DHEA and Pregnenolone
Two hormones that simply don't seem to get enough airtime are DHEA and pregnenolone. Like testosterone, both can really help the brain, improving
mental fog, cognition, alertness, mood, etc. They can also greatly help with sleep and anxiety. Best of all, they can even restore morning erections
and improve libido! Basically, if you are low in one of these hormones, supplementation can just plain help you feel better.
The tragedy in my opinion is that, since pharmaceutical companies cannot make money off of these two, they have taken a backseat and are ignored by virtually all physicians. Yet I can easily make a case that they are just as important as testosterone. To illustrate this let me relate a personal story (from early 2016):
MY SITUATION: I had been on TRT (testosterone therapy) using cypionate injections for a little over two years. I definitely felt much much better than I did pre-TRT. However, I still didn't quite feel right. For example, TRT got rid of all of my pre-TRT depression and about half of my anxiety. But there was still some anxiousness left. Yes, I had worked hard on lifestyle factors, including diet and exercise, which is why I decided to pull labs for some of the other hormones (Jan of 2016). Here are the results:
DHEA-S: 115.8 ug/dl (RANGE: 35-550)
Progesterone: pulled twice, both times undetectable
Cortisol (a.m.) 10.2 ug/dl (10-20)
Cortisol (~noon): 5.6 ug/dl
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As you can see from the above, my DHEA was low; my progesterone was so low that it could not be measured (at two different labs); and my cortisol was also quite low. Remember that cortisol comes from progesterone and so clearly this whole pathway was suppressed.
NOTE: I did not actually pull pregnenolone, because I am 55 and pregnenolone falls rather dramatically with aging.
Being low in any one of these three hormones could cause significant symptoms - similar to low testosterone -such as fatigue, mental fog, erectile dysfunction and lowered libido. In retrospect, I think the lifestyle changes and improved testosterone were what was allowing me to do so well in spite of low hormone output.
Fortunately, at about this same time I had signed up with Dr. Justin Saya of Defy Medical, who is one of the foremost HRT and TRT experts that I know of. He immediately put me on a compounded preparation of 25 mg of pregnenolone and 25 mg of DHEA daily.
NOTE: While one can argue that compounded DHEA and pregnenolone are not absolutely necessary, they a) do provide pharmaceutical grade dosing and b) are without binders and fillers.
Dr. Saya recommended that I take this before bed, because the pregnenolone can have a mildly relaxing effect and help many men with their sleep. I noticed this benefit immediately. I usually wake up feeling a bit "on edge" and "hyper." I had never really thought about it, but my sleep was obviously not providing the deep rest that I needed. The pregenenalone and DHEA combination definitely gave me improved sleep.
The other thing that I noticed almost immediately was that my anxiety was gone. For the first time in my life, I had no anxiety! I remember thinking, "So this is what a normal person feels like." Testosterone had vanquished my depression, but it took DHEA and pregnenolone to get rid of my anxiety. I will add that I believe most of this anxiety-lowering effect is from the DHEA, because I had taken it briefly in the past and noted a similar effect. And I believe that it is mostly the pregnenolone that helped with my sleep.
Of course, the next question is whether or not my numbers actually improved. I didn't think this was all in my head, but it's always a good idea to check things with a lab pull. It is also important in my opinion to make sure that you did not accidently overshoot safe levels as well. The results were impressive (2/24/2016):
DHEA-S: 407.4 ug/dl (RANGE: 35-550)
Progesterone: 1.01 ng/ml (typical range is 0.1-1.2 ng/ml)
Cortisol (~11 a.m.): 8.9 ug/dl
As you can see, I was now in the upper mid range on all three hormones. Physicians and patients can have different target levels, but this is where I like to shoot for, i.e. ample, youthful levels but no where near supraphysiological.
I have been on this protocol for about a month now with solid results and am still feeling great. Of course, if anything changes, I will update this page but, from what I have seen, the savvy doctors are doing the following with reasonably good success:
Measure levels and make sure you are below range or at the bottom of the range.
Take low doses daily. Men on TRT take approximately half of the DHEA of men not on TRT.
Measure levels afterward to make sure you have hit your targets.