DUTCH Test Interpretation: What an Australian Practitioner Looks For
A DUTCH adrenal test measures the pattern, not the number.
Dried urine, collected across a day, maps the rhythm of your cortisol and how your body clears it. Here is what an Australian practitioner actually reads on the adrenal panel.
The DUTCH test is a dried-urine hormone test read by mass spectrometry.1 This guide covers the adrenal panel, the one built around cortisol, which measures free cortisol at several points across a day, the cortisol breakdown products, and DHEA.
What an Australian practitioner reads is the pattern, not a single value: the shape of the daily cortisol curve and the balance between the cortisol your tissues see and the total your adrenal glands produce. It is a functional map of adrenal rhythm, not a diagnostic test for adrenal disease, which is assessed through the standard medical pathway.2
The DUTCH adrenal panel reads dried urine at several timepoints and measures cortisol alongside its metabolites and DHEA, so it captures how cortisol is produced and cleared, not only how much is present.
The clinical signal is the diurnal cortisol pattern. A flatter slope across the day tracks with poorer health across dozens of studies.
Free versus metabolised cortisol separates tissue exposure from total output. The two can move in opposite directions, and a single blood draw cannot tell them apart.
DHEA sits beside cortisol as the other adrenal output, and reading the two together says more than either one on its own.
The adrenal panel is a functional map, not a disease test. Results that suggest something serious route to the medical pathway, sent to your GP with a written brief.
What the adrenal panel actually measures.
DUTCH stands for Dried Urine Test for Comprehensive Hormones. You collect urine on filter paper at four or five set times, usually from just before bed through to the following afternoon. The paper dries, travels to the lab by post, and is read by mass spectrometry, the same class of method clinical steroid laboratories use.1
The adrenal panel measures three things. Free cortisol at each collection point, which gives the daily rhythm rather than a single moment. The metabolised cortisol, meaning the breakdown products your body makes as it clears the hormone, which reflects total production. And DHEA, the adrenal androgen that sits alongside cortisol. Reporting the metabolites, not only the parent hormone, is what separates this test from a one-off blood draw.
Reading the cortisol curve, not the number.
Cortisol is meant to move in a daily arc. It runs highest in the morning, then falls through the day to a low point overnight. The adrenal panel measures free cortisol at four points across a day, which is enough to see the shape of that curve rather than a single value pulled out of it. A morning blood draw gives you one dot and no line.
The shape is what carries the information. A systematic review of 80 studies found that a flatter cortisol slope across the day was associated with poorer physical and mental health, most strongly with immune and inflammatory markers.3 In the Whitehall II cohort of just over 4,000 people, a flatter daily slope predicted cardiovascular death, while the single morning value on its own predicted nothing.4 A later study in people with hypertension pointed the same way, with flatter slopes and higher late-night cortisol both tracking future cardiovascular events.5 For the wider context on when and how to assess it, this pairs with our guide to cortisol testing in Australia.
A single cortisol reading is one dot. The shape of the day is the line, and the line is where the clinical signal lives.
Free cortisol and metabolised cortisol.
The panel reports cortisol two ways, and the gap between them is often the most useful part of the result. Free cortisol is the small, active fraction your tissues actually see. Metabolised cortisol, the sum of the breakdown products, reflects how much your adrenal glands produced in total. When the two disagree, that discordance points somewhere specific.
High total output with low free cortisol suggests you are producing plenty but clearing it quickly, a pattern that can travel with a fast metabolic rate or an overactive thyroid. Low total output tells a different story about production itself. Underneath this sits an enzyme, 11-beta-hydroxysteroid dehydrogenase, that switches cortisol on and off inside tissues. Its activity helps explain why someone can carry the features of high cortisol exposure in fat and liver while their blood cortisol reads normal or low.6 Urinary cortisol and cortisone metabolites, and the ratio between them, track that enzyme activity, and in women they rise with central weight and fall again when it is lost.7 Reading the metabolites is what makes that visible, because the ratios between them reveal how the enzymes are behaving, which a single cortisol level cannot.1
DHEA, the adrenal glands’ other job.
Cortisol is not the only thing the adrenal glands make. They also produce DHEA, an androgen that sits alongside cortisol on the panel, and reading the two together says more than either on its own. DHEA and its sulphate are the standard measure of adrenal androgen output, and they fall steadily with age.8
That is why the pairing matters. A picture of high cortisol drive with low DHEA reads differently from one where both sit low together, and the panel shows which of those you are looking at. Because DHEA is measured through its metabolites in dried urine, the same principle holds as for cortisol: the breakdown products describe output that a single blood level can move straight past.
What a practitioner reads on a DUTCH result.
Each line is a pattern rather than a single value. It is the relationship between numbers, not any one of them on its own, that a practitioner interprets.
| Pattern on the report | What it reveals | Why one blood test misses it |
|---|---|---|
| Diurnal free cortisol | The daily rhythm, waking to night | One draw captures a single moment |
| Free vs metabolised cortisol | Tissue exposure against total output | Blood shows one fraction, not both |
| Cortisol : cortisone | How fast cortisol is switched off in tissues | Not derivable from a single value |
| Metabolised cortisol | Overall adrenal cortisol output | A single free reading misses total production |
| DHEA and its metabolites | The adrenal androgen output | Rarely read alongside cortisol |
Where the test ends, and the medical pathway begins.
DUTCH is a map of how your hormones are working day to day. It is not a test for the diseases of the endocrine glands. Conditions such as Cushing’s syndrome, Addison’s disease, or an adrenal tumour are diagnosed through blood, imaging, and specialist assessment, and urine steroid profiling has a defined role inside that formal workup rather than replacing it.2 The test also does not diagnose “adrenal fatigue”, a popular label the evidence does not support as a clinical condition.
That boundary is deliberate. When a DUTCH result raises a red flag, the job is to recognise it and route it, which is why a result that points to something belonging with a doctor goes to your GP with a written brief. Used inside those limits, the test does something a standard panel is not built to do: it shows the rhythm and the metabolism, the how rather than only the how much, for someone who feels off while their bloods read fine.
Then how it moves →
A single cortisol reading is a snapshot. How it moves across the day is the record.
What the report actually shows.
The DUTCH adrenal panel measures cortisol alongside its metabolites and DHEA, from dried urine collected at several set times across a day.
The diurnal cortisol curve carries more information than any single cortisol value; a flatter slope tracks with poorer health.
Free cortisol reflects tissue exposure while metabolised cortisol reflects total output, and the two can diverge.
The cortisol-to-cortisone ratio reflects how quickly cortisol is switched off inside tissues, which a blood level cannot show.
The adrenal panel maps how the adrenal glands are working; it does not diagnose adrenal disease, which needs the medical pathway.
Frequently asked.
What does the DUTCH adrenal test measure that a blood test doesn’t?
It measures cortisol metabolites alongside free cortisol, tracks the cortisol rhythm across the day rather than at one moment, and includes DHEA. That lets a practitioner read how cortisol is being produced and cleared, rather than its level alone.
Is the DUTCH test diagnostic for adrenal fatigue or Cushing’s syndrome?
No. It is a functional map of hormone patterns, not a disease test. “Adrenal fatigue” is not a recognised medical diagnosis, and conditions such as Cushing’s syndrome or Addison’s disease are diagnosed through blood, imaging, and specialist assessment.
How is a DUTCH test collected?
You saturate filter-paper strips with urine at four or five set times, from before bed to the next afternoon, let them dry, and post them to the lab. There is no blood draw and no 24-hour urine jug to carry around.
Who tends to get the most from the adrenal panel?
People whose symptoms point to the stress-and-recovery system, such as disrupted sleep, low morning energy, or feeling wired at night, especially when standard bloods have come back unremarkable.
Your cortisol, read as a pattern.
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Apply to the programReferences.
- Storbeck KH, Schiffer L, Baranowski ES, et al. Steroid Metabolome Analysis in Disorders of Adrenal Steroid Biosynthesis and Metabolism. Endocr Rev. 2019;40(6):1605-1625. doi.org/10.1210/er.2018-00262
- Bancos I, Taylor AE, Chortis V, et al. Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study. Lancet Diabetes Endocrinol. 2020;8(9):773-781. doi.org/10.1016/S2213-8587(20)30218-7
- Adam EK, Quinn ME, Tavernier R, et al. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2017;83:25-41. doi.org/10.1016/j.psyneuen.2017.05.018
- Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. 2011;96(5):1478-1485. doi.org/10.1210/jc.2010-2137
- Gan L, Li N, Heizati M, et al. Diurnal cortisol features with cardiovascular disease in hypertensive patients: a cohort study. Eur J Endocrinol. 2022;187(5):629-636. doi.org/10.1530/EJE-22-0412
- Morton NM, Seckl JR. 11beta-hydroxysteroid dehydrogenase type 1 and obesity. Front Horm Res. 2008;36:146-164. doi.org/10.1159/000115363
- Rask E, Simonyte K, Lönn L, Axelson M. Cortisol metabolism after weight loss: associations with 11β-HSD type 1 and markers of obesity in women. Clin Endocrinol (Oxf). 2013;78(5):700-705. doi.org/10.1111/j.1365-2265.2012.04333.x
- Schneider HPG. Androgens and antiandrogens. Ann N Y Acad Sci. 2003;997:292-306. doi.org/10.1196/annals.1290.033
