Last week’s blog was a “Hormone 101” in which I discussed the essential elements which are important for hormonal health: nutrient sufficiency and keeping on top of gut health as the bedrock of ensuring your body has everything it needs to create the hormones which run your body’s essential functions.
But so many people reading blogs like this, or interested in Functional Medicine, already have these ‘basics’ in check. If you have hormonal issues even though you’re eating healthily, keeping your gut function optimal and topping up any nutrients that may be missing from your diet, what might be going wrong?
Researching this situation you may come across ‘conditions’ or ‘states’ which might be the ‘reason’ behind your hormonal dysregulation.
Unfortunately, it seems to me that many of these states are very poorly misrepresented in the online world. Situations such as Adrenal Fatigue or the Pregnenolone Steal are thrown around as ‘justification’ for why things are going wrong. And whilst these terms may describe symptoms accurately (and I never doubt that people are really suffering from the excess fatigue or heightened stress that they report) however, neither the Pregnenolone Steal nor Adrenal Fatigue are quite what they are made out to be.
Why does this matter? Well – I always find that understanding precisely what is happening in our bodies helps us to more accurately and effectively tackle the situation.
So today, I’m going to dig into these two hormonal states – explain why they’re not accurate – and how to think about hormones differently so you can to work with your body to heal.
BUSTING A MYTH, NO. 1: IS THE PREGNENOLONE STEAL REAL?
I began my previous article by stating that hormones are messages. The argument for the pregnenolone steal is that these messages are only created when the body needs to send that specific signal.
The human body has a hierarchy of needs. This (roughly speaking) starts with survival and then moves onto metabolism and strength, then procreation and eventually mood. The argument would be that hormones are produced in that order – we do what we have to so that we survive, that we’re strong, then we create life – and then we focus on feeling good.
This rather simplified understanding of human biology has given rise to the notion of the Pregnenolone Steal.
The argument goes that you only have a certain amount of pregnenolone (the cholesterol-derived building block of hormones). This means that if your body produces hormones in the priority order laid out above, you will prioritise the creation of cortisol in order to survive – especially whilst under stress. This will thereby leave “not enough” pregnenolone to create all the rest of your hormones – most notably the sex hormones.
In layman’s terms this looks like the body cannot be stressed and procreate at the same time – because the stress takes all the energy that sex hormones would need.
In truth, this limited ‘pool’ of available pregnenolone doesn’t really exist. As with most things in the body, there isn’t a limited supply – it is forever replenishing (providing nutrient levels are sufficient).
Moreover, pregnenolone exists within the mitochondria of each distinguished cell type within the adrenal cortex. Those distinguished cell types make different hormones. So, each cell type has enough pregnenolone to produce its specific hormone at all times.
What differs is not the supply of pregnenolone (again, assuming nutrient/cholesterol intake is sufficient) – but instead, the signals sent for the hormonal production to occur.
And this is the key when it comes to hormones. Yes, they are the messages – but the brain is the central command which instructs those messages to be sent.
There are fiendishly nuanced enzymatic feedback loops which regulate and direct the flow and receptivity to hormonal traffic. Instead of a lack of sex hormones being due to ‘running out’ of pregnenolone, it is actually the action of feedback inhibitors, receptor signalling and regulatory enzymes which are responsible for ‘stopping’ (or not starting) the production and release of the steroidal sex hormones in the first place. The problem isn’t limited supply – it’s higher up than that. The problem is that the brain says “no”.
And it doesn’t always do this by just stopping production and release, either – sometimes it upregulates the binding of hormones it has already produced when it recognises a different environmental need. Sometimes it enzymatically shifts things to break down hormones more rapidly.
It is, therefore, the brain – through some fancy tools often involving binding up of hormones produced and shifting of enzyme/metabolism/breakdown – that de-prioritises procreation when there is impending danger and stress.
The net result is the same, perhaps – but the concept of the brain sensing threats and therefore engaging regulatory and cessation pathways to minimise the release of sex hormones is very different from ‘too much creation of stress hormones leaves not enough left for sex hormones’.
BUSTING A MYTH, NO. 2: IS ADRENAL FATIGUE REAL?
All of this talk of stress takes us onto another big hormonal myth: that of ‘adrenal fatigue’. Now, again, I am not calling symptoms into question – people really feel the way they feel and it is aptly described under the descriptions of adrenal fatigue.
But what I do object to is that here too we have yet another concept about hormonal health that is founded on the notion of ‘limited supply’: that if you’re too stressed for too long, you ‘run out’ of adrenal hormones – or your adrenals ‘stop working’ as hard.
I’ve written about this at length here. What happens is that instead of ‘running out’ of hormones or ‘fatiguing’ the adrenal gland (honestly, not something that gets tired), under long-term and unremitting stress the brain (with those infinite and finely tuned feedback loops) recognises that no matter how loudly the cortisol signal is sent around the body, there is no let up in the level of danger or the changing of the situation.
At that point the brain ceases to use cortisol as a strategy which is attempting to change our behaviour or state. Now, admittedly, after screamingly high cortisol outputs, a lowered cortisol level is the net result – but the mechanism isn’t one of scarcity or fatigue. Instead, this is a regulatory mechanism instigated by the brain which STOPS SENDING THE SIGNAL TO MAKE AND RELEASE CORTISOL.
WHY IS THIS IMPORTANT?
When I write articles like this, I often find people say to me that they didn’t know why it was relevant. It may just be geeks and people concerned with biological accuracy that worry about these things – patients who are sick mostly just care about their crushing fatigue, their lack of libido or their infertility.
Indeed, some clinicians may not even care much about the above distinctions – because in my explanations OR when working on the principles of the myths of adrenal fatigue or pregnenolone steal, the clinical recommendations may be the same.
However, I feel that these distinctions are important because it roots us in understanding where hormonal dysregulation begins.
In Functional Medicine we are searching for root causes – and it’s not enough to stop at the adrenals or pregnenolone, supplementing with pregnenolone or DHEA directly (which helps with symptoms though DOES NOT upregulate endogenous hormone production) or using adrenal adaptogens or glandulars to ‘support’ a fatigued organ.
Whilst both of the above strategies will help symptomatically, they run the risk of creating a dependency on supplementation. They also do not acknowledge a key component of healing – they don’t fully address why the brain, in its infinite wisdom, downregulated adrenal or sex hormone production in the first place.
The more I work with hormones, the more convinced I get that the body knows best. I explain the above feedback-loop intricacies not to dazzle with science but to impress upon you that these hormone/brain signal/receptors/regulator interfaces are so unspeakably complicated that intervening within them is fraught with challenge.
It’s not enough to wade in with herbs, pills, medications etc. to try and ‘right’ all the ‘incorrect’ signalling – we must look at this from a more basic level. We must ask why the brain may wish a signal to stop being sent.
Downregulation or suppression of any hormone is a choice. Not a conscious one, certainly – but still an elective selection made by the brain given the input and outputs being demanded at any one time. Those inputs are internal and environmental – the way the brain is receiving signals from the outside world is heavily influencing what synapses are fired and messages are sent. This broadens our view from the very narrow-focussed hormonal therapies to looking at all of the influences currently acting on our brains.
In this situation I recognise that my role is to help my clients deal with everything that may make the brain make a choice to downregulate, bind or overly metabolise certain hormones. This involves removing stressors and challenges of all types – including, but not limited to:
- Dietary allergens
- Gut dysbiosis or digestive/absorption issues
- Extraneous chemicals, hormones and toxicity
Those first three are pretty obvious… but then there’s:
- Stress – emotional, relationships, financial, social situations which are unsupportive, challenging or come with excessive demands on the central nervous system
- Spiritual and conflicts of self worth or self belief. This may sound bizarre, but sometimes what is really needed to change the brain’s signalling around hormone production is to change our relationship to ourselves and our body – down-regulation of sex hormones in particular can be a response to historic abuse, trauma and feelings of physical shame
It is these subtle points above that often get lost within a treatment strategy that focuses solely on hormonal repletion using supplements. By relying on the principles of limited supply and a body prioritising stress and survival, we forget to question why the brain is making certain ‘choices’. This means we cannot offer real root-cause resolution to some of our clients for whom their brain is doing complex message rerouting.
For most of the hormonal situations that I see in clinic, down-regulation of hormones that you would ‘expect’ to see are typically the result of the brain engaged in self-protection. Working holistically with clients we must help individuals to unlock the reasons behind their brain’s need to stay protected.
So yes, I may use adaptogens, bio-identical hormone replacements, supplements to boost hormones, re-regulate hormones, alter binding capacity or enzyme function… but I’m also always mindful that the body changed all of this out of its wisdom, not because it started doing things wrong. Thinking in this way enables us to work with the body’s wisdom, understanding what it is trying to say with the symptoms that it is manifesting and using that as the point at which to begin intervening to resolve health complaints.
If you want my help to unlock the mystery behind what your hormonal signalling and downregulation issues are trying to say, please do reach out to me directly and I’ll be delighted to help.