How about sublingual?
Also, I noticed that Dr. Myhill likes Preg for CFS:
"Prescribing adrenal hormones for CFS
I used to treat DHEA deficiency with DHEA. However, I believe pregnenolone is more physiological because it is upstream of all adrenal hormones including progesterone and cortisol.
Cholesterol is the raw material from which steroid hormones are made in the body. The next biochemical step is pregnenolone- this is the mother and grandmother of all steroid hormones. Starting off with pregnenolone means that all steroid hormones can be naturally synthesised in the correct physiological balance.
In theory this should greatly simplify the business of prescribing and monitoring hormones because the body can do its own natural balancing act. Please see
Wikipedia entry on Pregnenolone
A physiological dose of pregnenolone is 50mg. My office can supply Pregnenolone, 50mg, 60 caps. It is better absorbed under the tongue. This works because sublingual doses bypass the liver - the so-called "first pass effect".
This advice applies equally to men as it does to women. If you are taking DHEA now or if a future Adrenal Stress Profile (ASP) result shows low levels of DHEA, my advice is that you should consider taking/swapping to pregnenolone. If you do the ASP test through my practice, then I will recommend pregnenolone if indicated by the results. In addition to CFS sufferers, post menopausal women and those aged over 50 may also benefit from this therapy. For those 'transferring' from DHEA to pregnenolone, the conversion rate is approximately 1:2, so that if you are currently taking 5 mg daily of DHEA then you should transfer to 10 mg daily of pregnenolone.
In patients in which the Adrenal Stress Profile test shows a deficiency of cortisol it is worth trying hydrocortisone. This is the biologically identical hormone and if given in small doses (5-10mg in the morning) it has no side effects and induces no suppression of the adrenal gland. There are no long term side effects, there is no need to carry a steroid card, and no need to tail the dose off when stopping the course. Hydrocortisone should be seen as a crutch to the adrenal gland. The use of hydrocortisone allows the adrenal gland to rest a little and, in time, resume normal production, at which point the hydrocortisone can be stopped. This removal of the hydrocortisone support should only happen once the patient feels considerably better, which may take several months or even years. There is no need to recheck levels of cortisol once on treatment.
It may be that pregnenolone will be more effective as cortisol replacement - time will tell - watch this space!
Pregnenolone Steal
I think pregnenolone may be particularly pertinent in the treatment of chronic fatigue syndrome, and indeed the ageing process, for two reasons.
As described above, pregnenolone is the most upstream of all adrenal hormones and immediately downstream from cholesterol
. The conversion of cholesterol to pregnenolone takes place in the mitochondria and so one can easily see how poor mitochondrial function could result in poor output of pregnenolone and, therefore, adrenal hormones.
Pregnenolone steal – if the body becomes stressed, for whatever reason, then the production of adrenal hormones is moved away from the anabolic building, healing and repair hormones to the catabolic stress hormones such as cortisol. In essence, when sufficiently stressed, pregnenlone is diverted away from making anabolic hormones to making catabolic hormones, essentially cortisol. Consequently, less hormone is available for healing and repair. People with chronic fatigue syndrome are permanently stressed by many factors, not least of which is their inability to live up to their potential. Hence CFS sufferers will likely suffer from pregneolone steal. This is bad news not only because this will mean that there is less hormone available for healing and repair but also because pregnenolone steal worsens the problems of low pregnenolone production in CFS sufferers, as already described above, resulting from their poor mitochondrial function."
http://drmyhill.co.uk/wiki/Common_Hormonal_Problems_in_CFS_-_Adrenal
