TRT and Hormone Optimization

Introduction

• Discussion on whether to add DHEA and/or pregnenolone to TRT (Testosterone Replacement Therapy).
• Importance of understanding benefits, side effects, and appropriate dosing.
• Emphasis on testing labs before supplementing.

General Recommendations

• Supplementation should be based on clinical deficiency.
• Change or add one hormone at a time for controlled results.
• Avoid starting multiple medications simultaneously.

Role of DHEA and Pregnenolone

• DHEA:
  • Precursor to testosterone and estradiol.
  • More potent in women, especially post-menopause.
  • May improve testosterone in men if borderline; generally a failed approach.
  • Anecdotal evidence suggests it may improve sensitivity and alleviate anorgasmia in men on TRT.
• Pregnenolone:
  • Has two pathways: converts to progesterone or DHEA.
  • Progesterone is calming, helps with sleep, and anxiety reduction.
  • Favored route over direct progesterone.
  • Suggested use at bedtime; pharmaceutical grade recommended for consistency in dosing.

Dosing Recommendations

• Pregnenolone: Start with 10-30 mg before bed, adjust as needed.
• DHEA: Start with 25 mg in the morning, adjust based on DHEA sulfate test results.

Considerations for Supplementation

• Not all men on TRT need DHEA and pregnenolone.
• Response varies among individuals; some remain mid-range or even at top of the range.
• Decision should be collaborative between provider and patient.
• Supplement only if there are signs and symptoms needing treatment.

Side Effects and Concerns

• Concerns about increased aromatization and estradiol levels.
• Body self-regulates these processes; no significant adverse reactions known.
• Over-the-counter availability in the U.S. implies safety.

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Conclusion

• No blanket policy for all on TRT to use DHEA and pregnenolone.
• Importance of individual assessment and response.
• Video encourages further learning about TRT and hormone optimization.