Overcoming TRT Plateau: The Ultimate Solution

 So this video is for men who are already on TRT. So I'm not going to talk about why you may need to be on TRT or anything like that. What I've seen with working with over 2000 men is that after a couple of years on TRT, many men begin to experience. Memory issues, difficulty in concentrating, anxiety and depressive moods, low energy levels, joint pain, excessive urination, and decreased libido. This is where I want to talk about neurosteroids. So if you've been on TRT for an extended period of time, you may have decreased levels of two very important neurosteroids. Now the first one is pregnenolone. Pregnenolone is known as the granuloma. mother hormone. So over 150 steroid hormones are derived from pregnenolone. Cholesterol actually converts to pregnenolone, and then pregnenolone actually converts to progesterone and DHEA, which then converts to testosterone and estradiol, right? So it really is a very important hormone in the production of sex steroids. Sex steroids being very important to help with immunity, glycation, methylation, inflammation, oxidation, and libido. So this is why cholesterol blocking drugs can have huge effects on memory and sex hormones. They can also reduce pregnenolone. So pregnenolone is associated with positive support for cognition, memory, and mood. So it can improve your deep sleep stages. It can increase motivation, prevent fatigue, improve stress tolerance. There's a lot of data suggesting patients who are bipolar or schizophrenic or depressive or anxious We have low pregnenolone levels, and it does this probably by inhibiting cortisol rises, right? If you're kind of interested in learning a little bit more about cortisol, check out my video, 7 Ways Stress is Slowly Killing You. That'll give you a little more information on how to optimize your cortisol levels. So Dr. Raina, I guess I'm, you know, kind of confused. So why microdose TRT, or TRT, like, why does it cause pregnenolone to drop? What happens is it seems to decrease these enzymes, these side chain enzymes that convert cholesterol into pregnenolone. And it happens over time. One thing you can do to kind of prevent this is to get on beta HCG or to supplement pregnenolone. I typically recommend supplementing pregnenolone because a lot of my patients when they get on HCG tend to get a rise in their Now if you're trying to maintain sperm count Or if you don't like the decrease in testicular size, not everyone gets a decrease in testicular size on TRT, maybe you want to try beta HCG, but most of my patients do very well on pregnenolone. And the decrease can be very significant, be high as 80 to 90 percent. Pregnenolone levels can range from 22 to 237, so typically I like to see them a little bit higher. Now here's the thing though, pregnenolone levels can fluctuate throughout the day, so I don't typically test them unless I have a concern. If I have a patient that is on TRT and they're getting symptoms and I've treated them with pregnenolone and DHEA, then I'll go ahead and maybe test it because it can be somewhat reliable. Some people it peaks a little bit earlier in the morning, some people it peaks in the afternoon, some people it may even peak in the evening. The reality is I just, uh, usually use DHA levels, which are a lot more standard. They tend to rise in that. So you, you test for the blood serums. It's a blood test, right? Is there anything else like you can do to raise pregnenolone, preg levels? Through pregnenolone oral hormone replacement. So it's usually a capsule that you can get and it ranges anywhere from 30 to a hundred milligrams. I usually start people at 30. and titrate by symptoms. And then, uh, you can use beta HCG. But as I mentioned, uh, for a lot of my patients, they do really well in the capsule and it saves them an injection with beta HCG. If they are, again, concerned about testicular size as well as, uh, an estrogen rise, we go over and maybe add beta HCG instead. So, the next neurosteroid that's also very important, I think, maybe even a little more important, is DHEA. As I mentioned, TRT tends to reduce the Side chain enzymes that convert cholesterol to pregnenolone, right, and thereby many times will decrease DHEA too. DHEA is a neurosteroid that provides protective effects on the brain. Appropriate DHEA levels are associated with improved sexual function, cardiovascular health, increased bone density, reduction in visceral fat, body fat, improved mental acuity and emotional well being, improved sleep, blood glucose control, and even protective against cancer and insulin resistance. and thereby diabetes. It's a really important hormone and it's something that you ought to supplement if you've been on TRT or at least test if you've been on TRT for a while. Does everyone need DHEA and pregnenolone? No. I mean there are some people whose DHEA and pregnenolone levels don't drop but it's always a good idea to check. So I like to see, uh, DHA levels, typically for men, at least above 300, but, you know, 400 to 500 nanograms a deciliter. For women, I typically like to see them above 300. Typically, I'm able to get people's DHA levels, width and range, using anywhere from 25 to 100 milligrams daily. I've been with a lot of concierge physicians, right? None of them tested for DHA or PREG. Do you know why that is or? To be honest, in order to get it covered by insurance, many times you need a diagnosis that insurance will deem acceptable. So congenital adrenal hyperplasia is one, but that's Where basically your adrenal glands aren't working very well as an infant, or if you have adrenal trauma or adrenal damage, that's another. But if you don't have evidence of that, it's hard to get it covered. And a lot of primary care providers, it's not really on their radar. I mean, it's not part of the algorithm. Does that necessarily mean that they are bad physicians? I don't think so. It's just, you know, just not something they think about. Many times people are treated with antidepressants, right? Even anti psychotics or anti seizure meds to, uh, to. Treat depression and anxiety when reality is just a hormonal issue. The first time I heard the word neuro steroid, I was like, Whoa, so you're saying like this enhances your cognitive ability is interesting, right? Another thing that is interesting that we do is kind of the daily micro injections to copy how your body naturally produces in your twenties. How did you kind of come across that? Yeah, it's been around for a while. And interestingly, uh, there is some literature on PubMed that suggests that it works a little bit better that actually emanates from female to male transitions. Smaller daily dosing of testosterone, an individual looking to transition to a male, which with these females are taking very high levels of testosterone, actually led to less side effects, uh, less increases in their red blood cell count, less issues with blood pressure, less issues with LFTs, less changes in their HDL because it can raise your red blood cell count, less opportunities to get therapeutic phlebotomy, which, you know, it's good to get blood, but you have, you have to do it every two months. It's kind of annoying. Thank Yeah, I mean, that's some amazing though that you're a hematocrit and your ripples don't get stickier and thicker. Having to do those donations is like super annoying. And also I personally turned anemic because I used to give donations so much for me personally, I'm microdosing tests, but because I microdose, I don't have the issues with aromatase, right? Or estrogen test, how strong can bring the estrogen. So I don't have to take an asthma. I don't take it like, you know, any other medications, right? So it's like more minimizing the medications I need for my body. And that's important, right? When you use microdosing, there is less of a likelihood of estrogen converting to testosterone. Now, remember, if you have a lot of adipose tissue, some of my patients, regardless of microdosing or not, are going to get some conversion. But as you lean down, it may not be that big of a deal. Remember, we don't want super high estrogen levels because it can lead to gynecomastia. You want appropriate estrogen levels. Estrogen is good. You never want to crush it because it can help with your HDL, help with prevent osteoporosis, help with um, atherosclerosis, help with mood, right? But we don't want it too high because then you run the risk of gynecomastia, emotional moods, water weight. If you are noticing that TRT isn't working or isn't working as it used to, right, there's like two things you can do. You can look at the microdosing concept of TRT or do a double click with regard to the narrow steroids as Dr. Ryan mentioned. And we hope that that can be of help and service as you kind of amplify your, your journey, uh, in changing how you age and working with hormones.