DUTCH Plus
The DUTCH Plus test represents the most advanced hormonal assessment method available, combining dried urine analysis with saliva samples to provide a complete picture of the HPA axis and cortisol dynamics.
DUTCH Plus
What is DUTCH PLUS?
DUTCH Plus (Dried Urine Test for Comprehensive Hormones with CAR) is a state-of-the-art diagnostic tool that extends the parameters of the Complete test by adding the evaluation of Cortisol Response to Awakening (CAR).
This integrated profile collects both dry urine and saliva samples (via specific Salivette devices), allowing for precise monitoring of free cortisol and circadian rhythm. In addition to sex steroids and their metabolism, DUTCH Plus provides unique insight into adrenal function and the body's ability to adapt to stress.
The test results are essential for investigating complex symptoms, such as:
severe morning fatigue (inability to get out of bed)
burnout and adrenal exhaustion
sleep disorders and anxiety
immune and inflammatory dysfunctions
poor athletic performance or difficult recovery
DUTCH Plus
WHAT INFORMATION DOES THE DUTCH PLUS REPORT PROVIDE?
CAR (Cortisol Awakening Response) Assessment – measures the physiological increase in cortisol within the first 30 minutes of waking, a critical indicator of the health of the hypothalamic-pituitary-adrenal axis.
Complete Sex Hormone Profile – detailed analysis for estrogens (and their phase I and II metabolites), progesterone, testosterone and DHEA-S.
Cortisol and Free Cortisone – 24-hour graph of free cortisol (from saliva) and metabolized cortisol (from urine) to identify adrenal hypo- or hyperfunction.
Estrogen Metabolism – assessment of detoxification pathways (2-OH, 4-OH, 16-OH) to determine oncological and metabolic risk.
Neurotransmitter Markers – includes vanillylmandelic acid (VMA) and homovanillic acid (HVA) assays for indirect assessment of adrenaline and dopamine.
Oxidative Stress Marker (8-OHdG) – indicates the level of oxidative damage to DNA.
Nutritional Status B6, B12 and Glutathione – by measuring methylmalonic acid and other relevant organic acids.
DUTCH Plus
WHO IS THE DUTCH PLUS TEST FOR?
The DUTCH Plus test is recommended for patients who require a highly accurate assessment of stress response, beyond the limits of standard hormonal tests.
Categories of patients and pathologies targeted:
Patients with Chronic Fatigue and Burnout: For which measuring free cortisol alone is not sufficient, CAR evaluation is necessary to check the brain's energy "reserve" upon awakening.
Performance Athletes: For monitoring overtraining and optimizing the metabolic recovery window.
Treatment-Resistant Sleep Disorders: Identifying the exact moment when the HPA axis becomes hyperactive during the night.
Complex Management of BHRT: Patients on replacement therapy who require a fine correlation between free (salivary) and metabolized hormones.
Autoimmune and Inflammatory Pathologies: Where cortisol's control over the immune system is a decisive factor in disease remission.
FAQ's
DUTCH Plus includes all the components of the Complete test, but adds 5 saliva samples to measure CAR (Cortisol Awakening Response). This additional marker is crucial because a patient may have normal 24-hour total cortisol but have a poor awakening response, which explains the extreme fatigue.
The collection is combined: urine is collected on paper strips (as in DUTCH Complete) and saliva samples are collected using special tubes (Salivette) with a small cotton swab. It is very important that the first saliva sample is taken immediately after opening the eyes, without leaving the bed, in order to correctly capture the CAR peak.
Saliva measures only the “free” (bioavailable) fraction of hormones, that is, what the body can actively use. Correlating free cortisol in saliva with that metabolized in urine provides the clearest medical picture of how the adrenal glands produce, transport, and eliminate stress hormones.
