Many people have low levels of the hormones DHEA, testosterone, estrogen, and progesterone. And while there are numerous factors which can cause low levels of these hormones, one of the biggest factors that can cause this is something known as the pregnenolone steal, also referred to as the cortisol steal. Many doctors will recommend bioidentical hormones to correct hormone deficiencies, and while there is a time and place for hormone replacement, it of course is preferable to correct the cause of the problem whenever this is possible. And so in this post I’m going to discuss what the pregnenolone steal is, how it can lead to deficiencies in other hormones, and what you can do to correct this problem.
I’ve spoken about the hormone pathway in some past articles and posts, but I’m going to give a little refresher here. First of all, it’s important to understand that all of the steroid and sex hormones are derived from cholesterol. In other words, if you have very low cholesterol levels then this alone can result in low hormone levels. And the reason I need to emphasize this is because many medical doctors prescribe statins to a lot of their patients, and these statins can result in low cholesterol levels. So while you don’t want cholesterol levels that are extremely high, you also don’t want to have very low cholesterol levels.
So the hormone pathway starts with cholesterol, and the hormone pregnenolone is synthesized from cholesterol. This takes place in the mitochondria, and so if someone has mitochondrial dysfunction then this can affect the production of pregnenolone. But assuming this isn’t the case, pregnenolone can convert into either progesterone or DHEA, and these in turn convert into other hormones. Let’s take a look at each of these pathways:
Conversion of Pregnenolone Into DHEA. Pregnenolone gets converted into 17-hydroxy pregnenolone by the enzyme 17α-hydroxylase. 17-hydroxy pregnenolone will in turn get converted into dehydroepiandrosterone (DHEA) by the enzyme 17,20 lyase. DHEA is the precursor of androstenedione, which in turn is a precursor of testosterone. Testosterone in turn can convert into estradiol via the enzyme aromatase, and dihydrotestosterone (DHT) via the enzyme 5α-reductase.
Conversion of Pregnenolone into Progesterone. Pregnenolone converts into progesterone, which in turn gets converted into 17-hydroxy progesterone by the 17α-hydroxylase enzyme. 17-hydroxy progesterone will in turn be converted into 11-deoxycortisol, which in turn is converted into cortisol by the enzyme 11beta-hydroxylase. 17-hydroxy progesterone can also convert into androstenedione, with the help of the enzyme 17,20 lyase. So progesterone ultimately leads to the formation of cortisol, although it can also lead to the formation of androstenedione. Progesterone can also be converted into aldosterone, which takes place in multiple steps.
What Is The Pregnenolone Steal?
The pregnenolone steal is what happens when someone deals with prolonged chronic stress. Out of all of the hormones I listed above, the production of cortisol is a priority. And if someone is in a stressed out state, cortisol will be produced at the expense of DHEA. So with the hormone pathway I discussed, you’ll recall that pregnenolone can be converted into both progesterone and DHEA, which in turn will convert into the other hormones I mentioned. If someone is stressed out then this will inhibit the enzyme 17,20 lyase, which helps to convert 17-OH pregnenolone into DHEA, and 17-OH progesterone into androstenedione.
So what is the consequence of this? Well, if these enzymes are inhibited then this will result in a decrease of DHEA and androstenedione. And remember that these hormones are precursors to testosterone, and this hormone converts into estradiol and DHT. As a result, the pregnenolone steal can result in decreased levels of DHEA, androstenedione, testosterone, estradiol, and DHT. Keep in mind that not all of these hormones will instantaneously become depleted, and so initially you might see some of these hormones depressed, while other hormones will look fine.
So the pathway that converts pregnenolone into progesterone will predominate. However, cortisol is a priority over progesterone, and so progesterone will also decrease in order to produce more cortisol. This is why this process is also referred to as the “cortisol steal” by some sources.
How Can The Pregnenolone Steal Be Diagnosed?
Sometimes it can be challenging to tell if someone is going through the pregnenolone steal, but in most cases you will see elevated cortisol levels, followed by low levels of one or more of the sex hormones. If cortisol is high and all of the sex hormones are low or depressed, then you can be confident that the pregnenolone steal is a factor. But wait, if someone is in postmenopause, isn’t it normal for the sex hormones to be depressed? In other words, is it possible that if all of the sex hormones are low it’s simply due to the aging process?
Well, without question the hormones do decrease as we age. However, this doesn’t mean that they should be depressed. And if cortisol is elevated, then this is a pretty good sign that the pregnenolone steal is at least part of the problem. Sure, there can always be other factors, such as one’s age, but if chronic stress is a factor then this needs to be addressed.
What are some of the symptoms someone will experience during the pregnenolone steal? Since this involves high cortisol and low sex hormones, then the symptoms will usually correlate with this. So for example, if someone is experiencing hot flashes or a low libido, then this probably is due to a deficiency of one or more of the sex hormones. Other symptoms can include menstrual irregularities, anxiety or depression, vaginal dryness, insomnia, irritability, fatigue, and numerous other symptoms. So when someone has one or more of these symptoms then it’s possible that the pregnenolone steal is the root cause of the problem.
How Can You Reverse The Pregnenolone Steal?
As for how you can halt and reverse this process, the two most important things you can do is to 1) reduce the stress in your life, and 2) improve your stress handling skills. I realize that sometimes people can’t reduce their stress levels, but either way it is important to work on stress management. Remember that chronic stress will inhibit the enzymes which lead to the production of DHEA, along with the androgens and estrogens. And so if you don’t do anything to improve your stress handling skills, then your body will continue to produce cortisol at the expense of your sex hormones.
So you need to block out time to manage the stress in your life. I personally use a biofeedback program by the company Heart Math, as I block out 12 to 15 minutes each night before I go to bed. Sure, I probably should be doing more than this, but it’s definitely better than nothing. And in my opinion it’s better to spend 10 to 15 minutes EVERY DAY on stress management than 30 minutes three times per week. Of course you don’t need to use Heart Math, as many people improve their stress handling skills through techniques such as yoga and meditation. And there are other mind body medicine techniques as well. I talk more about this in my article entitled “Mind Body Medicine and Thyroid Health [1]“.
In summary, the pregnenolone steal occurs when someone is in a stressed out state. When this is the case the body will do everything it can to produce cortisol, which in turn will inhibit the enzymes that lead to the formation of the androgens and estrogens. So if someone has elevated cortisol levels and low sex hormones, then this is an indication that the pregnenolone steal is occurring. And in order to halt this process you need to reduce your stress levels and improve your stress handling skills. Some ways to accomplish this is through yoga, meditation, and biofeedback.