Have you ever been told your blood tests are “normal” while dealing with stubborn symptoms like acne, fatigue, poor sleep, painful periods, or low mood?
You leave the doctor’s office thinking, why do I still feel unwell?
That’s the frustration so many of my clients share when they come to me. And honestly, I’ve been there myself. That’s why the DUTCH test (Dried Urine Test for Comprehensive Hormones) has become one of my favourite tools in clinic — because it shows what standard tests miss.
It doesn’t just tell you how much hormone is circulating. It shows how your body is processing, metabolising, and clearing those hormones — and whether your stress response, detox pathways, and inflammation levels are helping or hindering that process.
Let’s unpack how it works, who it’s for, and what kind of patterns I see over and over again.
Why the DUTCH Test Is Different
Most hormone blood panels offer a snapshot: one point in time, usually with just free hormone levels. But they don’t show whether your body is converting testosterone into more potent forms, whether your estrogen is being metabolised down the inflammatory pathway, or how much total cortisol you’re making and clearing across the day.
The DUTCH Complete gives us a full picture of:
- Estrogen, progesterone, testosterone, DHEA
- Cortisol and cortisone rhythms and total output
- 5-alpha reductase activity, 5α-androstanediol (crucial in acne and PCOS)
- Estrogen metabolism (2-OH, 4-OH, and 16-OH pathways)
- Methylation capacity (especially COMT function)
- Organic acids — like markers for inflammation, B-vitamin status, melatonin, oxidative stress, and more
This is what makes it so useful — especially for women in their 20s through perimenopause and menopause, or even for men with low libido, fatigue, and aromatisation patterns.
Case Study: Acne and Androgens
Let’s start with something I see all the time — persistent hormonal acne around the jaw and chin, especially in the week before a period.
Blood tests might show “normal” testosterone. But the DUTCH test often reveals that the 5-alpha reductase pathway is dominant — converting testosterone into DHT, a much stronger androgen. That one pathway alone can drive breakouts, oiliness, and clogged pores.
I had a client in her early 30s with normal testosterone levels in blood, but on DUTCH, her 5α-androstanediol was very high. Once we supported this conversion pathway (zinc, saw palmetto, rebalancing stress), her skin started to improve.
Other acne drivers I check for:
- High DHEA-S (especially in women under chronic stress)
- High Estrogen and Low estrogen clearance — if the body’s detox systems are sluggish, estrogen levels build up, its not cleared from the body
- Elevated 4-OH estrogen — which is inflammatory and can worsen skin
- Stress/cortisol imbalance — which disrupts skin repair and triggers inflammation
And sometimes, it’s about the gut-skin-hormone triangle. Dr. Julie Greenberg’s work highlights how Candida or H. pylori can flare acne via immune disruption. I see this pattern often in women whose skin doesn’t respond to typical topical treatments — but improves when we address stress, gut health, and hormonal pathways together.
Case Study: PCOS That Isn’t “Classic”
PCOS is another area where the DUTCH test makes a huge difference. Not every woman with irregular cycles and fatigue has insulin-driven, ovarian PCOS.
While insulin resistance often drives ovarian testosterone production, the HPA axis also plays a role by increasing DHEA and androstenedione. These androgens can convert to testosterone in other tissues — independently of the ovaries or insulin.
So, a woman can show classic PCOS symptoms without having cysts or insulin resistance.
I’ve worked with several clients — including a recent one in her mid-20s —irregular cycles, normal weight, insulin and blood glucose levels. Her blood testosterone was within range, but her DUTCH showed low DHEA-S and high DHEA metabolites (indicating inflammation), she was making a lot of cortisol, very low progesterone (not ovulating), unhealthy phase 1 detox (favours 4-OH and 16-OH), strong 5-alpha dominance. Classic adrenal-type PCOS, made worse by years of undereating and overexercising.
The DUTCH helped us see:
- Her androgen excess was adrenal, not ovarian
- Her stress system (HPA axis) was driving the imbalance
- Her estrogen was clearing down the wrong pathways
- Her methylation was impaired
We started her on blood sugar-balancing meals and adaptogenic herbs to improve cortisol levels, focused on recovery and sleep, restored ovulation and used gentle support for her detox pathways. Her cycle began to regulate within 3 months.
This is why I always say: hormones don’t exist in isolation. If we don’t check the patterns beneath the surface, we risk treating the wrong problem.
The Estrogen Metabolism Patterns No One Is Talking About
Here’s where DUTCH truly shines: it shows what your estrogen is doing after it’s made.
Estrogen doesn’t just float around and disappear. Your liver has to break it down into metabolites. And some are more harmful than others.
- 2-OH: Clean, protective, the pathway we want to favour
- 4-OH: Reactive and potentially DNA-damaging — often elevated when there’s oxidative stress, inflammation
- 16-OH: Proliferative — linked to symptoms like fibroids, breast tenderness, and heavy periods
One client came to me with long, painful periods and fibroids. Her estrogen levels were average, but 16-OH was disproportionately high. We supported her Phase I and II estrogen detox with sulforaphane-rich foods, magnesium, choline, and calcium d-glucarate, within two cycles, her symptoms improved.
I also look closely at COMT activity — your body’s ability to methylate estrogen and neutralise reactive metabolites. Low 2-methoxyestrone on a DUTCH test can mean sluggish methylation.
My Personal Experience: High Estrogen, Methylation, and the Estrobolome
I’ve experienced high estrogen symptoms for most of my life — things like heavy periods, breast tenderness, acne and mood swings that would come and go with my cycle. My blood test results showed that everything is ‘’fine’’. Over time, I learned that it wasn’t just about how much estrogen my body was making — it was about how well I was clearing it.
When I ran a DUTCH test, I saw signs of poor methylation, especially in the COMT pathway. I also suspected my gut was playing a role — what we call the estrobolome, the collection of gut bacteria that helps metabolise and eliminate estrogen.
If your estrobolome isn’t working properly, your body can reabsorb estrogen instead of clearing it, leading to symptoms of estrogen dominance — even if your estrogen levels appear “normal” on a blood test.
What helped me:
- Eating more cruciferous vegetables like broccoli, rocket, and cabbage
- Supporting my gut and liver detox pathways
- Using targeted supplements like calcium d-glucarate and magnesium glycinate
- Strength training and regular movement
Case Study: Burnout and Flat Cortisol
Fatigue is one of the most vague but common complaints I see in practice. And it’s easy to dismiss — especially when your TSH, B12, and iron look good.
But the DUTCH test often reveals flat cortisol rhythms, low DHEA, and signs of adrenal dysfunction. One of my clients — a full-time teacher and mum of two — had been running on empty for years. She woke wired at 4am, crashed by 2pm, and had trouble sleeping deeply.
Her DUTCH showed:
- Low total cortisol, despite “normal” blood cortisol
- Blunted cortisol awakening response
- Low melatonin
- Low DHEA and poor estrogen clearance
We worked on nervous system regulation (morning light exposure, magnesium, energising herbs, parasympathetic support) and slowly brought back her resilience.
This is why the DUTCH Plus — which includes salivary cortisol samples upon waking — is so valuable. It shows how your brain and adrenals are communicating, which is essential for women navigating perimenopause, burnout, or post-trauma fatigue.
What About Men?
Hormonal imbalance isn’t just a women’s issue. I’ve seen several male clients struggling with low libido, poor muscle recovery, or abdominal fat — who turned out to have high aromatisation (testosterone converting to estrogen, especially in fat tissue or the liver).
DUTCH reveals:
- Elevated estradiol
- Low free testosterone
- High 8-OHdG (oxidative stress)
- Sluggish detox markers
Once we addressed liver health, weight, and inflammation, those symptoms often resolved without needing testosterone replacement. Hormones are about balance, not boosting one number on a lab.
The Test I Reach For Most
The DUTCH Complete is the panel I use most often — because it captures:
- Sex hormones and their metabolites
- Cortisol rhythm and total output
- Melatonin
- Organic acids like 8-OHdG, quinolinate, and B vitamin markers
I use it to investigate:
- PMS and perimenopause symptoms
- Acne and hair loss
- Irregular cycles
- Burnout and fatigue
- Fibroids and heavy bleeding
- PCOS (both adrenal and ovarian types)
- Endometriosis and estrogen dominance
For women in high-stress jobs or navigating complex cycles, I sometimes pair it with Cycle Mapping or the DUTCH Plus for even deeper insight.
When Testing Gives You Back Control
The truth is, most of the women I work with already know something’s off. Their intuition is strong. What they need is confirmation and clarity — not to be gaslit by “normal” ranges.
The DUTCH test helps connect the dots between symptoms, stress, inflammation, and hormones. It’s a roadmap. And it’s often the turning point where we go from guessing to targeted support.
In my next post, I’ll go deeper into perimenopause, menopause, endometriosis, and fibroids — and the specific hormone patterns I see there.
Until then, if this blog resonated, or you’re curious whether DUTCH is the right next step for you, feel free to reach out.
You don’t have to settle for “it’s just your age” or “everything looks fine.”
There are answers — and I’d love to help you find them.
If you want to know which DUTCH test is right for you, go to this blog: “Which DUTCH Test Is Right for Me?”
Disclaimer:
The information shared in this blog is for educational purposes only and is not intended to replace medical advice. Always speak with your doctor or a qualified healthcare provider before making any changes to your diet, supplements, or lifestyle. The case examples described here are based on real client experiences but have been modified for privacy. Your health needs are unique, and working with a trained practitioner is essential for safe and personalised care.
You may also like: How the DUTCH Test Reveals the Full Hormonal Picture (Part 2)
