question from a user
While TRT is great for testosterone levels, what are the wider impacts for health considering it suppresses other HPTA aspects? Examples: Pregnenolone is a neuro-steroid. It's neuro-protective and it's levels tie to cognitive function, memory, myelinization and potentially alzheimer's. Where does pregnenolone come from? It's converted from cholesterol by an enzyme called P450scc. Where does P450scc come from? Primarily the adrenal glands, as signaled mostly by FSH and LH. If we take exogenous testosterone though, we will see FSH and LH levels drop dramatically by virtue of feedback loop to the pituitary. So, we are tweaking a complex system here. By introducing testosterone we improve one aspect of the HPTA axis but what is the knock-on effect? Lower Preg? DHEA is the precursor to testosterone. By supplying testosterone are we inadvertently signalling for less DHEA production? That doesn't sound ideal. So, the question is does anyone understand the full range of impacts of raising testosterone by exogenous methods?
AlphaMD's Answer
Welcome to endocrinology, the most complex area of healthcare.
https://metabolichealing.com/wp-content/uploads/Post-The-Endocrine-Journey-1.jpg
Just so you know, this is a simplified version of the steroid hormone pathway.
So, to answer your question, yes TRT decreases pregnenolone. It decreases levels of all the intermediary steroid hormones as well. It decreases cortisol levels. It decreases aldosterone levels.
Long story short, nearly all of the intermediary hormones have no function. We have only recently learned about pregnenolone’s ancillary functions in the human body.
All we know about the long term effects of low pregnenolone due to downstream steroid hormone surplus is based on longitudinal studies of women of birth control and estrogen for menopausal symptoms. We know for a fact that low pregnenolone due to decades long estrogen use in women actually decreases risk of Alzheimer’s.
What we also are coming to learn is that FSH and LH levels (and pregnenolone) levels are dropping in all of society due to chemical and hormone exposures due to industrialization.
Alpha MD does recommend that all patients on any exogenous hormones supplement with pregnenolone and DHEA tablets. They can be taken for less than $2/day
We know that TRT decreases the risk of heart attack, stroke, obesity, osteoporosis, metabolic syndrome, depression, and anxiety. We know that these long term benefits outweigh the risks of continuing to live with hypogonadism.
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