Women

• Fatigue or low energy: Persistent tiredness that may relate to adrenal or sex hormone imbalance.
• Low mood or depression: Changes in emotional wellbeing or motivation linked to hormonal fluctuations.
• Reduced libido: Decline in sexual desire or satisfaction possibly influenced by oestrogen or testosterone levels.
• Premenstrual symptoms: PMS, irritability or mood swings occurring before menstruation.
• Menopausal changes: Hot flushes, sleep disruption or other signs of hormonal transition.
• Weight gain: Gradual or unexplained weight increase that may relate to changes in metabolism or hormone balance.

Men

• Fatigue or low energy: Ongoing tiredness or reduced stamina possibly linked to hormone levels.
• Low mood or depression: Persistent low mood or lack of motivation that may correspond with testosterone or cortisol imbalance.
• Reduced sex drive: Lower libido or sexual performance potentially influenced by changes in androgen activity.
• Sleep disturbance: Difficulty falling asleep or staying asleep associated with cortisol rhythm.
• Hair loss: Gradual thinning or changes in hair pattern possibly linked with hormone variation.
• Weight gain: Increased abdominal or overall body weight that may reflect hormonal shifts.

The DUTCH Complete provides a comprehensive assessment of sex hormone metabolism and adrenal function using dried urine sampling across the day. The panel measures parent hormones and downstream metabolites alongside the diurnal pattern of free cortisol and markers of melatonin metabolism, offering detailed insight into hormone production, clearance and circadian rhythm patterns.

In women, this type of profiling may be clinically relevant in contexts such as menstrual irregularities, premenstrual symptoms, menopausal transition, sleep disturbance or hormone replacement therapy monitoring. In men, it may support evaluation of fatigue, changes in mood or libido, altered body composition or age-related shifts in androgen balance. Inclusion of additional organic acid and oxidative stress markers enables broader consideration of metabolic and lifestyle factors that may influence hormonal regulation.

Results are interpreted alongside clinical presentation, lifestyle patterns and other laboratory findings. Reviewing hormone metabolite patterns over time can help practitioners build a more personalised picture of endocrine function and support discussions around nutrition, lifestyle and therapeutic strategies.

Practical

Specimen requirements:

Dried urine sample

Average processing time:

18 ±4 days

Restriction:

This test is not available for patients below 12 years of age.

Downloadable research

• Urinary Cortisol and Cortisol Metabolite Excretion in Chronic Fatigue Syndrome

• Comparison of Estrogens and Estrogen Metabolites in Human Breast Tissue and Urine

• Comprehensive study of urinary cortisol metabolites in hyperthyroid and hypothyroid patients

Other research

• C. Vantyghem, A. Ghulam, C. Hober, C. Schoonberg, M. D’Herbomez, A. Racodot, A. Boersma and J. Lefebvre (1998) “Urinary cortisol metabolites in the assessment of peripheral thyroid hormone action: Overt and subclinical hypothyroidism.” J.Endocrinol. Invest. 21:21-225.

• Contreras, L. N., S. Hane and J. B. Tyrrell (1986). “Urinary cortisol in the assessment of pituitary-adrenal function: utility of 24-hour and spot determinations.” J Clin Endocrinol Metab 62(5): 965-969.

• Cook, M. R., C. Graham, R. Kavet, R. G. Stevens, S. Davis and L. Kheifets (2000). “Morning urinary assessment of nocturnal melatonin secretion in older women.” J Pineal Res 28(1): 41-47.

• Denari, J. H., Z. Farinati, P. R. Casas and A. Oliva (1981). “Determination of ovarian function using first morning urine steroid assays.” Obstet Gynecol 58(1): 5-9.

• Hoshiro, Y. Ohno, H. Masaki, H. Iwase and N. Aoki (2006) “Comprehensive study of urinary cortisol metabolites in hyperthyroid and hypothyroid patients” Clinical Endocrinology 64: 37-45

• Jerjes, W. K., T. J. Peters, N. F. Taylor, P. J. Wood, S. Wessely and A. J. Cleare (2006). “Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome.” J Psychosom Res 60(2): 145-153.

• Miro, F., J. Coley, M. M. Gani, P. W. Perry, D. Talbot and L. J. Aspinall (2004). “Comparison between creatinine and pregnanediol adjustments in the retrospective analysis of urinary hormone profiles during the human menstrual cycle.” Clin Chem Lab Med 42(9): 1043-1050.

• Mistry, H. D., N. Eisele, G. Escher, B. Dick, D. Surbek, C. Delles, G. Currie, D. Schlembach, M. G. Mohaupt and C. Gennari-Moser (2015). “Gestation-specific reference intervals for comprehensive spot urinary steroid hormone metabolite analysis in normal singleton pregnancy and 6 weeks postpartum.” Reprod Biol Endocrinol 13: 101.

• Munro, C. J., G. H. Stabenfeldt, J. R. Cragun, L. A. Addiego, J. W. Overstreet and B. L. Lasley (1991). “Relationship of serum estradiol and progesterone concentrations to the excretion profiles of their major urinary metabolites as measured by enzyme immunoassay and radioimmunoassay.” Clin Chem 37(6): 838-844.

• Roos, J., S. Johnson, S. Weddell, E. Godehardt, J. Schiffner, G. Freundl and C. Gnoth (2015). “Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation.” Eur J Contracept Reprod Health Care 20(6): 438-450.

• Taioli, E., A. Im, X. Xu, T. D. Veenstra, G. Ahrendt and S. Garte (2010). “Comparison of estrogens and estrogen metabolites in human breast tissue and urine.” Reprod Biol Endocrinol 8: 93.

• Taniyama, M, Keiko Honma, K and Ban, Y (1993) “Urinary Cortisol Metabolites in the Assessment of Peripheral Thyroid Hormone Action: Application for Diagnosis of Resistance to Thyroid Hormone” Thyroid 3(3): 229-233

• Waller, K., S. H. Swan, G. C. Windham, L. Fenster, E. P. Elkin and B. L. Lasley (1998). “Use of urine biomarkers to evaluate menstrual function in healthy premenopausal women.” Am J Epidemiol 147(11): 1071-1080.