Blood vs Saliva vs DUTCH Test: What’s Best for Hormones?
There’s a lot of conflicting advice out there about the “best” way to test your hormones.
Some providers swear by blood work. Others say saliva testing is more accurate. And then there’s DUTCH testing, which is often marketed as the most comprehensive option.
So… which one is actually best?
The honest answer: it depends on your symptoms, your cycle, and what info we’re trying to learn. In my practice, I don’t use a one-size-fits-all approach to hormone testing. Instead, I choose the right tool for the right situation. Often, we start simpler than you might expect.
First: A Quick Breakdown of Each Test
Blood Testing (Serum Labs)
Blood testing measures the hormones circulating in your bloodstream at that exact moment.
For cycling women, I typically check estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) on day 3; progesterone 7 days after ovulation (or around day 21); DHEA-sulfate, free and total testosterone. I might also look at prolactin and sex hormone-binding globulin (SHBG), depending on symptoms.
This gives us a helpful snapshot of what your body is doing hormonally at key points in your cycle.
Salivary Testing
Salivary testing measures hormone levels at multiple points throughout the day or cycle, giving us a more comprehensive picture than a single blood draw
This is especially helpful when:
Symptoms don’t match blood work results
Cycles are irregular
We want to assess patterns (not just one moment in time)
We’re also wanting to check additional markers like cortisol or melatonin
DUTCH Testing (Dried Urine Test for Comprehensive Hormones)
The DUTCH test is a well-known urine test that doesn’t just look at hormone levels—it looks at hormone metabolites, or how your body is processing and breaking down those hormones.
In simple terms:
Hormone levels = what’s active right now
Metabolites = how your body is detoxing and clearing hormones
This can give us deeper insight into:
Estrogen metabolism
Adrenal function
Chronic stress patterns
My Clinical Approach (And Why I Often Start with Blood Work)
My controversial opinion in the functional medicine testing world? Hormone blood testing is often undervalued.
It’s affordable, often covered by insurance, and when timed correctly and interpreted alongside your symptoms, it gives us useful information about 80% of the time.
That’s why I usually start there. From a practical standpoint, it allows us to:
Get a baseline without overtesting
Make initial treatment decisions
Track progress over time
If symptoms and labs line up, we may not need any additional testing.
If they don’t? That’s when we dig deeper.
You can learn more about how I approach testing on my Labs & Diagnostic Testing page.
The Biggest Mistake I See with Hormone Testing
The most common issue isn’t which test is used—it’s how the test is done.
Hormone testing is highly dependent on timing, especially for women who still have a menstrual cycle. If labs aren’t drawn at the right point during your cycle, the results can be misleading or even meaningless.
For example: Progesterone must be checked after ovulation, not on any random day. If we check it before you’ve ovulated, it will appear quite low on labs (because it is released by the egg's follicle after ovulation).
Unfortunately, I often see testing either dismissed entirely or done incorrectly just to appease a patient who advocates for it. When they come to me to interpret their labs, we often have to start from scratch to get useful data.
When hormone labs aren’t properly utilized, it can lead to confusion and missed opportunities for real answers.
When I Move Beyond Bloodwork
While blood work is a great starting point, there are situations where it’s not enough.
I’ll often recommend saliva or DUTCH testing when:
Symptoms don’t match up with the blood work
Periods are very irregular or absent
Timing blood draws is difficult
There are concerns about cortisol, sleep, or chronic stress
We need a more detailed look at hormone patterns or metabolism
Do You Always Need Hormone Testing?
Not always. In many cases, your symptoms already tell us a lot.
If someone has:
Spotting before their period
PMS symptoms
Breast tenderness
I might suspect a higher estrogen-to-progesterone ratio. In these cases, we can often start treatment based on symptoms, support progesterone production, and help the body clear excess estrogen, then confirm with testing.
If they improve, great. If not, that’s when more testing helps us refine the picture.
Sometimes it makes sense to:
Start with targeted support
Make diet and lifestyle changes
Use minimal supplementation
Then use testing to confirm or adjust the plan. Testing should support your care, not complicate it.
What If You’re Set on DUTCH Testing?
I absolutely understand wanting the most comprehensive data upfront.
When patients come in specifically asking for DUTCH testing, I:
Review their symptoms in detail
Walk through all testing options (pros, cons, and cost)
Share my clinical recommendation
Let them decide how they’d like to proceed
Some people want the most data possible right away. Others prefer a stepwise approach.
Both are valid, and your preferences matter.
How This Fits Into Your Overall Hormone Health
No matter which test we use, results are always interpreted in the context of your symptoms.
That’s why I take a whole-person approach to care, looking at:
Your cycle patterns
Energy, mood, and sleep
Diet and lifestyle
Stress levels
Metabolism and digestion
If you’re dealing with PMS, irregular cycles, perimenopause symptoms, or other hormone concerns, you can learn more about my approach here.
The Bottom Line
Each type of hormone testing has its place.
Blood work is often a great starting point
Saliva testing helps us see patterns over the entire cycle
DUTCH testing gives deeper insight into how your hormones are metabolized
The key is choosing the right test based on your symptoms and your treatment goals. Your experience and treatment outcomes matter more than any lab result.
Ready to Get Answers About Your Hormones?
If you’re feeling overwhelmed, stuck, or unsure where to start, you don’t have to figure it out alone. I offer virtual visits for anyone located in Washington state.
Together, we’ll:
Review your symptoms
Decide if (and what) testing is needed
Create a personalized plan to help you feel better
Disclaimer: The information in this article is intended for general informational and educational purposes only. It is not intended to diagnose, treat, cure, or prevent any condition, nor should it replace guidance from a qualified healthcare professional. Please speak with your provider about your individual health questions and before making any changes to your care plan.