What is Dutch testing (Dried Urine Test for Comprehensive Hormones)?

What is DUTCH Testing?

DUTCH testing (Dried Urine Test for Comprehensive Hormones) is a method of hormone assessment that uses four dried spot urine samples collected throughout the day on filter paper to measure reproductive hormones, cortisol, cortisol metabolites, and organic acids via mass spectrometry, normalized to urine creatinine. 1, 2

Collection Method

• Four dried spot urine samples are collected during waking hours throughout a single day 1
• Samples are collected on filter paper and allowed to dry 1
• This method eliminates the burden of traditional 24-hour liquid urine collections 1
• All analytes are normalized to urine creatinine to account for variations in urine concentration 1

Analytes Measured

Reproductive Hormones:

• The test measures 17 reproductive hormones and metabolites including estrogen metabolites, progesterone metabolites, testosterone, and DHEA 1
• These measurements show excellent agreement (ICC > 0.90) with traditional 24-hour urine collections for 14 of 17 metabolites 1

Cortisol Assessment:

• Measures total urine free cortisol, total urine cortisone, and total cortisol metabolites 2
• The four-spot collection captures diurnal cortisol patterns comparable to those obtained from saliva testing 2
• Near-ideal consistency (ICC = 0.99 for free cortisol, 0.97 for cortisone, 0.96 for total metabolites) exists between dried and liquid urine samples 2

Organic Acids:

• Eight organic acid metabolites can be analyzed 1
• Good to excellent agreement (ICC range: 0.75 to 0.99) is observed between dried and liquid urine for these markers 1

Laboratory Analysis

• Dried urine undergoes extraction, hydrolysis, and derivatization before mass spectrometry analysis 1
• Mass spectrometry allows simultaneous analysis of multiple hormone and organic acid metabolites from small sample volumes 1

Clinical Validity

Comparison to 24-Hour Collections:

• The four-spot dried urine method shows excellent agreement (ICC > 0.9) for most reproductive hormones when compared to traditional 24-hour collections 1
• Good agreement (ICC 0.78 to 0.85) exists for remaining metabolites with no systematic differences between collection methods 1

Dried vs. Liquid Urine:

• Reproductive hormone results from dried and liquid urine demonstrate excellent agreement with ICCs greater than 0.90 1
• For cortisol assessment, consistency between liquid and dried urine is near-ideal (ICCs 0.96-0.99) 2

Clinical Applications

• Useful for clinical assessment of patients requiring comprehensive hormone evaluation 1
• Applicable for large epidemiologic studies due to ease of sample handling and shipping 1
• Captures diurnal hormone patterns without requiring multiple saliva samples or cumbersome 24-hour urine collections 2

Important Caveats

• This testing method is distinct from standard clinical hormone testing recommended in established guidelines 3, 4, 5
• For diagnostic purposes in conditions like adrenal masses, PCOS, or male infertility, guideline-recommended serum testing remains the standard of care 3, 5
• DHEA measurement via direct immunoassays has sensitivity of 0.67 and specificity of 0.70, while LC-MS/MS methods have sensitivity of 0.82 and specificity of 0.57 4
• The test should not replace guideline-directed diagnostic testing for specific endocrine disorders 3, 5