The DUTCH Plus Test: What It Measures, Who Needs It & Cost in India

Your hormones are not static. 

A blood test can tell you what a hormone looks like at the moment your blood was drawn. At the same time hormones do not work on a timetable that conveniently pauses when you walk into a lab.

Cortisol changes throughout the day and sex hormones are produced and metabolised. Their metabolites can tell a different part of the story and for some people, the question is not simply “Is my hormone level normal?”. It is always “What is my body doing with these hormones throughout the day?” That is exactly where the DUTCH Plus Test comes in.

DUTCH Plus uses dried urine and saliva samples collected at different points in the day to assess sex hormones, hormone metabolites, cortisol patterns and the Cortisol Awakening Response. Although it does not replace conventional blood testing but it simply gives your practitioner a different set of information to work with. And sometimes, that extra context is truly what you were missing.

What is the DUTCH Plus Test?

DUTCH stands for Dried Urine Test for Comprehensive Hormones.

The DUTCH Plus is an at-home hormone test developed by Precision Analytical. It uses dried urine samples alongside saliva samples to assess sex hormones, their metabolites, cortisol patterns and other markers included in the DUTCH panel.

The big difference is timing.

So like instead of collecting one sample at one point in the day, the test collects samples across a day. This allows your practitioner to look at patterns rather than relying on one isolated measurement.

The Plus version adds something particularly important: The Cortisol Awakening Response, or CAR.

CAR looks at how cortisol changes during the first hour after you wake up. The DUTCH Plus collects saliva immediately on waking and again at specific intervals during that first hour to capture this pattern. 

So, in simple terms:

Blood test: What does my hormone level look like right now?

DUTCH Plus: What are my hormones doing across the day, how are some of them being metabolised, and what does my cortisol awakening pattern look like?

What does the DUTCH Plus Test measure?

The DUTCH Plus looks at several groups of hormones and related markers.

Sex Hormones

The panel assesses hormones including:

• Estrogen

• Progesterone metabolites

• Testosterone

• DHEA S

It also looks at multiple estrogen and androgen metabolites, giving practitioners more information about how these hormones are being processed.

Cortisol and Cortisone

The test looks at cortisol and cortisone patterns throughout the day.

This matters because cortisol is not supposed to remain at one fixed level all day. It normally follows a daily rhythm, with levels changing around waking and gradually shifting through the day.

Cortisol Awakening Response

This is the feature that makes DUTCH Plus different from DUTCH Complete.

The Cortisol Awakening Response looks specifically at cortisol changes during the first hour after waking.

The DUTCH Plus uses saliva samples at waking, 30 minutes and 60 minutes after waking to capture this response. 

Organic Acids and Other Markers

The DUTCH Plus also includes markers such as melatonin metabolite, 8 OHdG and several organic acid markers. These include markers related to areas such as B vitamin metabolism, neurotransmitter metabolites, glutathione and oxidative stress.

So the report brings together several pieces of information that a practitioner can interpret alongside your symptoms and history.

Why do hormone metabolites matter? 

This is one of the parts of DUTCH testing that can sound complicated until you put it into context. Your body does not simply make a hormone and leave it sitting there. Hormones are produced, transformed and eventually broken down into metabolites. For example, DUTCH testing looks at different estrogen metabolites rather than only measuring one estrogen value. That can give a practitioner additional information about how estrogen is being metabolised.

But there is an important distinction here, a metabolite pattern is not a diagnosis by itself, it is just another piece of information.

Your practitioner still needs to look at your symptoms, medical history, medications, menstrual cycle stage where relevant and other test results before deciding what a particular pattern means. That is why reading a DUTCH report by yourself and immediately deciding that one pathway is “good” and another is “bad” is not the best way to use the test.

What does the cortisol awakening response actually tell you? 

You wake up and your cortisol changes. That change is called the Cortisol Awakening Response. The DUTCH Plus captures this using saliva samples taken immediately after waking and at specific intervals during the first hour.

Why is this useful?

Your waking cortisol pattern is different from simply knowing your cortisol level at one random point in the day. A DUTCH Plus report can show whether the waking response is relatively blunted, exaggerated or follows the expected rise and fall pattern. A particular CAR pattern does not automatically mean you have “adrenal fatigue” or HPA axis dysfunction, it needs to be interpreted in context.

The real value is that it gives your practitioner another way to understand your stress response alongside your symptoms, sleep patterns, medications and other findings.

DUTCH Plus vs Blood Hormone Testing: What’s the difference?

If you have ever wondered about a DUTCH test vs blood test, this is the simplest way to look at it.

Blood testing remains extremely important. It is the established method for many hormone measurements and medical diagnoses. DUTCH Plus is not a replacement for it. Instead, it can answer questions that a single blood draw may not answer, particularly around daily cortisol patterns and hormone metabolites. You can think of it as adding another layer of information, not replacing the foundation.

DUTCH Plus vs DUTCH Complete: What’s the difference?

This is probably the most common question if you are already considering DUTCH testing.

The easiest answer is that DUTCH Complete gives you the comprehensive hormone and metabolite picture, and DUTCH Plus adds the Cortisol Awakening Response.

Both panels assess sex hormones, adrenal hormones, metabolites and other markers included in the DUTCH Complete panel. The Plus version adds salivary cortisol measurements specifically designed to capture the cortisol response during the first hour after waking. 

If you want a deeper breakdown of the two tests, you can also read our DUTCH Plus vs DUTCH Complete guide.

The right test depends on the question you are trying to answer.

Who may consider a DUTCH Plus Test?

DUTCH Plus is generally considered when a practitioner wants more information about hormone patterns and cortisol response alongside a person’s symptoms and history.

It may come up in conversations around:

• Persistent fatigue or morning tiredness

• Sleep disturbances

• Stress related symptoms

• PMS or perimenopausal symptoms

• Changes in menstrual patterns

• Libido changes

• Concerns around estrogen or androgen metabolism

• Hormone related symptoms that need a more detailed assessment

• Situations where a practitioner wants to investigate daily cortisol patterns

But there is an important caveat. You do not need a DUTCH Plus simply because you feel tired, stressed or “hormonally imbalanced.” Testing should always start with a clinical question.

Your practitioner can then decide whether DUTCH Plus is actually appropriate or whether a conventional blood test, another investigation or no additional testing is more useful.

How is the DUTCH Plus Test done?

The entire collection happens at home.

You will collect 4 dried urine samples across the day and 5 saliva samples used to assess the Cortisol Awakening Response and daily cortisol pattern.

The exact collection schedule matters because the test is designed around timing. Precision Analytical’s instructions include saliva collection immediately upon waking, followed by samples 30 and 60 minutes later, with additional samples later in the day. The kit includes urine collection strips, saliva collection tubes, instructions, the required paperwork and return packaging. Once collection is complete, the samples are prepared according to the kit instructions and shipped back to the laboratory.

The important part?

Do not improvise the collection schedule. With a test that is specifically looking at hormone patterns across time, timing is part of the test.

How should you prepare for a DUTCH Plus Test?

Preparation can vary depending on your medications, supplements, hormone therapy and individual circumstances.

The laboratory’s collection instructions also specify certain restrictions around caffeine, alcohol, exercise, oral hygiene and food or drink around the early morning saliva collections. So instead of following a random preparation checklist from the internet, follow the instructions supplied with your specific kit and the instructions from your practitioner.

This is especially important if you use:

• Hormone replacement therapy

• Hormonal creams

• Certain supplements

• Medications that may affect hormone results

Never stop prescribed medication simply to prepare for a test unless the prescribing clinician has told you to.

How are DUTCH Plus results read? 

A DUTCH report can look overwhelming the first time you open it. There are graphs, reference ranges, metabolites, ratios and multiple hormone measurements. A practitioner generally isn’t looking at just one number.

They are looking at the pattern, which includes the following factors:- 

1. Hormone Levels

What are the measured hormone levels compared with the relevant reference ranges?

2. Hormone Metabolites

How are hormones being metabolised?

3. Cortisol Rhythm

What does the cortisol pattern look like across the day?

4. Cortisol Awakening Response

How does cortisol change during the first hour after waking?

5. Symptoms and History

Does the laboratory picture make sense alongside what the person is actually experiencing?

That last step matters most. A DUTCH report is data. The same laboratory finding can have a different clinical meaning depending on the person.

Can you read a DUTCH Plus report yourself?

You can certainly look at your report but understanding what every result means is another matter.

A report may show a hormone outside a reference range without that automatically explaining your symptoms. Similarly, a result within a reference range does not necessarily answer every question you have about your health. That is why DUTCH testing is designed to be used with practitioner interpretation.

The goal is to understand whether the overall pattern adds useful information to the clinical picture.

How much does the DUTCH Plus Test cost in India?

The cost can vary depending on the laboratory, provider, shipping, interpretation and service included with the test. At the time of writing, our iThrive Essentials DUTCH Plus Hormone Panel is listed at ₹60,299, including tax and free shipping on prepaid orders. iThrive also notes that customers should confirm whether their pincode is serviceable by FedEx before placing an order. Prices can change, so it is always worth checking the current listing before purchasing.

Where can you get the DUTCH Plus Test in India?

The DUTCH Plus panel available through iThrive Essentials is offered in collaboration with Precision Analytical Labs USA. The test kit is designed for at home sample collection, after which samples are sent to the laboratory for analysis. iThrive Essentials offers the DUTCH Plus Hormone Panel for people looking for access to this testing option in India, along with functional interpretation support through the broader iThrive ecosystem.

The important part is knowing why you are taking the test and what you are going to do with the information afterwards.

When does a DUTCH Plus Test actually make sense?

This is the question worth asking before you spend money on any advanced test.

Not: “Is DUTCH Plus better?” But: “What question am I trying to answer?”

If the question is about a hormone that needs conventional clinical diagnosis or monitoring, a blood test may be the appropriate starting point. If the question is about hormone metabolites, daily cortisol patterns or the cortisol awakening response, DUTCH Plus may provide information that a single blood draw does not. At times the answer is that you do not need either test yet.

Key Takeaway

The DUTCH Plus Test is not simply a bigger hormone panel. It looks at hormones and their metabolites using dried urine collected across the day, while adding salivary cortisol measurements to capture the Cortisol Awakening Response.

That makes it particularly useful when a practitioner wants to understand patterns over time, rather than one isolated hormone measurement. But the test should not be treated as a diagnostic shortcut.

The value of DUTCH Plus lies in what happens after the report comes back: connecting the results with symptoms, medical history and other clinical information to decide what actually matters.

Because more data is not automatically better, the right data is, if asked for the right reason.