Does anyone know much about adrenals please and can help with a query I have in Dr P’s book? I am trying to improve my DHEA which is below range, and I believe may be contributing to my chronic insomnia
Dr P talks about supporting the adrenal cascade directly. He said it requires pregnenalone, DHEA or 7-keto DHEA.
He talks about a blockage to cortisol manufacture at the 17-oh pregnenalone level and taking biotin to maintain enzymatic production such as the 21-hydroxylase enzyme.
I have tried pregnenalone and DHEA, which didn’t work, but not 7-keto DHEA. I wonder if I could have the aforementioned blockage. I take biotin within my B complex.
I hope it’s okay to tag humanbean , I know you’re very knowledgeable in this department!
Thank you 😊
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CornishChick
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True 21-hydroxylase deficiency is a life threatening genetic condition known as the salt wasting disease arising from insufficient mineralocorticoids.
It is responsible for biosynthesis of glucocorticoids and mineralocorticoids, ultimately helping to make cortisol and aldosterone (although in different pathways). During my worst 'adrenal fatigue' years my aldosterone dropped and it was later explained by a DUTCH practitioner that I most likely had a tendency for down regulation of this enzyme.
In spite of my symptoms and labs I received no adrenal investigation or intervention. Aldosterone eventually rose along with cortisol & DHEA after I introduced T3 meds several years ago. I also started HRT and was supplementing ashwagandha at that time. There are many research papers showing ashwagandha to raise adrenals hormone levels. The DUTCH recommends maca or rhodiola and all adaptogens work by normalising the HPA axis response/signaling (not directly on the hormones as some think).
When certain pathways are under-used by one hormone or overused by another dominant, they can become ‘blocked’. I too read Dr P’s take on biotin helping to support 21-hydroxylase enzyme. I haven’t ever read it anywhere else so assume he refers to a general improvement of the numerous enzymatic processes involved in the making of adrenal hormones, although riboflavin is a known 5a-Reductase inhibitor. I so wish he was still around to chat and educate.
Have you had testosterone and oestrogen tested? I ask because a common unwanted action is for DHEA to be fast metabolised by up-regulated 5a-Reductase into other hormones. If this were so then keto-DHEA is the preferred form as not converted to steroid hormones, but I still maintain to supplement only the missing hormone isn’t addressing a possible root cause and could make matters worse if certain pathways were to be blocked. Especially as you have already tried pregnenalone and DHEA.
wow thank you so much! I will re read that later when I have more time- a lot to take in!
I have had some bloods done by the endocrinologist a year ago. The results were:-
Oestradiol 333 - various ranges given depending upon phase, but endo never asked me which day of my cycle I was on. Should I be asking for sex hormones, if so, which ones are they please?
Testosterone 0.7 (0.5-1.9)DHEA-S 2.4 (1.5-7.7) With previous saliva tests this has been very bottom/below range, although it says DHEA and not DHEA-S. I’m unsure if the difference is relevant- I understand the S version is stored?
Cortisol 237 taken in an afternoon, not 9am. This has previously been around 220 at 9am.
I have never had the Dutch test. Would the NHS recognise this? What help could I get if results were askew? I’ve paid for two cortisol saliva tests as advised on here, and have low ish cortisol and below range DHEA, but no doctor has ever helped me fix these things. I don’t mind paying if someone might be able to help me fix whatever is wrong.
I agree both your DHEA and cortisol look low. Even not knowing the ranges cortisol looks quite dire if previously only 220nmol/L at 9am.
DHEA is the active form that binds to receptors and turns genes on, and made in our adrenal glands, ovaries and fat tissue. It has a circadian rhythm and is thought to be a good indicator of adrenal reserve. DHEA-S is the inactive reserve without circadian patterns. It is the majority amount of the total and just gives when needed to keep equilibrium of tissue glucocorticoid levels. Similarly cortisol converts to cortisone (inactive metabolite), and estrone (E1) that turns to estrone -S (reserve) but can also change into estradiol (E2) which is the most potent and prevalent.
For years functional medicine said the adrenal reserve ran low because hormones ran out as nutrients and enzymic actions started failing. Now high or low adrenal reserve is thought of as an adaptive response that needs nurturing back to normalisation by providing the right conditions. Your sleep issues will be massively impacting things like glucose metabolism and encouraging an over active insulin response which in turn effects other hormones in a long cascade.
The DUTCH tells you how your adrenal hormones are working, ie how they metabolise, whether they are turning genes on or changing into other hormones, and how they detoxify in both sulfation & glycosylation clearance phases. It also identifies which pathways are more at risk of DNA damage or which aren’t working well. Blockages occur when we can’t get rid of excess hormones or don't have good metabolising enzymic function, and may negatively influence usage of other hormones.
The NHS won’t recognise the DUTCH. Even your endo didn’t know to correlate your oestrogen levels with your cycle day. What a stupid man! 😁. Women do learn and interpret their own results (there are loads of vids available) but I would recommend an experienced practitioner who can determine best treatment, ie whether to replacement low hormones and/or implement dietary/life style changes, and/or supplement to encourage pathway opening, and/or to provide nutrients for better enzymic function. There are many layers to uncover and steps to encourage our hormones to function best.
The test is quite expensive and if you didn’t want to do it there is still lots of learning available. Dr Carrie Jones (from DUTCH) provides hormone information in her own Youtube vids, or if you like Dr Eric Balcavage, he has Dr Carrie as a guest for an hours intense learning in a podcast called DUTCH on 13.04.2021. It’s completely fascinating.
Thank you very much Radd, I am massively grateful to you for your help. It’s the first time in 20 years of chronic insomnia I feel that I might get somewhere with all this.
May I ask what sort of practitioner I need to look for please? Do they have a particular name if they specialise in this area?
The endo was actually a woman, so even more stupid then to not think about my cycle. She was off the Thyroid UK recommended list, although they removed her after I told her of my experience. I probably can look back to find what day of my cycle I was on as I keep a record of my cycle, if you think it would help you interpret my resents and see if my oestrogen is out?
The endo said there was nothing wrong with me from those results and sent me packing. I feel sure it’s contributing to my chronic insomnia. I told her I wake up at 1-2am every morning and mostly never get back off to sleep. She clearly wasn’t interested in helping me, or it was probably above her capabilities, who knows, I just feel badly let down by the NHS and probably need to pay to see someone privately, like you say, but have no idea who to see.
Oestrogen blood tests only give a snap shot of the level at that time on that day. Obviously oestrogen cycles but it also bounces around, especially when other hormones are out of synch. Therefore, when you are trying to establish hormone behaviours it isn’t useful.
I can’t recommend the DUTCH enough (I've done it twice) and if you are serious just google DUTCH UK as this will bring up clinics who use it, and then you can investigate those most local to you.
The test is easy as it’s just peeing on absorbent paper strips several times over 24 hours, and there’s even a paper strip for night time should you suffer insomnia 😬. Whether it’s glucose issues or hormones waking you they are all tied together. Even the establishing of the waking behavioural pattern can be changed by encouraging certain neurotransmitters and observing circadian hormones.
Thank you, I’ll look into it. You certainly know your stuff!if the DUTCH reveals I need eg testosterone and hydrocortisone, will the clinic prescribe that? I feel that my two saliva tests were a bit wasted because they showed the problem, but I’ve not been able to get anyone to prescribe anything off the back of it. It would be worth it if I can get treatment to fix the issues.
Can anyone recommend the type of practitioner I need to see who can guide me through testing and results please? I feel totally out of my depth with this and need help
If you Google DUTCH, you will get practitioners and clinics local to you. Some practitioners of DUTCH will also be able to prescribe UK meds, ie they might be a fully fledged doctor who specialises in women’s hormones or they might just have qualifications to prescribe only what’s applicable to their role. Others might work alongside a specialist with prescribing rights whom they might refer you to.
However, this is something you would need to ask when you check out the clinic before committing to the test because I would guess a large majority of practitioners would not be able to prescribe hormones.
I’ve only ever had sex adrenal hormone replacement given because all adrenal hormones can be encouraged to normalise through life style & dietary adjustments, adaptogens/supplements (the classic being DIM) and other hormone replacements such as HRT & thyroid. Remember they are all joined through their axis and normalising one or more helps others to normalise too.
If I were going for this test I would be looking for a recommended practitioner or clinic will good reviews more than a prescriber because it’s the interpreting of the test that you are basically paying for.
thank you Radd. I’ll have another look. I searched for practitioners in the UK on their website and it said there were none!
I live in Cornwall, so don’t expect there to be any near to me. Is there any reason why I couldn’t do a video consultation with a practitioner if they offer this service? Thank you.
I’m so sorry radd I must be doing something wrong. On the Google search I’m not getting any DUTCH UK practitioners, it’s just bringing up GP surgeries!
A search on the DUTCH website brings up zero results for UK practitioners. Sorry to trouble you, what am I doing wrong?!
Haha, I have no idea. I have no connection to these clinics but you could investigate them or else start a new post ask members for DUTCH practitioners recommendations. There are a few of us who have had them, and if you are doing an online consultation it doesn't really matter where they are.
Otherwise, I've just realised you could try Tanya Borowski In Lewes, East Sussex whom I am now using. Her knowledge is impressively extensive but she is expensive, has a long waiting list and likes you to do a whole package. You can view her website here ... tanyaborowski.com/the-journ...
That is so kind of you to take the time to provide all this information. Thank you, I will look into her and the others. When you say the whole package, what exactly do you mean please?
I’ve waited 20 years, so don’t mind waiting a bit longer for the best! Thank you.
Tanya will work with you over several months to assess change, and adjust advice as applicable. Like most practitioners she loves tests, and will want you to undertake several to get a better picture including genetic.
Just had a look at her website and she runs DNA MenoHealth and Hormone Health Packages but if you only wanted the DUTCH, she is not the practitioner for you. Personally I would go with as much as you can afford as these tests can be extremely informative but expense can run away if you don't make a budget.
Thank you, I saw that package on her website. I have no idea if that package is suitable to possibly help me, would you know please?
I tried to join her waiting list, but there is no link to it, and I can’t find an email or contact details either. I will keep searching in the meantime! Thanks again. You are obviously super knowledgeable yourself, so she must be brilliant too!
looks like she’s so good, she isn’t taking on any 1 on 1’s at present. I’ll ask to go on the wait list and explore other options in the meantime. Thank you so much, I am very grateful for your help.
I really recommend exploring this whole subject by reading, watching YouTube, listening to podcasts, etc. We are lucky now a days to be able to access free information and become more informed enabling better choices and understanding.
Lifecode Gx, the health/genetic testing company Tanya uses broadcast hour long discussions (much like other practitioners do) and the topics are so interesting. Less intense are the Liz Earle Wellbeing Show and the Zoe podcasts.
There are a few people following this thread. Just to let you know that whilst Tanya is fully booked this year, she does recommended other practitioners who are trained by her and able to offer help in accordance with her methods. I have now booked my first consultation. Thank you radd !
I had a consultation and the lady was lovely, but I don’t think she actually knew as much as me as a few things I mentioned she hadn’t heard of. So I decided not to sign up to a course of consultations.
I did find an ex GP who now does private consultations and specialises in hormones. So she knew all about DHEA etc. As I had explored other avenues, she suggested trying HRT as I am around perimenopause age and blood tests confirmed it was appropriate. She said as these hormones all work together, she’s hopeful my DHEA would rise and I’d start to sleep, especially with the progesterone. Only thing is, that is only taken for 14 days, then 14 days off, so I’m not sure how I sleep the other two weeks! I collect my tablets on Monday so can report back. The doctor was excellent, and very knowledgeable, she did a private prescription for bits and bobs which I took to my GP and will now get for free.
oh that so interesting! Thanks for replying. My DHEA is virtually non existent. And I’m way past menopause, but I’ve persuaded my GP for a trial of HRT. I long to sleep more than 5 hrs. Where is your private doc based?
I know the feeling. I only survive with my special antihistamine which makes me mostly sleep.
I’m in Cornwall, but she’s somewhere London way. But she does video consults, if you want her details please send me a message and I’ll give you details.
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Help please..using PREGNENELONE and DHEA and relationship to ADRENAL CORTEX.
Adrenal saliva test & DHEA 
Biotin?
Chronic adrenal fatigue; low DHEA levels
