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“.
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.
Thank you for this article. I find it very interesting. I do have a question. My physician has me taking a daily pregnenolone supplement yet I don’t see it mentioned in your article. Is it unusual for someone to take pregnenolone?
Pregnenolone steal is tied to excess cortisol production and ultimately Adrenal Fatigue. Dr. Michael Lam specializes in balancing your adrenals.
Dr. Thierry Hertoghe writes: “Pregnenolone is the most abundant hormone in the brain”. “it enhances memory, stimulates concentration, and prevents memory loss”.
Therefore, if you are overstressed, you will burn out your adrenals (fatigue) and your brain.
Yep. This is exactly what us happening to me. Live here in Charlotte …wish you were still taking in new patients. Guy you referred ran hormone tests but no recommendations after 9 weeks. I’m running low on most of them. Need to see someone else I guess. Too far to drive anyways from Ft Mill up to Cornelius. Thanks so much for all these articles. Love being informed!
What would you recommend to test cortisol levels?
My Endocrinologist doesn’t believe in adrenal fatigue or cortisol level issues (5th Endo I’ve tried, best so far, but no one else in my area I can try, so there’s no ‘find another Endo’ in my near future).
But my sex hormone levels are low, very low, to the point of me being diagnosed as early menopausal. But I’ve been living under huge amounts of stress for the last few years, and I have believed for a long time now that my cortisol levels have been affected.
I’ve been trying to de-stress, but I would really like to know where my cortisol levels stand now.
I know my Endo won’t order any tests. So what test would you recommend that I could get on my own that will give me the best results without breaking the bank?
Jenni Hunter says
You can order a saliva test to test from home…
maggie davies says
Hello, I am a 56 year old taking HRT and antidepressants for depression, anxiety and vasomotor symtoms. I am perimenopauseal, and have recently had a nervous breakdown losing a stone in weight, I now weigh 8 stone, so very slim. My question is this: If I have pregnenolone steal, would it be a good idea to increase my HRT to replace the stolen hormones while my body recovers?
I am off work and trying to keep my stress load to a minimum. I am trying to exercise and eat healthly as well. My main problem is morning anxiety upon waking and depression, I also have cognitive problems, concentration , memory etc. I would be grateful for your advice
I am sorry to hear about your depression. I am just wondering if you have had your t3 thyroid hormone levels checked? i found out my t3 levels were low and am now taking it on prescription..what a difference! like you i suffered brain fog and morning anxiety/depression which followed a daily pattern where it would improve by the evening. after 4 weeks on the t3 the symptoms had gone.
V Seabury says
Most people don’t realize that exercise during periods of high stress will only increase stress levels.Better to do yoga or incorporate stress relieving techniques to achieve balance.
I am now, 2018, 65 year old female. I took a short, low dose course of pregnenolone. Just four-five months or so. It helped me tremendously at first. Then came overdose symptoms so I tapered off and stopped taking it after trying again to just take a very small amount-5 mg a day. It just wouldn’t fly anymore. Then came the hair loss. I have lost more than half my hair over the last 3 years. I can’t make it stop. I have had PRP scalp treatment to no avail. I have also constantly gained weight at the same time and have now gained 20 pounds. I had Graves in the past and had my thyroid removed when I was 17 years old and am on Synthroid. I tried switching up my medication, but I do better on Synthroid. I also have had CFS most of my life and this new blow of getting fat and losing my hair is more than I can deal with. Is there any test I could have that might point me to a solution? So desperate. I am now looking at wigs and hair pieces. Ironically, I had the best hair of my life before this happened and only needed to lose 10 pounds. Any hint of what to do would be appreciated!!!
Dr. Eric says
Paula, I assume you regularly have the TSH and thyroid hormone levels tested? You might want to look into the DUTCH test, which is a comprehensive test for the adrenals and sex hormones, and this might reveal some imbalances that can be causing or contributing to the hair loss.
Stefanie Clark says
Go see a naturopath. I was skeptical but it is changing my life! I actually drove 5 hours to see one in Portland, Oregon because I couldn’t get help with my hashimotos thyroiditis anywhere near me. He didn’t talk to me about it because he knew adrenal fatigue was most likely the culprit. I am 35 and all my sex hormones were very very low. Pregnenlone, Dhea, progesterone, estrogen and testosterone. He also ordered a DUTCH test for my corticol and also tested me for Epstein Barr, which was positive. Amazing that after 12 years of working with modern medicine and getting worse instead of better, missing out on all of the 11 years of my sons life because of fatigue, I am now getting my life back!
Very low pregnenolone, dhea, and free testosterone with high SHBG. Chronic stress, bone loss, fatigue, pain, impaired cognition, post exertional malaise. Over 50 M, seeking comprehensive testing preferably Boston. Have wasted time and money with the main medical facilities that I moved here for. Previously made herculean effort to obtain help, groveling, in fear of worsening state now present. Paying almost 1400 “premium”/month for nothing, increasingly bitter over MD disconnect to readily available information on testing, diagnosis, treatment.
Dr. Eric says
I’m sorry that you’re not getting the testing and treatment you’re looking for. If you haven’t done so already I definitely would recommend working with a functional medicine practitioner.