortisol production changes throughout the day, including your Cortisol Awakening Response - some people have alterations in this production pattern which can cause a range of health problems.

The DUTCH looks at Adrenal Hormones - very closely - the hormones involved in stress response - AKA  ‘fight or flight’.

Results tell us everything we need to know about the production of stress hormones (including their metabolites) and cortisol awakening response (CAR) and how well these are being cleared from the body.

What is the Cortisol Awakening Response and why is it so Important?

When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50 percent. 30 minutes after waking, cortisol levels will still show this sharp increase. But 60 minutes after waking, cortisol levels have peaked and begin to decline.

‘Measuring this rise and fall of cortisol levels at waking can be used as a 'mini stress test.'

Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range.

A Low or Blunted Cortisol Awakening Response

This can be the result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased cortisol awakening response has been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases.

Elevated Cortisol Awakening Response

This can be a result of an overreactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine) and general depression.

And a Deep Dive into your Sex Hormones.

The DUTCH delves deeper into your sex hormones too.

For example - The Main Female hormone is Oestrogen - but there are 3 main types of oestrogen - each with its own actions. The dutch test shows us these and whether you are producing some of the nastier oestrogens. Important whether on hormone replacement or not. The DUTCH is the perfect tool for assessing how well we are metabolising our oestrogens:

Methylation of estrogen is the second p r o t e c t i v e step in the estrogen detoxification process which takes place in the liver. As such it is an indirect look into liver health and often impacted by the toxic burden in today's environment. There is plenty that can be done to encourage favourable oestrogen metabolism.

For men it shows us not just Testosterone levels - but how you are converting Testosterone - into Oestrogen (aromatisation) or into the highly active (but potentially baldness causing and prostate cancer causing DHT). As clinicians, we can intervene with supplements or medications to block these pathways - so that we get better levels of the healthy hormone we actually want.

Adrenals Hormones, Sex Hormones and Now Neurotransmitters!

The Dutch Plus also provides these added Extras:

The DUTCH plus continues to provide a powerful and insightful deep dive into our major Sleep hormone and potent antioxidant, Melatonin alongside a measure of oxidative stress...

What’s more, the new and improved DUTCH Plus includes SIX organic acid markers (OATs):

Vitamin B12 + Vitamin B6 - both vitamins crucial to optimal cellular function.

Glutathione- our master antioxidant, neutralize free radicals and prevent cellular damage.

Norepinephrine/epinephrine - Think ‘fight or flight’ hormones and another excellent insight into your adrenal nervous system health.

Serotonin - the pleasure, mood and sleep hormone.

Dopamine - the key reward, motivation and pleasure hormone.

We like to think of excitatory Dopamine as the gas pedal and Inhibitory serotonin as the brakes! The relationship between these two amino acid-based neurotransmitters is complex and crucial to wellbeing and here at Fibr we are well versed in optimising and rebalancing these chemical messengers.

All of these markers are essential to metabolism, neurotransmitter transmission, cognition, hormone output/production, general well being and much more. These insightful organic acid markers are intrinsically tied up with our complex adrenal and sex hormone system, therefore enable greater scope and context when interpreting these results.

So the DUTCH Plus really does provide the necessary cellular deep dive when investigating complex hormonal related issues. It is the most powerful tool for optimizing stress and sex hormone health by looking much deeper to include all metabolites and now several powerful organic acids markers.

This allows us to put the data into context for you but more importantly tell you what you can do to improve your health. We know our DUTCH :)

Is it for me?

Are you experiencing any of the following:

Feelings of ‘burnout’ AKA ‘Adrenal Fatigue’

Optimise and improve body composition

Improve adaptation to current exercise regime

Stubborn weight gain

Sleep Problems

Anxiety/Low Mood/Motivation

Hormonal issues - Mood-related, Low libido, Oestrogen dominance.

If you are experiencing one or more of the above or simply wish to explore your current hormonal health then the DUTCH Plus is a superb place to start.  

Find out more about your own stress hormones today - Contact Fibr for more information our upgrade your Hormone and Neurotransmitter health today for £419