Home › Guides › DUTCH test vs blood test
DUTCH test vs blood test: how hormone testing differs
The DUTCH test measures hormones and their breakdown products in dried urine collected at home over a day; standard hormone tests measure hormones in a blood (serum) sample. Here is how they differ and what guidelines say about how hormones are usually measured (checked Oct 21, 2026).
| DUTCH (dried urine) | Blood (serum) hormone tests | |
|---|---|---|
| Sample | Dried urine strips collected at home over one day | A blood draw, usually at one time point |
| What it reports | Sex hormones and their metabolites (estrogens, progesterone metabolites, androgens), the daily pattern of free cortisol and cortisone plus cortisol metabolites, a melatonin metabolite (6-OHMS), an oxidative-stress marker (8-OHdG) and several urinary organic acids, according to the lab and seller descriptions. | Circulating hormone levels at the time of the draw (for example total testosterone, estradiol, FSH) |
| Our evidence level | Emerging (sections below) | Not rated here; see the guideline statements below |
| Prices we track | $350–$499 (10 listings, DUTCH Complete) | We don't track blood hormone tests yet |
How guidelines measure hormones
- Testosterone in men (Endocrine Society, 2018): "We recommend diagnosing hypogonadism in men with symptoms and signs of testosterone deficiency and unequivocally and consistently low serum total testosterone and/or free testosterone concentrations (when indicated)." The guideline also says to confirm "by repeating the measurement of morning fasting total T concentrations", and recommends "against routine screening of men in the general population for hypogonadism."
- Menopause (NICE NG23): for people aged 45 or over with menopause-associated symptoms, NICE says to identify perimenopause or menopause "without laboratory tests", and not to use tests including oestradiol to identify it. It suggests considering a serum FSH level only in specific groups, such as people aged 40 to 45 with symptoms.
- Hormone therapy dosing (The Menopause Society, 2022): "Salivary and urine hormone testing to determine dosing are unreliable and not recommended. Serum hormone testing is rarely needed."
We found no guideline that evaluates dried-urine hormone panels such as DUTCH. A method study led by the lab's founder reported close agreement between dried and liquid urine; that measures agreement, not clinical outcomes.
DUTCH evidence by section
| Section | Our evidence level | Why |
|---|---|---|
| Cortisol / cortisone daily pattern and metabolites | Emerging | The Endocrine Society Cushing's guideline uses 24-hour urine free cortisol, late-night salivary cortisol and dexamethasone suppression, not dried spot urine; manufacturer-led studies report agreement with liquid/24-hour urine. |
| Estrogens and estrogen metabolites | Emerging | We found no guideline or systematic review that evaluates dried-urine estrogen metabolite testing. A systematic review of nine studies (Obi et al., 2011) concluded that "the results of the prospective studies do not support the hypothesis" that the 2-hydroxyestrone to 16α-hydroxyestrone ratio can be used as a predictive marker for breast cancer. The Menopause Society (2022) states that "salivary and urine hormone testing to determine dosing are unreliable and not recommended." A manufacturer-led method study reports agreement between dried and liquid urine. |
| Progesterone metabolites | Emerging | We found no guideline or systematic review that evaluates dried-urine progesterone metabolite testing. A narrative review (Su et al., 2017) cites a study in which urinary pregnanediol-3-glucuronide above a threshold on three consecutive days "could be used as positive confirmation of ovulation with a sensitivity of 92.2% and a specificity of 100%"; that study used a different collection method. The Menopause Society (2022) states that urine hormone testing to determine dosing is unreliable and not recommended. |
| Androgens and androgen metabolites | Emerging | Guidance on androgen testing is based on blood: the 2019 Global Consensus Position Statement on testosterone therapy for women says total testosterone "can be measured with high accuracy and reproducibility using liquid/gas chromatography and tandem mass spectrometry assays", and that "no cutoff blood level can be used for any measured circulating androgen to differentiate women with and without sexual dysfunction." We found no guideline or systematic review that evaluates urinary androgen metabolites for these uses. |
| Melatonin metabolite (6-OHMS) | Emerging | A meta-analysis of reference intervals (Braam and Spruyt, 2022; 68 studies) states that measuring 6-sulfatoxymelatonin "corrected for creatinine, in the first morning void is the most simple as well as reliable method to evaluate the total amount of melatonin produced at night", and reports that values vary with age. We found no guideline on clinical use, and no independent study of the dried-urine waking-sample protocol. |
| 8-OHdG (oxidative stress) | Emerging | A systematic review and meta-analysis (Graille et al., 2020; 84 articles) states that urinary 8-OHdG "can potentially be used to quantify excess oxidative stress due to external exposures when background values have been established in different populations", and that chromatographic methods "are considered to be the gold standard." We found no guideline on clinical use. |
| Organic acids (B-vitamin, neurotransmitter, glutathione markers) | Emerging | Same evidence as the OAT marketed uses: the 2026 review found studies did not establish that test-guided assessment improves outcomes. |
This page summarizes guidelines and published evidence; it is not advice about which test to take or what results mean. Talk with a clinician.
Compare prices
See also: DUTCH Complete vs DUTCH Plus · Is the DUTCH test worth it?
Sources
- Nieman LK, et al. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526. https://pmc.ncbi.nlm.nih.gov/articles/PMC2386281/
- Newman M, Curran DA. Reliability of a dried urine test for comprehensive assessment of urine hormones and metabolites. BMC Chem. 2021;15:18 (authors are Precision Analytical's founder and an employee). https://pmc.ncbi.nlm.nih.gov/articles/PMC7962249/
- 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;13:20 (Precision Analytical study). https://pmc.ncbi.nlm.nih.gov/articles/PMC6661742/
- Obi N, et al. Estrogen metabolite ratio: Is the 2-hydroxyestrone to 16α-hydroxyestrone ratio predictive for breast cancer? Int J Womens Health. 2011;3:37-51. https://pmc.ncbi.nlm.nih.gov/articles/PMC3039007/
- The North American Menopause Society. The 2022 hormone therapy position statement. Menopause. 2022;29(7):767-794. https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
- Su HW, et al. Detection of ovulation, a review of currently available methods. Bioeng Transl Med. 2017;2(3):238. https://pmc.ncbi.nlm.nih.gov/articles/PMC5689497/
- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
- Braam W, Spruyt K. Reference intervals for 6-sulfatoxymelatonin in urine: A meta-analysis. Sleep Med Rev. 2022;63:101614. https://doi.org/10.1016/j.smrv.2022.101614
- Graille M, et al. Urinary 8-OHdG as a Biomarker for Oxidative Stress: A Systematic Literature Review and Meta-Analysis. Int J Mol Sci. 2020;21(11):3743. https://pmc.ncbi.nlm.nih.gov/articles/PMC7313038/
- Schauer M, et al. Urinary Organic Acid Analysis in Preventive Health Assessment and Healthy-Aging Research: A State-of-the-Art Review. Metabolism Open. 2026 (abstract read only). https://doi.org/10.1016/j.metop.2026.100511
- Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy
- NICE. Menopause: identification and management (NG23), recommendations 1.3.1-1.3.6. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations
Evidence summaries are those on our test pages; guideline quotes checked 2026-10-21. Prices update when we re-check sellers.
Informational only, not medical advice. See about & disclaimer.
Get price-drop alerts
A short email when a tracked test's lowest price changes, plus new tests and sellers as we add them. Free, no spam, unsubscribe anytime.
A short email when a tracked test's lowest price changes, plus new tests and sellers as we add them. Free, no spam, unsubscribe anytime.
Sign up for alertsOpens a 30-second form (hosted on Notion). It asks for your email and first name.