The Pregnenolone Steal Is Wrong — But Your Tanked Hormones Are Real

If you've spent any time in the functional medicine world, you've probably heard of the pregnenolone steal. The idea is clean and elegant: pregnenolone is the "mother hormone" — the first thing your body makes from cholesterol, and the precursor to everything else. Cortisol, DHEA, testosterone, estrogen, progesterone, aldosterone. They all start as pregnenolone.

The theory says that when you're chronically stressed, your body "steals" pregnenolone away from making sex hormones and funnels it all into making cortisol instead. Stress goes up, testosterone and estrogen go down. Simple. Intuitive. Makes perfect sense on a whiteboard.

I know — I've drawn it that way myself. Cholesterol at the top, pregnenolone in the middle, pathway splits into cortisol on one side and DHEA and sex hormones on the other. Under stress, everything gets shunted toward cortisol.

There's just one problem. That's not how your adrenal glands actually work.

Why the "Steal" Can't Happen

Here's the anatomy. Your adrenal glands have distinct cell layers, and each one converts cholesterol to pregnenolone independently in their own mitochondria. The zona fasciculata makes cortisol. The zona reticularis makes DHEA. The zona glomerulosa makes aldosterone. There's no communal pregnenolone pool that gets fought over.

Think of it like three separate assembly lines in the same factory. They all start with the same raw material — cholesterol — but each line has its own supply chain. Ramping up production on Line A doesn't steal materials from Line B. They're independent operations.

Research has confirmed this. There's no known mechanism for pregnenolone transfer between adrenal cell types. The "steal" as a literal biochemical event simply doesn't happen.

So why do I bring this up? Because the clinical observation the pregnenolone steal tries to explain is absolutely real. Chronically stressed patients do have lower sex hormones. I see it in labs constantly in my Central Texas practice. Zero estrogen. Bottomed-out testosterone. Sky-high SHBG binding up what little free hormone is left. A hormonal desert. The pattern is real. The explanation is wrong. And the real mechanisms are actually more interesting.

What's Actually Tanking Your Hormones

There are four well-documented pathways through which chronic stress suppresses sex hormones. None of them involve stealing pregnenolone.

​Enzyme regulation. Under chronic stress and metabolic dysfunction, certain enzymes critical for converting precursors into sex hormones get downregulated. Less enzyme activity means less DHEA means less of everything you need downstream.

​Inflammatory signaling. When you're chronically stressed, your immune system produces inflammatory molecules. Research has shown that these directly increase cortisol release while simultaneously decreasing adrenal androgen release. So inflammation itself acts as a hormonal switch — turning up cortisol and turning down sex hormone precursors.

​Metabolic disruption. High blood sugar and insulin resistance — which are extremely common in chronically stressed patients — directly reduce DHEA production. Even acute blood sugar spikes decrease circulating DHEA levels. So if your blood sugar is dysregulated from stress-driven eating, that's directly hitting your hormones.

​Brain-level suppression. In women specifically, chronic stress suppresses signaling from the hypothalamus, which reduces hormonal messages to the ovaries, which tells them to stand down. This is the same mechanism behind stress-induced amenorrhea. The brain literally shuts down reproductive signaling when survival stress is high enough.

Four independent, well-documented mechanisms. The net result is exactly what the pregnenolone steal predicts — low sex hormones in chronically stressed patients. But through real pathways, not a simplified one that doesn't hold up.

The Testosterone Conversation Nobody's Having With Women

This is one area where, sadly, women have been truly shortchanged when it comes to hormones in medicine.

Here's the reality of HRT in mainstream medicine: Pre-menopausal women with hormonal problems are either ignored entirely or handed birth control pills — as if suppressing your own hormonal axis is the same as fixing it. Post-menopausal women get estrogen for hot flashes and that's it. End of conversation. Nobody's looking at the full picture. Women are left in estrogen-dominant states without anyone ever considering their testosterone or progesterone levels. It's a two-hormone problem being treated with a one-hormone answer — when it's treated at all.

And this isn't just a quality-of-life issue — there are real risks. Estrogen without progesterone increases endometrial cancer risk. That's been known for decades. But here's what most doctors still aren't talking about: the data on testosterone is actually reassuring — and possibly protective. That same 2019 Global Consensus Statement I referenced earlier specifically concluded that testosterone therapy does not increase mammographic breast density and does not impact breast cancer risk (Level I, Grade A evidence — the highest). It's also not associated with increased cardiovascular risk. Meanwhile, a 2021 study in the European Journal of Breast Health went further — women treated with subcutaneous testosterone actually had a reduced incidence of invasive breast cancer, and adding estradiol didn't increase that risk. And a 2004 analysis in Menopause concluded that adding testosterone to estrogen-progestin regimens may actually ameliorate the stimulating effects of hormones on the breast.

So we're not just leaving women feeling terrible — we may actually be increasing their risk profile by giving estrogen alone while ignoring testosterone and progesterone. That's not conservative medicine. That's incomplete medicine.

I cannot tell you how many women walk into my office who would pop positive on a depression screening. They're exhausted. Foggy. No motivation. Low libido. Gaining weight. They've been on SSRIs for years. Nothing's working.

We check their testosterone. It's in the gutter. We address it. And the "depression" improves dramatically.

The benefits go beyond libido. Mental clarity — that ability to walk into a situation and just know what needs to happen. Energy — not jittery stimulant energy, but sustainable, all-day capacity. Recovery from exercise. Drive for physical activity. Deeper, more restorative sleep.

Now, the testosterone-mood relationship is nuanced. Research shows it's actually parabolic — both low AND high testosterone are associated with depression in women. The sweet spot matters. This isn't "more is better." It's "optimal is better." That distinction is critical, and it's why you need someone monitoring your levels, not just throwing treatment at you and hoping for the best.

The SHBG Problem Most Doctors Miss

Here's a scenario I see constantly. A woman gets her testosterone checked. The total comes back "normal." Her doctor says she's fine. But she still feels terrible.

The problem is SHBG — sex hormone-binding globulin. It's a transport protein that binds testosterone in the bloodstream. Only about 1 to 2 percent of your testosterone is actually free and available for your cells to use. The rest is bound up, mostly to SHBG.

If your SHBG is high — which happens with oral contraceptives, liver issues, thyroid problems, and low-calorie diets — your total testosterone can look perfectly normal while your free testosterone is essentially zero. You're rich on paper but broke in practice.

This is why checking both total and free testosterone alongside SHBG is critical. If your doctor only checked total testosterone and told you it's fine, they missed the story.

What Actually Fixes This

So if the pregnenolone steal is wrong but the symptoms are real, what do we actually do?

​Address the stress response. This starts with the foundations — and I mean actually addressing them, not just listing them on a handout.

​Sleep is non-negotiable. Cortisol and melatonin run on opposite rhythms. If you're not sleeping 7-8 hours in a dark room with a consistent schedule, your HPA axis never gets a chance to reset. Blue light at night, irregular bedtimes, alcohol before bed — all of these disrupt cortisol cycling.

​Nutrition matters more than people realize. Blood sugar instability is a direct cortisol trigger — every crash sends a stress signal to the adrenals. Getting adequate protein, eating at regular intervals, and reducing processed carbohydrates stabilizes the metabolic foundation that everything else sits on.

​Movement — but the right kind. Over-exercising with a wrecked HPA axis makes things worse, not better. Walking, yoga, strength training at moderate intensity — these lower cortisol. Running a half marathon when your DHEA is bottomed out? That's pouring gas on the fire.

​Stress management isn't optional hippie stuff. Breathing techniques, prayer, time in nature — these measurably lower cortisol output. The patients who dismiss this piece are usually the ones who need it most.

Sometimes adaptogenic herbs help normalize cortisol patterns — not just lower cortisol, but restore the rhythm. But they work best when the foundations are in place. No supplement outperforms terrible sleep.

​Fix the metabolic piece. Lower-carb diets reduce insulin, which reduces one of the pathways suppressing DHEA production. They also stabilize blood sugar, which reduces metabolic stress on the adrenals. But here's the nuance — going very low-carb without adequate sodium can actually increase cortisol demand. Salt matters, and most people on low-carb diets aren't getting enough.

​Optimize hormones directly. For many women, especially those with documented low free testosterone and high SHBG, testosterone replacement makes sense. A 2019 Global Consensus Position Statement published in The Journal of Clinical Endocrinology & Metabolism — endorsed by the Endocrine Society, the International Menopause Society, and eight other professional bodies — concluded that testosterone therapy is effective for women, with moderate therapeutic effect on sexual function and emerging evidence for mood, energy, and musculoskeletal benefits. We use bioidentical hormone pellets — small implants that provide steady, consistent levels without the peaks and valleys of daily creams. Simple, effective.

​Don't skip the foundations. Here's the nuance though — sometimes I have to jump straight to hormones first because a patient's functional status is too low to address lifestyle without help. If someone can barely get out of bed, telling them to start exercising and meditating isn't a treatment plan — it's a wish list. That's fine — hormones become the tool that creates enough bandwidth to go back and fix the fundamentals. Get their testosterone up, stabilize their thyroid, address the cortisol dysfunction — and suddenly they have the energy and mental clarity to actually implement the lifestyle changes that make everything sustainable long-term. You have to meet people where they are.

The Bottom Line

The pregnenolone steal is a useful teaching metaphor that happens to be mechanistically wrong. Chronic stress absolutely tanks your sex hormones — just not through a shared pregnenolone pool. It works through enzyme regulation, inflammatory signaling, metabolic disruption, and brain-level suppression.

The clinical takeaway is the same: if you're chronically stressed and your hormones are in the gutter, address both the stress response AND the hormones directly. Not one or the other. Both.

And if you're a woman who's been told her depression is "just depression" while nobody's checked her free testosterone, SHBG, DHEA-S, and cortisol patterns — you deserve better care than that. The labs are straightforward. The treatments work. The lack of attention to women's hormones is one of the biggest blind spots in modern medicine. And it's fixable.

If any of this sounds familiar, that's worth a conversation.

Give us a call at 254-780-0023 or visit rootedhealthclinic.com.

Rooted Health Clinic — Salado, TX