Medically reviewed by Dr. Pamela Frank, BSc(Hons), ND
Patients often ask me whether the DUTCH test is “better” than standard bloodwork for assessing hormones. The honest answer is that they’re validated for different things, and neither one replaces the other across the board. Here’s what each can actually tell you, and where the evidence gets thinner than the marketing suggests.
What Blood (Serum) Hormone Testing Does Well
Standard blood testing is the foundation of hormone assessment for good reason. Decades of large-scale research have linked specific serum levels to specific diagnoses and treatment thresholds: TSH cutoffs for hypothyroidism, day 3 FSH, LH, estradiol and AMH for ovarian reserve, fasting insulin for insulin resistance. These reference ranges are outcome-linked, meaning they were built by correlating blood levels with actual health outcomes across large populations, not just by measuring what’s typical.
Blood testing is also what’s covered by OHIP when ordered by a medical doctor for a medically appropriate reason, and it’s what every specialist you might be referred to, whether endocrinology, fertility, or otherwise, will expect and interpret using the same standards.
Where Blood Testing Falls Short
The main limitation is timing. A standard blood draw is a single point-in-time snapshot. For hormones that fluctuate throughout the day, cortisol being the clearest example, one morning draw tells you the level at that moment and nothing about the pattern across the day. Saliva cortisol testing allows for multiple collections throughout the day to map the pattern of diurnal cortisol production.
For hormones with monthly cycles, timing the draw to the right cycle day matters enormously, and a mistimed draw can look abnormal when it isn’t.
Blood testing also doesn’t show hormone metabolites, the breakdown products your body produces as it processes and clears hormones like estrogen. Metabolite pathway information requires a different kind of test entirely.
What the DUTCH Test Adds
The DUTCH test (Dried Urine Test for Comprehensive Hormones) uses dried urine samples collected at multiple points across the day. Two things it’s genuinely built to capture that a single blood draw isn’t:
- A diurnal cortisol pattern. Instead of one morning cortisol value, DUTCH collects four samples across the day to map the rise-and-fall pattern. Research on the underlying method found close agreement between dried and liquid urine cortisol measurements, and that the diurnal pattern captured through urine matched the pattern captured through saliva testing.1
- Estrogen and androgen metabolite pathways. DUTCH breaks estrogen (estradiol, estriol, estrone) and testosterone down into their metabolite fractions, information a standard serum estrogen (estradiol only) or testosterone level doesn’t provide. Validation research on this method found good to excellent agreement between dried urine and both liquid urine and 24-hour urine collection for these metabolites.2
The underlying collection method, meaning whether dried urine accurately reflects what’s actually in the urine, holds up reasonably well in the research that exists.
Where the DUTCH Test’s Evidence Is Thinner
This is the part worth being direct about. The validation studies just cited were conducted by Precision Analytical, the company that manufactures the DUTCH test, using their own researchers. That doesn’t make the findings wrong, but it does mean this isn’t independent, third-party validation, and it’s a meaningfully different evidence standard than the decades of independently replicated outcome data behind standard serum testing.
More importantly, confirming that a test method measures something consistently (methodological validity) is a different question from confirming that the specific values and ratios on a DUTCH report predict health outcomes or should drive treatment decisions (clinical validity). For most of the metabolite ratios and pathway markers on a DUTCH report, that second kind of evidence, the kind linking a specific ratio to a specific outcome across large populations, doesn’t yet exist the way it does for serum TSH or fasting insulin. The DUTCH test is not FDA-cleared, and major endocrine and reproductive medicine bodies have not endorsed it as a replacement for standard testing in diagnosing thyroid disorders, adrenal conditions, or reproductive hormone imbalances.
How I Use Each Test in Practice
In my own practice, this isn’t an either/or choice. Blood testing is where diagnosis starts for anything with established clinical thresholds: thyroid function, ovarian reserve, insulin resistance, PCOS, and any condition with a guideline-based or clinical outcome cutoff.
I use the DUTCH test selectively, for specific questions blood testing genuinely can’t answer well: mapping a cortisol pattern across the day when circadian rhythm disruption is suspected, or investigating estrogen metabolite pathways when that level of detail is clinically relevant to the case.
If you’re unsure which test is appropriate for your situation, that’s exactly the kind of question a proper intake and case review with me sorts out, rather than ordering every available test by default. See lab testing at my Toronto naturopath practice → for more on how I approach test selection, or the estrogen metabolism pathway page → for more on what estrogen metabolite testing specifically can add.
Frequently Asked Questions
Is the DUTCH test more accurate than a blood test?
Neither is more accurate across the board. They measure different things. Blood testing has decades of historical use for standard hormone assessment, but it needs to be interpreted in the context of what is optimal or ideal, not just lab averages.
DUTCH captures information blood testing structurally can’t, like a cortisol pattern across the day, but the clinical evidence linking its specific metabolite ratios to health outcomes is less established.
Is the DUTCH test covered by OHIP or insurance?
No. DUTCH is a functional lab test paid out of pocket, unlike standard bloodwork through LifeLabs or Dynacare, which OHIP covers when ordered by a medical doctor (not when ordered by a naturopath) for a medically appropriate reason. Some extended health plans may reimburse functional testing under a lab testing, diagnostic testing, or medical testing benefit, or under a Health Spending Account; check your specific plan.
Why would my naturopathic doctor order both tests?
Because they answer different questions. Blood testing establishes a diagnosis and can provide valuable information about frank hormone imbalances. DUTCH can add information about pattern (cortisol across the day) or pathway (how estrogen is being metabolized) that supports the treatment plan once a diagnosis is established, not in place of it.
Should I be skeptical of DUTCH test marketing claims?
It’s reasonable to apply the same scrutiny you’d apply to any test’s marketing. The core dried urine methodology has published validation research behind it, though that research comes primarily from the test’s manufacturer rather than independent investigators. The clinical significance of many specific metabolite ratios on a DUTCH report is less firmly established than the reference ranges used in standard bloodwork.
How Often Do I Order DUTCH Testing in Practice?
The honest answer is, rarely. It is an expensive test. Most often, I would recommend comprehensive serum hormone levels, which will be covered by OHIP if your medical doctor orders them.
Rather than testing hormone metabolites through the DUTCH test, if I suspect there may be liver hormone metabolism issues, I will support all of the necessary steps for efficient Phase I and Phase II liver hormone processing (hydroxylation, methylation, sulfation, glucuronidation).
I would never replace extensive blood testing for hormones with a DUTCH test.
DUTCH Test vs. Standard Blood Hormone Panels References
- Newman M, Curran DA, Mayfield BP. Dried urine and salivary profiling for complete assessment of cortisol and cortisol metabolites. J Clin Transl Endocrinol. 2020 Nov 27;22:100243. doi: 10.1016/j.jcte.2020.100243. PMID: 33354516; PMCID: PMC7744704.
- 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 Chem. 2019 Feb 4;13(1):20. doi: 10.1186/s13065-019-0539-1. PMID: 31384769; PMCID: PMC6661742.
- Newman M, Smeaton J. Exploring the impact of 3,3′-diindolylmethane on the urinary estrogen profile of premenopausal women. BMC Complement Med Ther. 2024 Nov 22;24(1):405. doi: 10.1186/s12906-024-04708-7. PMID: 39578798; PMCID: PMC11583660.
