Do you need hormone replacement therapy or do you need to stop hormone thievery?
Can you bring your hormones up to optimal levels on your own without HRT? Most likely yes!
Maybe you are feeling off with your hormones or had testing that revealed them to be suboptimal and you are wondering if you really need HRT. Perhaps you are experiencing the pregnenolone steal? The pregnenolone steal is when the body prioritizes cortisol production over making sex hormones like progesterone, testosterone and estrogen.
Pregnenolone is a precursor hormone in the body that is produced from cholesterol and is the starting point for the synthesis of several other hormones, including:
Cortisol (a stress hormone produced by the adrenal glands)
Progesterone
DHEA (Dehydroepiandrosterone)
Testosterone
Estrogen
When your cholesterol is too low or when the body is under chronic stress, there may be an increased demand for cortisol production. This is where the "steal" happens: the body shifts pregnenolone away from the production of other hormones (like progesterone, estrogen, or testosterone) to focus on making more cortisol to handle stress. This can result in a deficiency of the other hormones, particularly in cases of long-term or chronic stress.
The main trigger for pregnenolone steal is chronic stress. The body prioritizes cortisol production in response to prolonged stress, and this takes precedence over other hormone production. Stress factors can include:
Emotional or psychological stress (e.g., anxiety, trauma, chronic worry)
Physical stress (e.g., illness, injury, chronic inflammation, lack of sleep, over exercising)
Nutritional deficiencies (e.g., poor diet, lack of vitamins and minerals, undereating)
Environmental stressors (e.g., toxins, pollutants, lifestyle choices)
Adrenal fatigue or dysregulation, where the adrenal glands are overwhelmed by constant demand for cortisol.
Because pregnenolone is involved in producing various hormones, the steal can result in a range of symptoms related to the hormonal imbalances caused by the depletion. These can include:
Fatigue (feeling tired despite adequate sleep)
Hormonal imbalances:
Low progesterone (leading to menstrual irregularities in women, PMS, or fertility issues)
Low estrogen (causing mood swings, hot flashes, or vaginal dryness in women)
Low testosterone (leading to low libido, muscle weakness, or low energy in men)
Weight gain, particularly around the abdomen
Cognitive issues, such as brain fog, memory problems, or trouble concentrating
Sleep disturbances, like insomnia or poor-quality sleep
Mood swings, anxiety, or depression
So how can you prevent or mange the pregnenolone steal?
First, work to better manage stress. Work on mindfulness practices and prioritize sleep and sleep hygiene. Mindfulness can include meditation, yoga, deep breathing. Try a technique called box breathing where you imagine building a box with your breath; 4 second inhale though nose up the side of the box, hold breath 4 seconds across top of box, take a 4 second forceful exhale though pursed lips down the other side of the box and again hold the breath for 4 seconds across the bottom of the box.
With sleep hygiene, bank melatonin during the day by getting as much outdoor light exposure as possible. Then allow melatonin to be released at night before bed by limiting blue light exposure. This can be done by avoiding screen time before bed, blocking blue light with amber colored glasses. Avoiding increased physical activity, before bed and limit caffeine intake after morning time. If anxiety and racing mind keeps you awake, try 120-300mg mg glycinate before bed. My favorite brand is Pure Encapsulations Magnesium Glycinate found here: https://us.fullscript.com/welcome/eatpractical
Next, prioritize appropriation nutrition. Ensure adequate intake of calories relative to activity. Undereating, relative to activity can increase stress on the body. Increase intake of protein and produce at each meal. This will help increase your vitamin and mineral intake. Magnesium, vitamin B5, vitamin C, and zinc play a role in adrenal health and hormone production. Supplements might be needed if deficiencies are present. A good quality multivitamin like Basic Nutrients Two A Day by Throne found here: https://us.fullscript.com/welcome/eatpractical can help meet nutritional needs depleted from daily stressors and pharmaceutical drugs if taking. Avoid blood sugar imbalances by eating meals that stabilize blood sugar, which can prevent excessive cortisol spikes. These include quality protein paired with fiber rich fruits and veggies and healthy fats, evenly spaced throughout the day. Sometimes additional adrenal support can be helpful. Adaptogenic herbs like ashwagandha, rhodiola, and holy basil may support the adrenal glands and help regulate cortisol production. Do be sure to work with your provider to make sure there are no negative med/supplement interactions. Bioidentical hormone therapy or supplements like pregnenolone or DHEA (under medical supervision) may help rebalance hormone levels when necessary.
Lifestyle modifications can reduce the risk of the pregnenolone steal as well. Do prioritize exercise but don’t over do it. Moderate exercise can support hormone balance and reduce cortisol levels. Avoid excessive or high-intensity workouts if you’re already stressed or fatigued, as this could exacerbate adrenal depletion. Intense exercise on an empty stomach will also increase cortisol. Walking is a great exercise that does not increase cortisol levels. Finally, limit stimulant intake from caffeine and sugar and these can spike cortisol levels, which can contribute to the pregnenolone steal process.
Not sure if you are experiencing the pregnenolone steal? Consider testing. Hormone testing (saliva, blood, or urine tests) to assess cortisol, progesterone, estrogen, and other hormones can help identify imbalances and inform treatment plans. For cortisol testing, it is best to have a 24hr cortisol test vs a single point in time. The DUTCH hormone test is a great option.
If you find the pregnenolone steal is a challenge for you, work to build your list of stress management techniques, focus on getting a balanced diet, and considering lifestyle adjustments as noted above. It is a good idea to consult with a healthcare provider for appropriate testing and guidance.