There are many ways to support the adrenal glands – we can use nutritional strategies, lifestyle strategies, herbal strategies to name just a few. Another strategy is supplementing DHEA and pregnenolone for adrenal health. DHEA and pregnenolone are precursors to cortisol, progesterone, estrogen and testosterone. If a person is under chronic stress, and the adrenals are working hard to produce more cortisol to cope with that, other hormones can suffer and fall. The cortisol demand is “hogging” the building blocks which takes away from the other hormones, potentially giving rise to other symptoms over and above the adrenal fatigue. DHEA and pregnenolone supplementation can ensure that there is enough to go around for everybody.
Here is a simplified diagram of the adrenal hormone pathway:
You can see that it all starts with cholesterol. Interestingly, while we hear so much these days about the perils of high cholesterol, having low cholesterol is equally bad because we then can’t produce our steroid hormones. I have a few patients who have low cholesterol and have to supplement with cholesterol itself.
From there we have pregnenolone, fondly nicknamed “The Grandmother Hormone.” Pregnenolone can go one of two ways – either to progesterone, and then on to cortisol; or over to DHEA which can convert to estrogen or testosterone.
There’s something called “pregnenolone steal.” When the body is under stress, and demands for cortisol are high, more pregnenolone will be shunted towards the cortisol part of that pathway. The body will prioritize making more cortisol to help cope with the stressors, but at the expense of progesterone, DHEA, testosterone and estrogen. There’s only so much pregnenolone to go around, after all. Over time, even that mechanism will wear out, and cortisol levels will drop too.
What does this mean? Well, remember that 35% of our reproductive hormones are made by the adrenals through this exact pathway. Also remember that feedback loops involving cortisol and ACTH (a hormone produced by the pituitary that regulates adrenal production) also have influence over the thyroid gland. So all your other hormones could get royally stuffed up, leading to symptoms of hypothyroid (fatigue, depression, weight gain etc), and reproductive hormone imbalance (leading to PMS, PCOS, infertility, perimenopausal symptoms, irregular periods etc).
There are many ways to support the adrenals – using nutrition, watching out for lifestyle factors that put more stress on them, herbal regimens and more. I’ve written about some of them here, and some stress-management techniques here. Supplementing with DHEA and/or pregnenolone is simply another option. What I like about it is that it fills the tank of the raw materials needed to produce adrenal and reproductive hormones, ensuring that there is enough for everyone, and no one has to suffer just because cortisol is hogging all the pregnenolone.
DHEA doses range from 5mg daily up to 50mg daily. Pregnenolone averages 25mg daily. There is a supplement that I like called DHEA Plus by Douglas Labs that combines both into one capsules – but it’s 25mg of both which I think is fairly high for women. It’s a good one for men though. For women, I typically dose around the 10mg daily mark. Pure Encapsulations have a good 10mg pregnenolone; and 10mg DHEA.
I always give DHEA/pregnenolone supplements in the morning to support the higher production of adrenal hormones earlier in the day, in sync with our natural circadian rhythm. Taking DHEA by itself is fairly common, however, if you look at the pathway, you see that while DHEA is a much-needed adrenal hormone, and while it can feed estrogen and testosterone, it’s not helping on the progesterone/cortisol front. That’s why I like doing a combination of both.
You can test pregnenolone and DHEA levels through blood tests or saliva tests – it’s more common to see DHEA being tested. That’s a good way to see how depleted the system is. I think it’s fair to say that if the adrenals are out of whack with imbalances in cortisol and DHEA levels, then supplementing with pregnenolone is safe, and a good idea too.