The Best Testing for Adrenal & Sex Hormones

So many people are struggling with hormone imbalance and do not have any idea where to start when it comes to evaluating hormone levels or getting a proper treatment plan to help combat this issue. Until recently, the testing available was not very accurate and the only available treatment options were hormone replacement therapy (HRT). HRT comes with risks, like an increase risk for cancer, and is not addressing the root cause of the imbalance.

Cortisol, our stress hormone, is a very important hormone in the body. Too little or too much cortisol can cause symptoms like weight gain (especially in the belly), fatigue, insomnia, brain fog and more. Measuring this important hormone is extremely important when trying to figure out how these symptoms started and how to get rid of them. However, measuring cortisol on a blood test is not very accurate. A blood test is only a snapshot in time and we really need to look at how cortisol rises and falls throughout the day.

A few years ago, holistic doctors started using a saliva test to help get a more accurate reading of cortisol levels by taking multiple samples throughout the day. This was a great idea which came with some issues. For one, collecting a tube full of saliva is not easy to do, especially multiple times throughout the day. Another issue with the saliva test is that it only measures free cortisol, which is only 1-3% of total cortisol in the body. This method, while more accurate than blood, still presents with many flaws.

Photo taken from Precision Analytic website

Enter the new kid on the block in ultimate hormone testing, the DUTCH test. Finally a test that looks at free cortisol plus total cortisol and breaks down sex hormone levels like estrogen, progesterone and testosterone more thoroughly than any other tests out there. Here is more info on this test from their website:

DUTCH vs. Saliva Testing

While the free cortisol pattern in saliva has clinical value, there is a significant missing piece to surveying a patient’s HPA-Axis function with saliva testing – measuring cortisol metabolites. To properly characterize a patient’s cortisol status, free and metabolized cortisol should be measured to avoid misleading results when cortisol clearance is abnormally high or low. Likewise with sex hormones, measuring estrogen and androgen metabolites gives a fuller picture for more precise clinical diagnosis of hormonal imbalances and HRT monitoring.

DUTCH vs. Serum Testing

While the most universally accepted testing method (due to the availability of FDA-cleared analyzers that are reliable and inexpensive), serum testing is lacking in some areas. Adrenal hormones cannot be effectively tested in serum because free cortisol cannot be tested throughout the day. There is also a lack of extensive metabolite testing (especially for cortisol and estrogens).

DUTCH vs. 24-Hour Urine Testing

There are two primary drawbacks to 24-hour urine testing of hormones. First, the collection is cumbersome, and as many as 40% of those who collect, do so in error (Tanaka, 2002). Secondly, dysfunction in the diurnal pattern of cortisol cannot be ascertained from a 24-hour collection. Some providers add saliva for daily free cortisol. DUTCH eliminates the need for two tests.

Here is an example of someone with very low free and total cortisol levels. Typical symptoms associated with this type of presentation are:

  • Puffy face
  • Weight gain
  • Trouble staying asleep
  • Afternoon fatigue
  • and more….



While cortisol is an extremely important hormone to measure, the sex hormone levels are extremely important to measure as well. Estrogen dominance is a very common issue that I see more and more women struggling with each day and includes symptoms like:

  • Weight gain (hips, waist and thighs mostly)
  • PMS
  • Fibrocystic breasts
  • Low libido
  • Fatigue
  • Anxiety/depression

Here is what this looks like on this test:

The company I use to perform this test has also added an organic acids profile, measurements of neurotransmitter levels, melatonin levels (sleep) and more. I use this test on about 95% of the people that I work with one-on-one and I recommend it to everyone I know.

I used to require people to be a patient of mine to order this test, but I am offering it now to anyone that wants to order it HERE! Knowing what your body is doing through testing is crucial in getting better. There are a lot of people offering programs to get rid of symptoms, but it is best to find out what is actually causing the symptom first before you can know what program will work best for you. Once we get your results back from the testing, you can schedule a consult with me for a detailed plan on what your test results mean and how to best support your body.

If you are not ready to order the test and want to know how to best support overall hormone health, read this article on liver support to learn more.




Hi, I am Dr. Becky Campbell. I work with men and women who’ve had a health set back and are willing to do whatever it takes to reach optimal health so they can perform their best in their careers and be fully present with their family again.

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