Practitioners Get a Deeper Look at Stress and Adrenal Function From Precision Analytical, Inc.'s New Clinical Lab Test, the DUTCH Plus™ With Cortisol Awakening Response.

DUTCH Plus with Cortisol Awakening Response

Precision Analytical, Inc., the creators of DUTCH™ (Dried Urine Testing for Comprehensive Hormones), announce the newest innovation in hormone testing, the DUTCH Plus™. The DUTCH Plus™ brings an important piece of the HPA axis into focus by adding salivary cortisol measurements to the world-leading test in comprehensive hormones, the DUTCH Complete™. The new salivary cortisol measurements provide the cortisol awakening response (CAR), giving practitioners more insight than ever before.

Precision Analytical's flagship hormone test, the DUTCH Complete™, uses dried-urine collections to offer a comprehensive look at sex and adrenal hormones, their metabolites, melatonin, 8-OHdG (an oxidative stress marker), as well as the diurnal pattern of free cortisol and metabolites of cortisol. The DUTCH Plus™ adds salivary cortisol markers to create an unprecedented tool for functional medicine practitioners.

DUTCH Plus™ is a game-changer in the world of hormone testing. It provides the most comprehensive look at adrenal and sex hormones available in one test, which means more accurate diagnoses and more effective treatments.

Chris Kresser, New York Times best-selling author and founder of the Kresser Institute for Functional and Evolutionary Medicine

Over the past few years, scientific literature has collected an impressive list of studies that show the cortisol awakening response has independent clinical value in evaluating HPA-axis function. In 2010, researchers at Northwestern University, found that while absolute levels of morning cortisol didn't correlate significantly to Major Depressive Disorder (MDD), the cortisol awakening response did. The difference between the salivary sample taken 40 minutes after waking, compared to the waking sample, was significantly larger in people who went on to develop MDD.1

Precision Analytical's Medical Director Dr. Carrie Jones explains, "When we open our eyes upon waking, cortisol levels naturally begin to rise by an average of 50 percent. 30 minutes after waking, cortisol levels will still show this sharp increase. By 60 minutes after waking, cortisol levels have peaked and begin to decline. Measuring this rise and fall of cortisol levels at waking can be used as a 'mini stress test.' Research shows that the size of this increase correlates with HPA-axis function, even if the sample measurements are all within range. A quick saturation of saliva swabs upon waking, and at 30 and 60 minutes after waking, provides what is required to assess a patient's cortisol awakening response."

A low or blunted cortisol awakening response can be a result of an underactive HPA axis, excessive psychological burnout, seasonal affective disorder (SAD), sleep apnea or poor sleep in general, PTSD, chronic fatigue and/or chronic pain. A decreased cortisol awakening response has been associated with systemic hypertension, functional GI diseases, postpartum depression, and autoimmune diseases. Conversely, an elevated cortisol awakening response can be a result of an overreactive HPA axis, ongoing job-related stress (anticipatory stress for the day), glycemic dysregulation, pain (i.e. waking with painful joints or a migraine) and general depression.

While this unique assessment is only available in saliva testing, few saliva labs in the United States offer a true cortisol awakening response assessment because the specifically-timed collections can be difficult to manage. The DUTCH Plus™ uses specialty, FDA-approved, and patented collection devices called Salivettes™. Salivettes™ are specifically made for testing cortisol when timing needs to be precise and they are used in nearly all of the published CAR studies. The small synthetic cotton swab can be quickly saturated with saliva, providing a very fast and simple collection. Unfortunately for labs using saliva to test reproductive hormones (Precision uses dried urine), they are not a viable option as the swabs cannot be used when testing progesterone (a key component in hormone testing). The DUTCH Plusoffers the most accurate salivary cortisol sampling with Salivette™ collection and analysis using LC-MS/MS. An unparalleled clinical tool is created when combining salivary cortisol with the extensive urine metabolites from DUTCH™.

New York Times best-selling author and founder of the Kresser Institute for Functional and Evolutionary Medicine, Chris Kresser says, "DUTCH Plus™ is a game-changer in the world of hormone testing. It provides the most comprehensive look at adrenal and sex hormones available in one test, which means more accurate diagnoses and more effective treatments."

For more information on Precision Analytical, Inc.'s innovative DUTCH Plus™, or to order your test today, visit or contact 503.687.2050.

About Precision Analytical, Inc.
Precision Analytical, Inc., established by Mark Newman, M.S., in 2012, is committed to improving wellness and lives by providing important insight into our hormones and their function in our bodies. Precision's state-of-the-art innovation in hormone testing uses the acronym DUTCH (Dried Urine Test for Comprehensive Hormones). The DUTCH Test™ quickly caught the attention of functional and integrative medicine influencers, and has become the world leader in hormone testing as their method is the most comprehensive informationally and has the easiest sample collection.


1.      Adam EK, Doane LD, Zinbarg RE, Mineka S, Craske MG, Griffith JW. Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence. Psychoneuroendocrinology. 2010 Jul;35(6):921-31.

2.      Chida Y, Steptoe A. Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biol Psychol. 2009 Mar;80(3):265-78

3.      Clow A, Hucklebridge F, Stalder T, Evans P, Thorn L. The cortisol awakening response: more than a measure of HPA axis function. Neurosci Biobehav Rev. 2010 Sep; 35(1):97-103.

4.       Fries E, Dettenborn L, Kirschbaum C. The cortisol awaking response (CAR): Facts and future directions. International Journal of Psychophysiology 2009 Apr, 72(1):67-73

5.      Huber TJ, Issa K, Schik G, Wolf OT. The cortisol awakening response is blunted in psychotherapy inpatients suffering from depression. Psychoneuroendocrinology. 2006 Aug;31(7):900-4

6.      Jakuszkowiak-Wojten K, Landowski J, Wiglusz MS, Cubała WJ. Cortisol awakening response in drug-naïve panic disorder. Neuropsychiatr Dis Treat. 2016 Jun 27; 12:1581-5

7.      Roberts AD, Wessely S, Chalder T, Papadopoulos A, Cleare AJ. Salivary cortisol response to awakening in chronic fatigue syndrome. Br J Psychiatry. 2004 Feb; 184:136-41.

Source: Precision Analytical, Inc.