Hair cortisol vs the DUTCH test: one day in detail or three months on average?

The DUTCH test, a product of the laboratory company Precision Analytical, measures cortisol, cortisone and their breakdown products in urine dried on filter paper, usually collected at four points across a day.¹ A hair cortisol test measures the cortisol built up in your hair over roughly the past three months.² So DUTCH gives a detailed picture of one day, while hair gives an average across many. For long-term cortisol, hair is the most accurate measure from a single sample. DUTCH's published validation is small and company-authored, and we found no clinical guideline that endorses it. Hair is not in the diagnostic guidelines either, so neither replaces a doctor's tests.

What the DUTCH test measures

You wet strips of filter paper with urine at set times, let them dry and post them to the laboratory, which analyses them by mass spectrometry.¹ The adrenal version measures free cortisol and free cortisone at four points across a day, together with metabolites of cortisol and cortisone and the adrenal hormone DHEA-S. An optional fifth, overnight sample can be added, and the broader DUTCH Complete adds sex hormones.³ Metabolites are the breakdown products the body makes from cortisol and cortisone before passing them in urine. Another version, DUTCH Plus, adds free cortisol measured in saliva.¹

The collections are timed across an evening and the following morning, with limits on fluids before the evening samples and no alcohol or caffeine on collection days; the table further down gives the times. The adrenal panel cost $399 as of October 2026 through the company's online shop, which takes international orders, with ordering restrictions in some US states.³ Our guide to the DUTCH test covers collection and results in more detail.

What the published evidence shows

The main published validation comes from two papers led by authors at Precision Analytical, the company that runs the test.¹⁴

• In 20 people, dried urine agreed closely with the same urine tested as liquid: intraclass correlations of 0.99 for free cortisol, 0.97 for cortisone and 0.96 for total metabolites.¹
• In 28 people, four dried spots across a day agreed with a full 24-hour collection at 0.89, 0.95 and 0.92 for the same measures.¹
• A follow-up found that four-spot and 24-hour collections agreed above 0.9 for 14 of 17 reproductive hormone metabolites.⁴

An intraclass correlation measures agreement between two sets of measurements, where 1 is perfect. These results suggest the dried format is a reasonable way of sampling urine at home. What they do not show is that a DUTCH profile reflects anything beyond the day it was collected, predicts health outcomes or diagnoses a condition. The studies are small, they are company-authored, and they compare DUTCH only with other urine methods.¹⁴ Guidelines for Cushing's syndrome use 24-hour urine, late-night saliva and dexamethasone suppression tests,⁵⁶ and adrenal insufficiency is diagnosed with blood tests, the standard being the Synacthen test.⁷

The research base for hair is larger and comes from many different research groups. A 2017 meta-analysis pooled 66 studies with more than 10,000 people,⁸ and hair has been tested against the standard tests in people with Cushing's syndrome, with accuracy similar to the first-line tests.⁹ Hair is still not in the guidelines, and a 2024 expert review said it needs validating outside research settings.¹⁰

One day versus three months

The biggest difference is the span of time. However detailed, a DUTCH profile describes one day, and cortisol varies a lot between days. In studies of healthy adults sampling saliva, about half the variation in the awakening response, the daily slope and total daily output was day-to-day fluctuation,¹¹ and researchers estimate that at least three days of sampling are needed for a reliable average and ten for the daily slope.¹² Full 24-hour urine collections varied by about 52 per cent from one collection to the next in people with Cushing's disease.¹³ Those studies did not test dried urine, but a single day of dried urine samples the same changeable daily output.

A hair sample averages those days for you. Hair cortisol correlated at r = 0.84 from one month to the next in the same people,¹⁴ and a stable personal component explained 59 to 82 per cent of the variation in repeated hair measurements.¹⁵ It does not depend on the time of day the sample is cut.¹⁶

What hair cannot do is show the shape of a day, such as the rise after waking or the fall towards evening. If that is your question, timed urine or saliva samples are the only way to see it, ideally on more than one day. See hair vs saliva for more on daily profiles.

"Adrenal fatigue" and cortisol testing

If you are considering a cortisol profile because of "adrenal fatigue", the idea that long-term stress wears out the adrenal glands, it is worth knowing where the evidence stands. The Endocrine Society says there is no scientific proof that adrenal fatigue is a real medical condition, that no test can detect it, and that tests offered for it are not based on scientific evidence.¹⁷ A systematic review that screened 3,470 articles and included 58 found results that conflicted almost systematically, and concluded there is no evidence that adrenal fatigue is an actual medical condition.¹⁸

That applies to every test, hair included: no cortisol test can diagnose adrenal fatigue. If you have persistent tiredness, see a doctor. The Endocrine Society notes that symptoms put down to adrenal fatigue can come from conditions such as adrenal insufficiency, depression or obstructive sleep apnoea, which need proper assessment.¹⁷ Read more in our guide to adrenal fatigue.

Practical differences

• Collection. DUTCH needs four timed samples over about a day, or five with the overnight option, with limits on fluids, alcohol and caffeine.³ Hair needs one cut from the back of the head, at any time.
• What can upset the result. For DUTCH, a missed or mistimed sample, and anything that changes cortisol on the day. For hair, dye and heat treatments, long exposure to sunlight and some steroid medicines.^19202122
• What you learn. DUTCH gives one day's curve plus metabolites. Hair gives one figure for roughly the past three months, or a month-by-month timeline from longer hair.
• Availability. The DUTCH adrenal panel is priced in US dollars. Hair kits are sold direct; the note at the end of this guide gives the price of one.

Which test fits your question?

If you want to know whether your cortisol has been running high or low over recent months, a hair test answers that directly and consistently. If you want to see the shape of a single day, a timed urine or saliva profile shows it, with the caveat that one day is one day. If you have symptoms that could mean Cushing's syndrome or adrenal insufficiency, neither is the right starting point: see a doctor, who will use the tests in the clinical guidelines. Our guides to hair vs 24-hour urine and at-home cortisol tests go further.