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Is the DUTCH test worth it? Cost and evidence by section
Whether a test is worth it depends on why it is being ordered, which is a question for you and a clinician. What we can show is what the DUTCH Complete costs, what each section of the report is backed by, and what it does not tell you (prices checked Oct 19, 2026).
| DUTCH Complete | |
|---|---|
| Prices we track | $350–$499 (10 listings from 10 sellers) |
| Lowest open to the public | $350 at DHA Laboratory |
| Overall evidence level | Emerging |
What the evidence says
We found no clinical guideline or systematic review that evaluates dried-urine hormone panels such as DUTCH. For a related use, the Endocrine Society's Cushing's syndrome guideline lists 24-hour urine free cortisol (at least two collections), late-night salivary cortisol and dexamethasone suppression testing as initial tests; it does not address dried spot-urine testing. Validation studies of the dried-urine method, led by Precision Analytical's founder, reported close agreement between dried and liquid urine, and between the four-spot collection and a 24-hour collection, for most hormones measured; these studies assess measurement agreement, not clinical outcomes.
Evidence section 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. |
What it does not tell you
- We found no guideline or systematic review that evaluates dried-urine hormone panels such as DUTCH; the method studies measure agreement with liquid urine, not clinical outcomes.
- The Menopause Society (2022): "Salivary and urine hormone testing to determine dosing are unreliable and not recommended."
- Guidelines on testosterone and menopause use blood tests or no tests at all; see DUTCH test vs blood test.
This page does not say whether anyone should take the test. Insurance and HSA/FSA rules are covered in insurance and HSA for lab tests.
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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
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.
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