WHY THE ‘DUTCH’ TEST MAY HOLD BACK YOUR FERTILITY

FertilityTesting

Nov 29

Let’s talk DUTCH tests.

After 19 years as a fertility acupuncturist and supporting over 1,000 embryo transfers, I've had many patients walk into my office clutching their DUTCH test results like a treasure map to conception. They've spent $400-500, waited weeks for results, and now have pages of colorful graphs showing their hormone metabolites throughout a single day.

"Now we finally know what's wrong," they tell me, relieved to have data.

Let’s back up a second. If you don’t know what the DUTCH test is, that’s okay. It stands for Dried Urine Test for Comprehensive Hormones and it basically attempts to provide a detailed picture of your body’s hormone function.

But here's what I've seen. More often than not, that expensive DUTCH test is leads people further from fertility — not closer to it.

Let me explain why.

The Problem: Hormones are not static.

The DUTCH test is a lot like snapshots (not movies). And a handful of snapshots of one of the most dynamic systems in your body, taken at four or five arbitrary moments on one day, and then treated as some definitive truth isn’t actually all that definitive (or instructive).

What Research Actually Tells Us About Hormonal Fluctuation

Progesterone

Progesterone is a hormone many obsesses over for fertility, and it can fluctuate 8-fold within 90 minutes during the mid-luteal phase. In the same healthy woman, over 24 hours, progesterone can range from 2.3 to 40.1 ng/mL. Let that sink in. The exact same person, on the same day, can have progesterone levels that span nearly the entire ‘abnormally low to super healthy range’ depending on when you measure.

Medical literature explicitly states: "Because this rapid fluctuation traverses almost the entire range of luteal values, there can be no standard for appropriate luteal phase progesterone in fertile women, and therefore a single value can neither diagnose nor exclude [luteal phase deficiency]."

Yet, here we are making treatment decisions based on a single day’s urine collection. Hm.

Cortisol

The hormone cortisol too follows a dramatic circadian rhythm, surging 50-60% in the first 30-40 minutes after waking, then declining throughout the day. Time of day accounts for 72% of the variance in cortisol levels. The body also releases 12-18 distinct pulses of cortisol every 24 hours!

LH (Luteinizing Hormone)

LH pulses every 60-90 minutes during the follicular phase, with 8-14 pulses per 12 hours depending on where you are in your cycle.

Your hormones are supposed to fluctuate. They're in constant conversation with each other, with your environment, with your stress levels, your sleep, your meals. They're dynamic and responsive — exactly as they should be. A DUTCH test freezes this intricate dance mid-step and calls it diagnostic.

And even in cases of some of the more stable hormones (androgens like testosterone and DHEA), if you truly have hormonal issues on an ongoing basis, there are symptoms! Male pattern balding, facial and body hair growth (hirsutism), acne, cycle irregularities. You can tell if you truly have too many ‘male’ hormones.

Baby Blinders: When a test narrows your focus — instead of expanding it.

You probably know it well by now. I call it baby blinders — that tunnel vision that happens when someone gets test results back. Suddenly, their entire fertility journey becomes an obsession to ‘fix’ the numbers on that report.

Let me tell you about Sarah (not her real name). She came to me with DUTCH results showing "low progesterone metabolites in her luteal phase”. She'd already ordered $200 worth of supplements. She was convinced this test result was why she hadn't conceived yet.

I asked about her cycle. It was perfect. 28 days like clockwork. Clear thermal shift on her BBT chart around mid-cycle. Temperature stayed elevated for >10 days. Cervical mucus patterns were textbook. No spotting. No PMS. Good energy throughout her cycle.

"So you're ovulating beautifully, and your cycle is saying everything is sufficient… actually abundant and ‘text book,’" I said.

"But my progesterone is low!" said Sarah.

I replied, "It’s low according to a test done on one single day. But your body is telling me, through your symptoms and cycle patterns, that your progesterone is doing exactly what it needs to do."

We talked about her bigger picture. Only sleeping 5-6 hours a night. Working 60-hour weeks. Eating a “strict fertility diet.” Sarah hadn't seen friends in months because she was "too busy trying to conceive,” and many of them had said hurtful things. Her heart was grieving as she was falling more and more out of sync with them.

Her body didn't need progesterone supplements. Her body needed her to live in a way that supported fertility. Those are not the same thing.

The DUTCH test had given her baby blinders. Instead of seeing the whole picture — an isolated woman putting herself into unrelenting stress cycles due to baby blinders — she was fixated on a metabolite number.

We worked on sleep. Making time for joy. Moderation in eating. Building community and grief support. Her cycle didn't change — cuz it didn't need to. Sarah conceived within three months.

What The Research Actually Shows About Short Luteal Phases

Short luteal phases (less than 10-11 days) occasionally occur in 5% of healthy fertile women. And here's the kicker. Fertility at 12 months is not lower for women with occasional shorter luteal phases. So even if you sometimes have a little bit shorter cycle (maybe you were really sick that month or you had a crazy work deadline), very few of us have a consistent luteal phase deficiency of progesterone. Consecutive short luteal phases only occur in about 3% of women. And if you are one of them, then there are much better ways to know (like your cycles!), and progesterone probably IS a great fit for you at that point.

What we've been calling ‘abnormal’ is often just normal variation. And that variation doesn't predict fertility outcomes or necessitate treatment or strict lifestyle and supplement changes. It’s NORMAL. (Did I just yell?! Sorry.) And when things are consistently off, you’ll know without a test. But when you're staring at red numbers on a DUTCH report, you can't see that. You can only see what it’s saying needs to be ‘fixed.’

The Supplement Trap: Mistaking intervention for evidence.

Here's where I'm going to lose some colleagues, but it needs to be said: Most supplement protocols based on DUTCH results are not evidence-based medicine. They're biochemical whack-a-mole.

I see it constantly.

“Low progesterone metabolites? Here's bioidentical progesterone or vitex.”
“High androgen metabolites? Here's saw palmetto and DIM.”
“Flat cortisol curve? Here's adaptogens and adrenal support.”
“Estrogen dominance pattern? Here's indole-3-carbinol and calcium-d-glucarate.”

Now, show me the randomized controlled trial that demonstrates these interventions improve live birth rates in women with regular cycles who feel well but have "abnormal" DUTCH patterns. Go on — I'll wait.

Don't get me wrong. I'm not anti-supplement. I use targeted supplementation in my practice all the time. But I use it based on:

Clear clinical deficiency (like iron-deficiency anemia or vitamin D deficiency confirmed by appropriate serum testing)
Evidence-based protocols for specific conditions (like CoQ10 for egg quality in advanced maternal age, or myo-inositol for PCOS)
Symptoms that indicate a specific need

Not because a urine test showed a number outside an arbitrary reference range.

Meanwhile, the interventions that DO have strong evidence for improving fertility often get less attention:

Optimizing body composition (both underweight and overweight affect ovulation)
Stabilizing blood sugar through regular, adequate meals
Reducing and disrupting chronic stress and building resilience
Improving sleep quality and circadian rhythm alignment
Addressing thyroid dysfunction
Treating actual PCOS with appropriate medical management
Supporting the nervous system's capacity to feel safe

None of those require a $400 DUTCH test. They require paying attention to how you actually feel and live.

If you’re interested, check out my post about fertility supplements I actually use and brands that won’t break the bank, AND have rigorous testing.

The Cortisol Trap: When ‘adrenal fatigue’ meets DUTCH testing.

Speaking of stress reframes, if you've been told you have adrenal fatigue based on a DUTCH test (or any other test), I need you to read my companion post on why adrenal fatigue isn't real. The short version is your adrenals don't get "fatigued" from stress. They're either working (sometimes in overdrive responding to chronic stress), or they've failed (like in Addison's disease, which is life-threatening and diagnosed with very different testing).

The ‘adrenal fatigue’ framework is a perfect example of how DUTCH tests get misused. Here’s an example. Maybe you’re exhausted (a real symptom, with real suffering). DUTCH shows a flat cortisol curve (could be normal variation, time-of-day artifact, or your body's current stress response pattern). So you're diagnosed with "adrenal fatigue" — not a real diagnosis. You're prescribed adaptogens and adrenal support supplements (rarely evidence-based for the actual problem). Meanwhile, your real issues go unaddressed: sleep deprivation, overwork, lack of boundaries, nutritional deficiency, thyroid dysfunction, depression, and trauma responses.

Let me be very clear. If you're exhausted, that's real. If your energy crashes every afternoon, that matters. If you can't handle stress the way you used to, something needs attention. But you don't need a $400 test to confirm that you're stressed and tired. You already know that. Your body is telling you every single day.

What you need is to examine is: Are you sleeping 7-9 hours in a dark, cool room? Are you eating enough, frequently enough, with adequate protein? Are you carrying an unsustainable load at work or home? Do you have untreated hypothyroidism? (Common, missed frequently, and actually treatable with appropriate serum testing). Are you depressed or dealing with unresolved trauma? Have you had your iron levels checked? B12? Vitamin D?

These are the questions that matter. These are the places where intervention actually changes outcomes. A DUTCH test showing ‘low morning cortisol’ doesn't change the treatment plan. You need to address your actual life circumstances. Only now you've spent $400 and you're focused on adrenal support supplements instead of the hard work of examining why you're in chronic stress to begin with.

The Androgen Paradox: When "abnormal" results meet normal people.

Here's a case that crystallizes everything wrong with DUTCH over-reliance.

A 29-year-old woman has regular 28-day cycles, no symptoms whatsoever: no significant acne, typical female-type hair loss (all-over her head), no hirsutism (excess body hair), no weight issues, ovulating regularly. Overall feeling pretty great, just being ‘proactive’ about fertility planning.

Her DUTCH showed:

Androsterone: 174% of upper limit
Etiocholanolone: 162% of upper limit
5α-DHT: 150% of upper limit
5α-Androstanediol: 257% of upper limit
5β-Androstanediol: 130% of upper limit

Everything lit up red on the report, with "High Androgens" stamped all over it. The provider wanted to start her on supplements to ‘lower androgens’ and ‘support estrogen metabolism’.

But here's the thing — she has no symptoms. Her body is handling these metabolite levels perfectly well. This appears to be her own healthy baseline — her body efficiently metabolizing and clearing androgens without any tissue effects.

So should we ‘treat’ this? With what? And for what outcome?

Here's what we know from androgen research.

Unlike progesterone, which fluctuates wildly, androgens in women are relatively stable. Testosterone in women shows only about 7% variation from morning to evening. So her elevated metabolites are likely real findings and not just artifacts in timing. But, more importantly, they're real findings that don't correlate with any clinical problem.

“This is the danger of treating test results instead of treating people. When you have labs without context, you create problems that don't exist. You pathologize normal variation. You intervene where no intervention is needed.”

And worse, you make someone who felt healthy start to question their body. You turn someone who came in feeling empowered into someone who now feels broken.

The Salutogenesis Crisis: One step forward, two steps back.

Now, this is where we get to the heart of why DUTCH testing troubles me so much.

I’ve talked about salutogenesis a lot — it’s the study of what creates health rather than what causes disease, and should be at the core of fertility work. Yet, DUTCH testing pulls us inexorably toward pathogenesis — the study of what's wrong. When you start with "So, what's broken?" you get very different outcomes than when you start with "What does this body need to thrive?"

DUTCH testing actually creates these problems:

Pathogenic thinking. "Something is wrong with my hormones that needs to be fixed," instead of "How do I support my body's innate wisdom?"
External locus of control. "I need a test to tell me what I feel and supplements to correct my levels," instead of "My body communicates with me well and responds appropriately to how I live."
Reductionism. "My androgen metabolites are high," instead of "Am I ovulating? Do I feel well? How’s my sleep?"
Biochemical fixation. Staring at metabolite graphs instead of feeling your actual energy, tracking your actual cycles, noticing your body's actual rhythms.
Analysis paralysis. "I need to fix these 12 things the test showed," instead of addressing the 2-3 foundational issues that would actually move the needle in the right direction.

What was once a proactive trip to ‘get healthier, has suddenly turned into 15 ‘very important!’ supplements you NEED and hours spent researching hormone protocols, anxious about every number and disconnected from your body's actual signals. AKA, spending energy managing test results instead of building the conditions for your health to flourish.

This is one step forward, two steps back.

And here's the cruel irony. Stress about your hormones affects your hormones. Anxiety about your cortisol curve changes your cortisol curve — for the worse. Obsessing over your progesterone can disrupt your cycle. Stress hormones are close enough to sex hormones that they compete for building blocks and receptors! The testing itself becomes an iatrogenic stressor.

When is testing actually appropriate?

I can hear the objections now. "But what about when something IS wrong? Don't we need testing then?"

Yes. Absolutely.

But let's distinguish between diagnostic medicine and optimization obsession.

When To Get a Diagnostic Workup

Cycles are absent or very irregular — >35 days or <21 days consistently — and honestly, I can tell you what the tests will say based on what your cycle is doing, not kidding
There are signs of PCOS — hirsutism, cystic acne, elevated androgens clinically apparent, plus long follicular phases or absent ovulation
Recurrent pregnancy loss — that’s 2 or more losses
Known endocrine disorders
Clear signs of thyroid dysfunction — hair loss, outer eyebrow thinning, sleep issues (too much or too little), feeling cold all over, gaining or losing weight without any lifestyle changes
Actual fertility challenges after 6-12 months of trying — depending on your age

In those cases, the appropriate testing is:

Comprehensive thyroid panel (TSH, Free T3, Free T4, antibodies) — serum
Day 3 FSH, LH, estradiol, AMH — serum
Day 21 (or 7 days post-ovulation) progesterone — serum (though as we've discussed, single values are limited)
Fasting insulin and glucose, HbA1c
Total and free testosterone, DHEA-S, androstenedione — serum
Pelvic ultrasound to assess ovaries and uterus
Prolactin if cycles are irregular
Complete metabolic panel, CBC, iron studies, vitamin D, B12
I encourage full bacterial infection testing for certain groups too

Do you notice what's not on that list? That’s right, DUTCH testing.

These serum tests, combined with a thorough history and cycle tracking, give us actionable information. They can identify conditions that have actual evidence-based treatments:

Hypothyroidism → Levothyroxine
PCOS → Lifestyle modification, metformin if indicated, possibly inositol
Hyperprolactinemia → Identify cause, potentially cabergoline
Iron deficiency → Appropriate supplementation
True luteal phase deficiency with short cycles and spotting → Maybe progesterone support in luteal phase if trying to conceive

But if you're having regular cycles, ovulating consistently, and feeling well? You don't need to spend $400 to find problems that don't exist.

Instead, try the salutogenic approach.

So if NOT suggesting DUTCH testing, then what? How do we support fertility without falling into the testing trap?

My Recommendation

1. Track Your Actual Cycle

Basal body temperature (BBT) is one of the most informative tools we have, and it's free. I don’t recommend month after month after month, but 1-3 cycles to establish where you’re at and clear patterns are super helpful.
If you’d prefer to throw a little money at the problem instead of taking your temps every day, consider the MIRA or INITO test kits. I’m a certified MIRA provider. I think both are very good for testing for 1-2 months to establish solid data and patterns to confirm symptoms and spot test in subsequent cycles. I’ll be adding a blog about this in the coming months, but if you’re working with me in person, just ask!
Cervical mucus observations
A simple journal noting energy, mood, sleep quality, and any symptoms throughout your cycle

This real-time data about YOUR body, tracked over time, is infinitely more valuable than a snapshot test.

2. Notice Your Lived Experience

Ask yourself:

Do I ovulate regularly (confirmed by BBT shift)?
Are my periods appropriate for my body (not too heavy, not too light, not too painful, no odd flooding, clots, tissues, slime, or smells)?
Do I have relatively good energy across my cycle (based on my actual life circumstances)?
Is my mood relatively stable?
Am I sleeping well?
Do I feel resilient to normal life stress?

If yes, then you're likely fine. Invest in foundational health, not testing. And if no, then we investigate. But probably not with a DUTCH test.

3. Build the Conditions for Health

This is where the real work happens:

Sleep. 7-9 hours in a dark, cool room. Consistent sleep/wake times. This alone profoundly affects hormones.
Nutrition. Three meals a day, sitting down, with adequate protein, fiber, and fat. Blood sugar stability is foundational for hormone production. Trouble shoot your gut if this is a problem area for you - that’s good for fertility too.
Movement. Enough to feel strong and energized, not so much that you're depleting yourself. Some women over-exercise their way into fertility challenges (see my video on how much exercise is too much).
Stress management. Yes, stress reframes, resets, and offsets. And ALSO thinking about whether or not you’re attempting to maintain an unsustainable lifestyle — examine what needs to change. Boundaries. Rest. Joy. Community. These aren't luxuries.
Nervous system support. Your reproductive system only functions well when your nervous system feels safe. This is where trauma-informed care, somatic practices, and emotional support matter enormously.
Appropriate medical care. Treat your hypothyroidism. Address your insulin resistance. Work with a therapist for mental health and trauma needs. These are the interventions that change outcomes.

4. Use Targeted Supplementation Wisely

I'm not anti-supplement, I use them daily in my practice. But when I do it’s always based on:

Clear clinical need (CoQ10 for egg quality over 35)
Confirmed deficiency (iron, vitamin D, B12)
Evidence-based protocols for specific conditions (inositol for PCOS, methylfolate for those with MTHFR variants trying to conceive)

Not because a test showed a metabolite outside of range.

5. Give It Time

For women under 35, 12 months of trying is normal. For women 35-40, 6 months. We've created an unrealistic expectation of immediate conception that's not aligned with biology. So during that time, focus on living in a way that supports fertility rather than obsessing over whether you're doing enough. Your body is wise. Trust it.

The Through-Line: Your body isn't the problem.

The same principle I discuss in my post about adrenal fatigue applies here. We've medicalized normal physiological responses to abnormal circumstances.

Your cortisol curve isn't "broken" — it's responding to your life.

Your progesterone isn't "deficient" — it's fluctuating normally.

Your androgen metabolites aren't "too high" — they might just be your baseline.

The DUTCH test, like the adrenal fatigue diagnosis, offers an appealing promise: If we just identify the right biochemical "imbalance" and take the right supplements, we can optimize our way out of the actual work of living differently.

But 19 years of supporting people through fertility challenges has taught me this: Your body isn't the problem. Your body is doing it’s best to thrive given the conditions it's in.

So the question isn't "What does my DUTCH test show?" The question is: "What does my body need to thrive?" And you already know the answer to that question. Your body has been telling you. You don't need to spend $400 to hear it. You just need to listen.

A final note on DUTCH testing.

If you've already done a DUTCH test, please don't hear this as criticism. You were trying to be proactive. You were seeking answers. That all makes sense. But I want to offer you permission to set those results aside and come back to what truly matters:

How do you feel? What does your cycle show you? What does your body need? Those answers will guide you more reliably than any urine metabolite pattern ever could.

And if you're considering a DUTCH test right now, I invite you to pause and ask yourself, “What am I really looking for?” If it's reassurance, you won't find it in numbers. If it's answers, start with the questions your body is already answering through your symptoms and cycles. If it's a path forward, that path is built through how you live, not what you measure.

Your fertility isn't hiding in your urine. It's expressing itself every month in your cycle and every day in a myriad of signs and symptoms — including what it’s doing RIGHT. Pay attention to those instead.

Nicole