Stress and Hormones: The Pregnenolone Steal

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In our medicine, we do not believe that “health equals absence of disease” as is the case with other medical paradigms.  We strive to bring our patients beyond the absence of disease to VITALITY.  In this way, we believe in a spectrum model of health: at one end you have disease; in the middle you have a grey zone where lab tests are ‘normal’ but symptoms are present (aka you don’t feel well but nothing is ‘wrong’); and at the optimal end of the spectrum you’ll find vitality.  Here is where we are always aiming to bring our patients.  At vitality, the body is doing what we want it to – we feel energized from when we wake up until bed time, we aren’t holding on to extra weight, we feel mentally sharp and clear, we have endurance and maintain muscle mass easily, and can become pregnant and maintain a healthy pregnancy to bring home a healthy baby.  We find many of our patients are in the middle grey zone of no active disease, but no vitality.


By now, most of my patients have heard me harp about what I consider to be one of the most important modern day barriers to reaching vitality – an overworked stress response.  No matter who you are, or where you work, we are all exposed to stressors on a daily basis.  The problem is that many of us fail to focus on the extremely important practices of self-care and down time that balance out the constant stress.  As your physician, I can’t turn off your stress, but I can help you discover ways to train your body not to respond to the stress as strongly.


One of the most important reasons for working on how your body responds to stress is the intricate link between cortisol (the stress hormone) and the sex hormones in the body.    Normally, cortisol should be highest in the morning, and gradually decline during the day until bed time (around 9-10pm).  When the body is under great amounts of stress on a daily basis, cortisol levels are high for most, if not all, of the day, and over time this starts to deplete the building blocks (precursors) to cortisol.  Have a look at the chart at the bottom of this page – you can see that the main precursor to cortisol is a hormone called pregnenolone.  When stress is high, and cortisol output has to be high to meet the demands, pregnenolone gets pushed toward cortisol, leaving little left over for its other functions.  What’s wrong with that?  You’ll notice that pregnenolone is also a precursor to some other important hormones in the body – progesterone, DHEA, testosterone and the estrogens.


Over time and under stress, pregnenolone gets turned predominantly into cortisol, leading to a shortage of progesterone, DHEA, testosterone and estrogen – your reproductive hormones!


I often explain it to patients like this – your body has a hierarchy of needs.  Near to the top of that list is stress management, and near to the bottom is reproduction.  This means that if the body is stressed out, it’s not a good time to get pregnant, and we need to repair the stress response before your body can even think about having regular periods and producing good quality eggs (or sperm).


Depletion of the sex hormones, for men and women, spells trouble for fertility.  And the thing is.. we can work on boosting estrogen, testosterone, and progesterone naturally (or artificially in the case of Western medical treatment of infertility), but until we address the stress we’re just putting a Band-Aid over the issue.


We’re testing many of our patients for their salivary cortisol levels, in order to specifically address how depleted they are, and supplement appropriately at the right times of the day.  We are finding good success with using this functional approach to stress management, and it’s leading to success for many of our patients on their infertility journeys.


If you’d like to know more about how the stress response impacts fertility, or how natural interventions can help with stress management, call for your free 15-minute consultation or send us an email.


In health,

Dr. Kali MacIsaac HBSc, ND
Naturopathic Doctor


Diagram credit: Ben Wilson - Adrenal Fatigue and the Steroid Hormone Pathway