question from a user
For your patients on TRT therapy do you also recommend and/or assist in the monitoring of other hormone levels, such as pregnenolone and DHEA, that may be impacted by the testosterone replacement? If so, what is the optimum ranges you like to see for Pregnenolone and DHEA-S?
AlphaMD's Answer
We don’t routinely test for neurosteroids unless a patient on TRT complains of cognitive issues. The prevailing wisdom is that all upstream hormones will decrease while on TRT, so it is always safe to assume that pregnenolone and DHEA-S will be low, or at least lower than when you started TRT.
The reason we don’t routine test for these hormones is primarily a financial decision. Labs demand payment for these tests, which are not cheap and never covered by insurance. While our partnership with national lab companies does provide a discount, it does not extend to these less common tests.
Lastly, considering both pregnenolone and DHEA-S are easily supplemented with cheap OTC oral meds, we usually will do a therapeutic trial if we suspect low neurosteroids.
TL;DR: Pregnenolone ($113-180) and DHEA-S ($49-140) tests are not cheap and not covered by insurance; pregnenolone ($17-35/90 tabs) and DHEA-S ($7-20/90 tabs) pills are dirt cheap, and it’s easier and cheaper to try the pills to see if you improve in 2 weeks on them.
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