DUTCH Adrenal Metabolism

DUTCH Adrenal Metabolism

This test is suitable for anyone looking for a comprehensive way to measure and assess the impact of stress levels on their health. This profile provides insight into the body’s ability to manage stress by assessing the hormones cortisol and DHEA. Imbalances in these hormones can result in a wide range of symptoms from fatigue to loss of motivation, depression and hormonal problems.

What do the adrenal hormones do?

The HPA-axis is responsible for the stress response and gut brain communication. When a physical or psychological stressor occurs, the brain sends a message to stimulate the adrenal glands to make the stress hormone, cortisol and to a lesser extent DHEA and DHEA-S. This is part of a series of steps that start with the HPA-axis made up of the hypothalamus (H) and pituitary (P) in the brain down to the adrenal glands (A) that sit on top of the kidneys.

Normally, the HPA-axis production follows a daily pattern in which cortisol rises rather rapidly in the first 10-30 minutes after waking in order to help with energy, then gradually decreases throughout the day so that it is low at night for sleep. The cycle starts over the next morning.

There can be problems with the signalling and communication between the brain and the adrenal glands, and/or with the production of our stress hormones, resulting in many different symptoms or conditions of adrenal dysfunction.

At Smart Nutrition we pride ourselves in offering the best cost possible for the DUTCH adrenal metabolism.

 The DUTCH Adrenal Metabolism is a urine test that provides data that parallels saliva testing. It looks at:

  • 24 hour free cortisol
  • 24 hour free cortisone
  • Cortisol (free) x 4
  • Cortisone (free) x 4
  • DHEA-S
  • Metabolised cortisol (THF+THE)

Why test adrenal hormones via urine?

When testing hormones, we have the option of three different sample types which all provide different information. To better understand this you need to know the cortisol is the active hormone whilst cortisone is the inactive hormone.

1. Testing hormones in blood provides an assessment of both the active hormone and the binding protein. The binding proteins help to transport the hormones around the body.

2.  Testing hormones in saliva means we are measuring the “free”,  unbound fraction of the hormone which is bioavailable to act on cell receptors , but which usually represents only about 1-3% of total production leaving the bound part of the hormone unassessed. A 4-point salivary unbound cortisol profile provides insight into the pattern of free cortisol throughout the day.

3.  Testing hormones in urine means that the free unbound cortisol is represented in the same way as the unbound saliva, but this also assesses the total cortisol production, and a comparison between the active form of cortisol and the inactive form of cortisol (cortisone).

We can use the analogy of money to help explain this:

Testing hormones in blood is akin to having your money tied up in investments. It is present but not available to be spent (blood). When we draw down the investment and release the cash, we now have it available to spend (saliva, and also reflected by urine). Once we have spent it, all we have left after the purchase is the cash receipt (urine).

Symptoms of adrenal dysfunction may include:

  • Fatigue or low energy
  • Depression
  • Insomnia
  • Anxiety
  • Loss of libido or sex drive
  • Loss of motivation and focus
  • Weight gain
  • Mood swings
  • Poor concentration and memory


  • 24 hour free cortisol
  • 24 hour free cortisone
  • a-Tetrahydrocortisol (a-THF)
  • b-Tetrahydrocortisone (b-THE)
  • b-Tetrahyrodcortisol (b-THF)
  • Cortisol (free) x 4
  • Cortisone (free) x 4
  • DHEA-S
  • Metabolised cortisol (THF+THE)





DUTCH stands for Dried Urine Test for Comprehensive Hormones – it’s a urine hormone test.

The DUTCH test is simple and easy to do. Urine samples are taken using filter paper, making the test suitable for use at home.


DO NOT TAKE oral DHEA 48 hours before, or any oral oestrogen* or pregnanolone 72 hours
before your first collection. *Do not skip doses of birth control for this test unless instructed by your practitioner.

Always consult your GP before stopping any medication.

Any other hormones taken at night (including oral progesterone) should be taken after the
bedtime sample. Generally, hormone creams or gels can be taken as usual during the test. All
hormones taken in the morning should not be taken until after sample #4.

If you take glucocorticoids (Prednisone, Dexamethasone, etc.) check with your practitioner. For patches, pellets and injections, collect midway between doses. If you take sublingual hormones (absorbed in the mouth or under the tongue) or if you take oral hydrocortisone (cortisol), visit dutchtest.com for specific video instructions. Do please contact us for help if needed.


12 years and above.

Please return via UPS using the included label and shipping instructions.



14 days.


Your test results will be emailed to you.

DUTCH Adrenal Metabolism

related tests

Test your adrenal and sex hormones with the benefit of additional organic acid markers and your Cortisol Awakening Response tested. This will give you a comprehensive overview so that you can support any imbalances.



Please do not return samples to the laboratories that may arrive after Wednesday 27th March and up to and including Monday 2nd April.

The laboratories are closed from the 28th March – 2nd April for the Easter Holiday.