DHEA and cortisol.
These are both key hormones that are coming out of your adrenals,
and today we’re going to find out how they’re related.
I’m Dr. Carrie Lam. This is Dr. Michael Lam.
So first the pathophysiology of how your adrenals actually produce cortisol and DHEA.
You have your mother of all hormones which is the pregnenolone,
and all of the hormones need cholesterol.
So, cholesterol becomes pregnenolone.
Pregnenolone can either decide to make aldosterone, cortisol or DHEA,
and all your like testosterone and estrogen.
So, if your body decides to make cortisol, then it can make all three.
Or sometimes if your body says, “I’m in a lot of stress.
I’m going to make more cortisol.”
So it can shunt your products to be more cortisol and less of the DHEA and the reproductive hormones.
Versus if your body’s saying, “I need more estrogen and testosterone.”
It’s going to shunt more towards the DHEA side and less on the cortisol side.
So, how does this relate to someone with adrenal fatigue and their lab values?
That is what we’re going to go through today.
Well, as you’ve said, the auto-balancing is very critical,
and you have to respect the body’s way.
The body knows when to shunt towards more cortisol, when to shunt towards more DHEA
and resulting in testosterone, etcetera.
This mechanism is auto-regulated and you should not touch it.
If you try too much to modulate and micromanage this,
you can actually cause some of the feedback loops to be in dysregulation mode.
Now, a lot of people come in with a low cortisol curve from the four-point salivary cortisol.
It’s like a flat line.
What we call classically in the people with adrenal fatigue in advanced stages.
They also have a low DHEA.
So the common approach is to
“Well, let’s bump up the DHEA to give the body more energy.”
In fact, it does because the DHEA leads to testosterone
and therefore testosterone’s an anabolic hormone so therefore people use it as muscle building,
but also to increase energy.
However, there’s a problem with this, it is that you’re basically trying to increase energy
and not really increasing the cortisol.
You think you’re increasing the cortisol, but actually the cortisol curve runs differently
because the physiology as you mentioned is that it goes from pregnenolone to cortisol
or pregnenolone down to DHEA.
So if you want to increase cortisol,
you actually should be increasing the pregnenolone more so than the DHEA,
provided that you do it right.
Right, and it’s always… you've got to be very careful when you start DHEA on someone.
It’s not something you should be taking by yourself.
You should always have an experienced practitioner
because what are the side effects if someone starts to take DHEA?
Especially women, it can be hair loss.
It can be quite drastic.
Acne because of the testosterone type effect.
In male you can also have hair loss, coursing of the voice,
all these are possible side effects if you take too much.
Of course, it’s dose-dependent and sensitivity dependent too.
People who are very sensitive can have an exaggerated response
or even paradoxical responses from time to time.
So even if you have a low DHEA,
Can you talk a little more about the serum versus the free lab saliva?
Well, the saliva test measuring DHEA is measuring the free DHEA which is the best.
This is the amount that’s actually in the cells working.
The serum is measuring DHEA sulfate as a surrogate of DHEA
because then the serum or the blood… The serum and the blood are the same thing in this context.
The DHEA’s half-life is very short.
So in the moment it comes out from the adrenal glands, it’s already broken down.
So you don’t really measure.
So you have to bind it to a sulfate molecule and it’s more stable and that’s what you get.
So it’s not one hundred percent but it gives you a good indication as a surrogate marker.
So someone with low cortisol and low DHEA, don’t just jump to taking DHEA.
Yes, and not only DHEA,
even the precursor or the mother of DHEA, pregnenolone, should also be taken with a grain of salt
because there can be a shunting mechanism that goes on.
The low DHEA could be a result of other things that is not necessarily adrenal related.
So you don’t want to just jump to conclusions and take care of the numbers
because you can normalize the DHEA number relatively quickly,
but if you throw enough DHEA into the system… they can also trigger adrenal crashes
and a host of side effects that we mentioned,
and actually, it can make things worse.
The best thing to do is to allow the body to self-regulate, but for this to happen you have to be patient.
You have to give the body what it wants naturally, nutritionally, and the body will use those nutrition to redirect itself
because it knows where to go better than you and me try to micromanage everyday which can change.
Right, so giving your body the nutrition that it needs to make its own hormones
rather than giving your body the hormones that you think it needs because it might crash it.
So, today we talked about the DHEA and cortisol and how they’re related.
We’re here to empower you to take control of your health.
Thank you for watching this video.