Hormone Replacement Therapy and Bioidentical Hormones Why we need DHEA and Pregnenolone

Hormone Replacement Therapy and Bioidentical Hormones 

Why we need DHEA and Pregnenolone

Jake Ames, MD, HMD

Mexico

I see many women and men over age 50 who are supplementing with estradiol and testosterone, but most of them are not taking DHEA (dehydroepiandrosterone) and pregnenolone.

All steroid hormones originate from cholesterol.  Steroid hormones are produced in the testicles, ovaries and adrenal glands.  Pregnenolone is the first steroid hormone originating from cholesterol, and it is the precursor for all steroid hormones, such as estradiol, DHEA, testosterone, aldosterone, cortisol, and others.

I specialize in treating patients with Lyme disease, adrenal fatigue, allergies, cancer, chronic fatigue syndrome, fibromyalgia, and chronic degenerative diseases.  Most of these patients have adrenal fatigue and require DHEA and pregnenolone supplementation.  Some also need hydrocortisone (cortisol), and a few need aldosterone.

Most DHEA is produced by the adrenal glands.  The optimal range of DHEA-sulfate is between 250 µg/dL to 300 ug/dL in most adults.  In some elderly people over 200 ug/dL is fine.

DHEA and pregnenolone are synthesized from wild yams (Dioscorea villosa), which are grown here in Mexico and other tropical locations in the world and soy.  DHEA and pregnenolone reach maximum production in the mid-twenties, and then slowly decline with aging.

DHEA has many health claims, and many of these are unproven.  It will raise testosterone levels in women, but not in men.  I have given men 300 mg of DHEA daily, and it did not raise their testosterone levels.  I have seen DHEA in my patients improve their energy and support their immune systems.  Many of my chronic fatigue syndrome patients in their 20’s and 30’s have DHEA levels that of an 80-year-old person.

I have seen DHEA help osteoporosis in women, but I’m not sure if it’s the testosterone doing this since DHEA does raise testosterone levels in women.

It does help with vaginal atrophy and increases vaginal moisture.

DHEA does help thicken the skin but testosterone and human growth hormone are much better at doing this.

Taking DHEA mainly helps my patients feel better overall in that it helps decrease their fatigue.

Always take micronized DHEA and pregnenolone because they are better absorbed.

Some women cannot even take DHEA 5 mg a day without getting acne even though they have very low levels.  In this case, I usually have them take DHEA at 1 mg a day for a month, and then try slowly increasing their dose.  If they still get acne taking only 1 mg a day, I have a compounding pharmacist make a 1 mg vaginal suppository and this usually works.  The next dose of the vaginal suppository will be 5 mg.

Licorice will keep the DHEA around longer in the body, so it can help keep the DHEA-sulfate levels a little higher.  Licorice can raise some people’s blood pressure.

Side Effects

The most common side effect is facial acne, then acne on the upper back and chest and sometimes the scalp.  Acne occurs more often in females than males.  The second most common side effect is facial hair above the lip in females.  Too much DHEA in men and women can cause aggression and testosterone side effects.

Pregnenolone

I previously mentioned pregnenolone is the first steroid hormone originating from cholesterol, and it is the precursor for DHEA and all steroid hormones.

I prescribe pregnenolone for my patients to keep their brains healthy, help their fatigue and support their adrenal glands.  It is the number one steroid hormone for the brain.  Thyroid hormone and lithium are also very important for brain function.  Four out of ten of my patients are low in thyroid hormone and all of my patients are low in lithium (See my blogs on lithium and thyroid hormone).

Pregnenolone declines as we age.  Most of my patients who take pregnenolone do not notice they are taking it.  Some of my patients have more energy and a better emotional tone taking it.  I like to get all of my patient’s steroid hormones back to age 25.  I have found even though pregnenolone is the precursor hormone for all steroid hormones, I have to give patients each steroid hormone they are low in.  I have been able to lower a patient’s cortisol dose with pregnenolone.  Sometimes, I can lower their anti-inflammatories for degenerative and rheumatoid arthritis, when they take pregnenolone daily.

Pregnenolone has been proven to protect nerves and the brain, so all of us need to take it if we are low in it.

How do you know if you are low in pregnenolone?

This is not as easy as it seems.  If your DHEA-sulfate levels are over 200 ug/dL, and you are in the bottom 25 percentile on your pregnenolone blood test, you don’t need pregnenolone, because the pregnenolone is being converted into DHEA.  However, if you are over 50 years old or younger suffering from a chronic disease, you might want to be on a trial of pregnenolone and see how you feel on it.  I don’t go higher than 200 ng/dL on the blood test.

How to dose pregnenolone

For women, I start them on 10 mg a day in the morning of micronized pregnenolone.  For men, I start them on 30 mg in the morning of micronized pregnenolone.  Pregnenolone should be taking in the morning because sometimes it can cause insomnia if taken in the evening.  I work women up to 30-50 mg a day of pregnenolone and men, I work them up to 50-100 mg of pregnenolone.

Side Effects

At the dose I have my patients taking, I usually don’t see any side effects.  Since pregnenolone is the precursor to all steroid hormones, it can possibly cause side effects of each steroid hormone.  I have seen it raise blood pressure-it’s probably increasing aldosterone.  It can sometimes cause vaginal spotting.  If taken at night, it can cause insomnia.

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