The short answer
The DUTCH Adrenal Stress Test is a dried urine test that provides a comprehensive evaluation of adrenal hormone function, including cortisol, cortisone, DHEA, and their metabolites, measured at multiple points throughout a single day. It uses the same dried urine technology as the DUTCH Complete and DUTCH Plus, but is specifically designed to assess adrenal and HPA axis function in depth, rather than the full sex hormone and reproductive picture those panels provide.
At SeshDx, the DUTCH Adrenal Stress Test is recommended for women whose primary concern is HPA axis dysregulation, such as burnout, fatigue, stress intolerance, sleep disruption, and the physical and hormonal consequences of chronic stress, and who want the most comprehensive adrenal picture currently available from an at-home test.
Want the most complete picture of how your adrenal system is actually functioning? Or have you recently done a Dutch test and want to re-test for an update? This is for you!
The DUTCH Adrenal Stress Test is available through SeshDx for $355.95, with a health history review, detailed results breakdown via video, and one-time protocol included.
Order the DUTCH Adrenal Stress Test →
What makes the DUTCH adrenal test different from other cortisol testing
Most cortisol testing falls into one of two categories: a single blood draw taken in the morning, or a saliva panel with four collection points across the day.
Both have clinical value. Both have significant limitations.
The morning blood draw captures one data point and is designed primarily to detect severe adrenal pathology: Addison’s disease or Cushing’s syndrome. It tells you nothing about cortisol rhythm, the cortisol awakening response, or total daily cortisol output.
The four-point salivary panel is a meaningful improvement; it maps the daily cortisol arc and provides information about free cortisol at different points in the day. But it does not measure how the body is metabolizing and clearing cortisol overall, and it does not provide the DHEA and metabolite data that gives the full adrenal picture.
The DUTCH Adrenal Stress Test does both. It measures free cortisol and free cortisone at multiple time points, including the cortisol awakening response, and it measures total metabolized cortisol. This distinction between free cortisol (what’s circulating and biologically active) and total metabolized cortisol (what the body is actually producing and clearing) is clinically critical and is what makes the DUTCH methodology uniquely useful.
What the DUTCH adrenal stress test measures
1. Free cortisol: four time points plus cortisol awakening response
Free cortisol is collected on waking, 30 minutes after waking (capturing the cortisol awakening response), mid-morning, afternoon, and evening. This produces a detailed cortisol arc, the most comprehensive daily cortisol picture available from a non-invasive test.
The cortisol awakening response (CAR), the surge in cortisol that occurs in the 30 to 60 minutes after waking, is one of the most sensitive indicators of HPA axis health. A blunted or absent CAR is associated with burnout, depression, immune dysregulation, and poor cognitive resilience in the morning. A robust CAR indicates an HPA axis that is ready to meet the demands of the day.
The five-point collection allows patterns to be identified that a four-point salivary test can miss, including whether morning cortisol is appropriately high, when the peak occurs, how quickly it declines, and whether evening cortisol is appropriately suppressed.
2. Free cortisone
Cortisone is the inactive form of cortisol. The body converts cortisol to cortisone (and back) through enzymes in the liver, kidney, and fat tissue. Measuring both free cortisol and free cortisone at each time point allows the DUTCH to assess how the body is managing the balance between active and inactive cortisol, a clinically meaningful distinction that salivary cortisol alone cannot provide.
Elevated cortisone relative to cortisol can indicate altered cortisol metabolism. The relationship between cortisol and cortisone across the day provides information about tissue-level cortisol exposure that circulating cortisol levels alone don’t capture.
3. Total metabolized cortisol
This is the marker that most distinguishes the DUTCH from salivary cortisol panels. Total metabolized cortisol reflects how much cortisol the body is producing and processing overall, regardless of how much free cortisol is circulating at any given moment.
This distinction matters because two women can have similar free cortisol levels but dramatically different total cortisol production. One may be clearing cortisol rapidly, so free levels look normal but total output is actually high. Another may be producing very little cortisol, with free levels that look low because production is genuinely suppressed.
Without total metabolized cortisol, free cortisol patterns can be misread. The DUTCH provides both, and interpreting them together gives a clinically complete picture of adrenal output.
4. DHEA and DHEA-S
DHEA (dehydroepiandrosterone) is produced by the adrenal glands and serves as the primary counter-regulatory hormone to cortisol. In a well-functioning system, DHEA and cortisol are in relative balance. DHEA supports immune function, mood, cognitive function, muscle maintenance, bone density, skin health, and reproductive hormone production.
DHEA-S (DHEA sulfate) is the sulfated, stored form of DHEA, more stable in circulation and reflective of the adrenal gland’s overall DHEA output capacity.
Together, DHEA and DHEA-S provide a picture of adrenal anabolic reserve (the capacity of the adrenal system to support repair, resilience, and hormone production), as distinct from the catabolic output reflected in cortisol.
5. Cortisol:DHEA ratio
The ratio of cortisol to DHEA is one of the most clinically useful calculations in functional HPA axis assessment. A high ratio (elevated cortisol relative to DHEA) suggests the adrenal system is in a prolonged stress state, prioritizing cortisol production at the expense of its anabolic, repair-supporting hormones.
A low ratio may indicate that overall adrenal output is suppressed, a pattern often seen in the later stages of chronic stress exposure, sometimes described as adrenal exhaustion.
The cortisol:DHEA ratio, interpreted alongside the free cortisol curve and total metabolized cortisol, gives a nuanced picture that no single marker can provide.
6. Cortisol metabolites: THF, THE, allo-THF
The DUTCH Adrenal test includes specific cortisol metabolites, such as tetrahydrocortisol (THF), tetrahydrocortisone (THE), and allo-tetrahydrocortisol, that reflect how cortisol is being broken down and cleared by the liver.
These metabolites reveal liver cortisol clearance capacity and provide insight into 5-alpha and 5-beta reductase enzyme activity, pathways involved in cortisol metabolism that are clinically relevant in the context of metabolic health, androgen conversion, and hormonal balance.
What the DUTCH adrenal stress test can help explain
The DUTCH Adrenal Stress Test can be useful for investigating:
Chronic fatigue, particularly fatigue that doesn’t respond to rest or sleep
Difficulty waking in the morning: low energy, dependence on stimulants to function
Wired but tired: exhausted but unable to relax, fall asleep, or stay asleep
Afternoon energy crashes followed by late-evening energy surges
Burnout: physical and emotional depletion that persists despite reduced demands
Poor stress tolerance: feeling overwhelmed by stressors that wouldn’t previously have been significant
Anxiety that feels physical: racing heart, tight chest, hypervigilance
Low mood that tracks with stress exposure
Frequent illness or slow recovery from illness
Poor recovery from exercise: feeling worse after training, not better
Salt cravings, dizziness on standing, low blood pressure
Hormonal disruption that worsens significantly during or after periods of stress
Thyroid symptoms that don’t fully resolve with thyroid support
A history of burnout, overtraining, or prolonged high-demand periods
“The DUTCH adrenal test gives me the most complete picture I have of what the HPA axis is actually doing. Free cortisol tells me the rhythm. Metabolized cortisol tells me the output. DHEA tells me the resilience reserve. The metabolites tell me how the liver is clearing it. Taken together, you can’t miss what’s happening, and you can’t misread it.” Shae Davis, FDN-P, CPT, SeshDx
DUTCH adrenal vs saliva cortisol panel vs stress hormones profile: which is right for you?
The Stress Hormones Profile (four-point saliva + DHEA) is a solid entry-level HPA assessment, appropriate when the clinical question is relatively straightforward and a focused cortisol curve with DHEA is sufficient.
The DUTCH Adrenal Stress Test is the right choice when:
You want the most comprehensive HPA picture available
You need total metabolized cortisol alongside free cortisol; the distinction matters clinically
The cortisol awakening response specifically needs to be assessed (5-point collection)
Cortisol metabolite data is relevant: liver clearance, enzyme activity
A previous cortisol assessment gave an unclear or conflicting picture
You want a dried urine test rather than saliva collection
The DUTCH Adrenal Stress Test is not the DUTCH Complete or DUTCH Plus; it does not include sex hormones, estrogen metabolites, reproductive hormone data, or the organic acid markers included in those panels. If you need both adrenal and reproductive hormone assessment, the DUTCH Complete or DUTCH Plus is the more comprehensive choice.
How the DUTCH adrenal stress test is done
The DUTCH Adrenal Stress Test uses dried urine collection on filter paper strips, the same method as the DUTCH Complete. You collect urine at five points throughout a single day: on waking, 30 minutes after waking, mid-morning, afternoon, and evening. Samples are dried, labeled with the collection time, and mailed to the lab.
There is no blood draw, no lab visit, and no 24-hour urine collection required.
Results are typically returned within 2 to 3 weeks.
At SeshDx, results are reviewed directly with Shae, covering what each point on the cortisol curve means, how total metabolized cortisol reads in context, what the DHEA findings suggest about adrenal reserve, and what the overall pattern points toward in terms of protocol.
The DUTCH adrenal stress test at SeshDx
The DUTCH Adrenal Stress Test is offered through SeshDx for $355.95.
It includes:
Five-point free cortisol collection including cortisol awakening response
Free cortisone at each time point
Total metabolized cortisol
DHEA and DHEA-S
Cortisol:DHEA ratio
Cortisol metabolites: THF, THE, allo-THF
Health history review including stress history, sleep, training load, and lifestyle
Detailed results review: every marker explained in the context of your full pattern
One-time protocol with targeted nutrition, supplementation, sleep, stress, and lifestyle recommendations
This panel is a particularly good fit for women who:
Have done a salivary cortisol panel and gotten an unclear or incomplete picture
Have symptoms strongly suggestive of HPA axis dysfunction and want the most comprehensive assessment
Are recovering from burnout or a period of significant stress and want to understand their current adrenal status
Have hormonal symptoms that worsen significantly under stress and want to quantify the HPA component specifically
Are training heavily and want to assess whether training load is suppressing their adrenal function
Order the DUTCH Adrenal Stress Test →
Take the quiz to see which lab is right for you →
Frequently asked questions
Is this the same as the DUTCH Complete?
No. The DUTCH Complete is a comprehensive hormone panel covering sex hormones, estrogen metabolites, reproductive hormone patterns, cortisol, and organic acid markers. The DUTCH Adrenal Stress Test focuses specifically on adrenal function (cortisol, cortisone, total metabolized cortisol, DHEA, and metabolites) with greater depth in the adrenal section than the DUTCH Complete provides. If you need both sex hormones and a comprehensive adrenal picture, discuss with Shae which panel, or combination, is most appropriate. This test is often a follow up re-test to do DUTCH Complete when re-testing.
What’s the cortisol awakening response and why does it matter?
The cortisol awakening response (CAR) is the surge in cortisol that occurs in the 30 to 60 minutes after waking each morning. It is one of the best-studied and most sensitive markers of HPA axis integrity. A blunted CAR is associated with burnout, depression, immune dysregulation, and morning cognitive impairment. The DUTCH Adrenal Stress Test captures the CAR specifically through the waking and 30-minute post-waking collections.
Can I have normal free cortisol but abnormal total cortisol?
Yes, and this is exactly why the DUTCH methodology is clinically distinct. It is possible to have free cortisol that looks within range but total metabolized cortisol that is significantly elevated or suppressed, because the body’s clearance rate affects what’s circulating at any given moment. Interpreting both together is essential for an accurate clinical picture.
What if I work irregular hours or don’t wake at a consistent time?
Collection timing is based on your personal wake time, not a fixed clock time. Shae will provide specific instructions based on your schedule before you begin collection.
Can I do this test while taking adaptogenic supplements?
Adaptogens and cortisol-modulating supplements can affect results. Discontinuing these 5 to 7 days before collection is generally recommended to get an accurate baseline. Shae will advise based on what you’re currently taking if qualified.
The bottom line
The DUTCH Adrenal Stress Test is the most comprehensive non-invasive assessment of HPA axis function currently available, measuring free cortisol at five time points including the cortisol awakening response, free cortisone, total metabolized cortisol, DHEA, DHEA-S, the cortisol:DHEA ratio, and cortisol metabolites.
It is not a replacement for medical care and is not used to diagnose conditions by itself.
But for women whose fatigue, burnout, sleep problems, stress intolerance, and hormonal disruption have not been fully explained by standard testing, and who want the most complete adrenal picture before building a protocol, the DUTCH Adrenal Stress Test provides data that no other at-home test can match.
At SeshDx, results are reviewed alongside your full clinical picture (stress history, training, nutrition, sleep, and other lab data) to build a protocol that addresses the adrenal pattern specifically.
Order the DUTCH Adrenal Stress Test at SeshDx →
Take the quiz to see which lab is right for you →
This content is educational and does not constitute medical advice. Please consult a licensed healthcare provider before making changes to your health protocol.
