Would it be beneficial to add DHEA and or pregnenolone to our TRT? How would we know? What symptoms to look out for?
What would be the benefits and side effects of both? And what would be the dosing? This is the TRT and hormone optimization YouTube channel. If you want to learn all about the science-based information on this topic, consider subscribing, hit that notification bell, and you'll be on your way.
Welcome everyone to the TRT and Hormone Optimization YouTube channel. Today again as a guest we have Gil T. Welcome Gil. Thanks Steven.
And the question for today is would it be beneficial to add DHEA and or pregnenolone to our TRT? How would we know? What symptoms to look out for? What would be the benefits and side effects of both?
And what would be the dosing? So yeah that is a fairly common question and As with any hormone, unless you have a clinical deficiency, it's pretty much recommended to, you know, to check, to test your labs prior to just going ahead and supplementing. When we do supplement, we always recommend adding or changing one thing at a time so we have a controlled environment and we can determine over the course of a couple of weeks or months if the treatment that we have opted to manipulate is actually working in a adverse or detrimental way or if it's actually beneficial and that helps you put a finger specifically on the outcome to effectively see if you're getting a desired outcome or or if it's counterproductive so when you change too much at once it is not a a proper way to do it so when I see guys going to a clinic or a physician that prescribes them you know eight or nine different medications right out of the gate they're on testosterone and ACG and b12 and you know an astrozole and clomiphene and and DHEA and pregnenolone, to me, this is just a way of selling medication and charging them $1,000 out of the gate just to provide something.
But I mean, you really don't want to go that route. So in short, when you test your labs, if you feel that you are deficient in an area, if your provider understands what these upstream hormones essentially do, and they're not just hormones, they're also pro-hormones because they do convert downstream into other active hormones in a naturally producing male. DHEA is a precursor to testosterone and therefore estradiol as well. All of these steroids are synthesized from cholesterol, and this then goes downstream into pregnenolone.
Pregnenolone then has essentially two pathways which it follows, one being progesterone and then one being DHEA. And DHEA will further reduce, as we said, into testosterone and then estradiol. Progesterone is a very calming, soothing hormone. In women, we know it helps to shed the uterus lining in the phase of the menstrual cycle that allows the buildup of blood to shed out in a menstrual cycle.
And it also helps women get to sleep. So it's a calming, anxiety-reducing sleep type of a hormone. In addition to...
the physiological aspects. And men it can also have a similar effect. You want to be careful not to overdo it. What the reason I like the pregnenolone route is because it will convert to progesterone rather than taking direct progesterone unless there's a deficiency there. And pregnenolone, we typically tell guys who do need it to use it before bedtime.
And while it is sold over the counter in the United States, I tend to favor the pharmaceutical grade because the supplement industry is not regulated. you don't know what you're getting, you don't know if the dosing is accurate, etc. When you get the micronized version of the compounded medication, you know exactly what is in the capsule and you know what the dose is. So it's a much easier route to control.
But if you want to go the over-the-counter route, there's a couple of good brands out there, which again, I'm not here to endorse any brands, but you can actually go and get some Pregnenolone on your own and see how that works for you, starting at anywhere from 10 to 30 milligrams before bed, and then you could titrate up as needed. It should improve sleep quality. DHEA we know is more potent in women, specifically post-menopause because they are more sensitive to androgens due to the mere fact that they have less of them.
In men, if you're naturally producing your hormones still and you're not on replacement therapy, a DHEA supplement may, and again, I like to go the pharmaceutical route as always, but it may improve your testosterone if it's borderline. For the most part, it's a failed approach. I know why some clinics or physicians will attempt it. It's more of a litigation mitigation type of approach of, hey, look, I've tried everything possible before putting the guy on therapy.
For those of us on TRT. The conversion down to the end hormones is not really as important. There are some effects that have been noted on the upstream hormones like pregnenolone, progesterone, etc. But even on DHEA, and this is purely anecdotal because I have looked and I have not found any studies.
I don't know if it's because they don't exist due to the fact that it isn't something that is promoted by the big pharmaceuticals. But I haven't found any conclusive studies on this. But anecdotally, I have seen with our own patients. And we know this to be true by reading the forms and whatnot, but some men on TRT after a while develop anorgasmia or delayed ejaculation. And I've noticed that DHEA tends to improve sensitivity and tends to, in some patients, alleviate or reverse some of this condition.
So DHEA is very interesting for men who experience asexual dysfunction with orgasm because I think that it actually can improve that. The exact pathway by which it works, again, is unclear because I haven't seen any scientific data, but anecdotally, I've seen this over and over with our own patients. So this is something to keep in mind. Again, pregnenolone being upstream, fairly weak as a DHEA analog because some of that conversion goes a different path, but supplementing directly with DHEA for guys on T who have experienced a level of delayed or inability to orgasm. I think is a worthwhile approach.
And typically you would start with about 25 milligrams in the morning and figure it out from there. You can, again, run your labs and see where you come in on the DHEA sulfate test. Doesn't it seem logic that every man would need DHEA and pregnenolone since the LH and FSH go to zero on TRT?
Not necessarily. We've seen guys come back with fairly mid-range levels. And again, it's one of those things where everybody's body responds differently.
Some guys come back grossly deficient. Some guys come back in mid-range. Some guys come back even at the top end of the range. And again, if we're treating signs and symptoms and someone has no complaints of anything that we can attribute to benefiting by the supplement, then why are we adding more medication in on top of regimen that isn't broken?
All right. Even if a guy comes in on the slightly lower end of the HEA, let's say, and he says, look, I feel great. Life is good. I have no adverse effects. Don't touch me.
You know, now we're going to say, well, go ahead and throw this in. And, you know, in his mind, he's going to look to blame the first thing that goes wrong in his life on the new supplement or medication. So it's more of a, I guess it's a judgment call on the behalf of the provider and patient to make on their own collaboratively.
But at the same time, I wouldn't say it's a blanket policy to say, well, you're on TRT, you must be on X, Y, and Z as well. Just like HCG, you know, no different there. I mean, some guys feel great, some guys don't. If you feel good without it and you don't need the benefits of it, then by all means, why are we adding it in? Any side effects to be expected from one of both?
I mean, I've read some of the stuff where people are like, well, you know, increase the HEA, increase the aromatization, increase the estradiol. We've already beat that horse a million times. Your body's going to self-regulate that. It's not necessarily a bad thing.
Is it really going to convert into endogenous testosterone? I mean, remember, these hormones generally come from the adrenals. So it kind of bypasses that whole, you know, testicular aspect where we know a majority of your testosterone comes from.
But I don't know of any specific scientific proven, you know, studies showing that there's an adverse reaction. And if there was, I'd venture to guess that it would probably be prescription only. But it is available, both Pregnenolone and DHEA are available in the U.S. over the counter, which is very interesting because I think it's the only country in the world where you can get them over the counter.
We also know that the FDA rushes to ban anything that has any sort of a reaction, whether it's good or bad. So maybe this is just one of those things that they haven't looked at yet. But for the meantime, there's really nothing I could point out. that would suggest that it is causing anyone any harm. Okay, thanks Gil.
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