Practitioner Question of the Month
Using DHEA supplementation without lab testing
Allie Nowak asks:
I see that you frequently use supplemental DHEA/Preg in most patients for adrenal support including fatigue/brain fog. What dose(s) do you typically use since you aren’t testing levels? Any risks to empirically treating?
Good question Allie. I used to be meticulous regarding dosing, then I realized this was your typical superfluous practice seen in functional medicine. I use about 30 drops of preg and 15 drops of DHEA each per day. Divided among 2-3 doses. Example Preg 10 drops 3x. Sometimes a little more or less depending on how someone responds initially and/or if they have a history of reactivity.
A small percentage of people are sensitive to DHEA and will react with a racing heart, sweaty palms, insomnia or like reactions. In these cases, I simply use other supports: herbal, vitamin, etc… In those with known PCOS, I usually avoid DHEA. Some with reflux are also bothered by the alcohol, so again I’ll use other methods.
I see no danger if you are working to find the minimal effective dose over time. Some are strongly against ever using these without lab testing and I know of no data that shows this to be the case. What I do know is many people are using oral DHEA OTC and seem to be just fine. I’m open on this, but it appeared in a clear area where we could simplify things. I’ve had no regrets since my switch about 4 years ago.
Don’t Rush During Your Charting – Take Time to Reflect and Learn
There is so much one can learn if they take time to review a patient’s chart notes. I spend a few minutes reviewing a chart before and after every office visit. During this time I am:
- Looking for trends and patterns
- Questioning my current beliefs
- Searching for blind spots
- Digging for ways to simplify the process
- Reflecting on what the most efficient next step is
- Thinking on what I would do if this next step does not work
- Updating my differential diagnosis
- Checking that there are not treatment recommendations that the patient is still on even though no benefit has been produced
- Considering if any retesting is needed
I truly believe that much of what clinicians are paying to learn from seminars and clinical training programs can be discovered right here. In fact, I feel I am living proof of this. Despite doing MUCH fewer seminars and training over the past 4 years, my clinical results have improved measurably. A large part of this was because of learning from the cases right in front of me.
There is an old saying which applies:
You can have five years’ experience once or one years’ experience five times.
Make sure you aren’t repeating the same thing, year after year, but rather learning from that experience.
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I’d like to hear your thoughts or questions regarding any of the above information. Please leave comments or questions below – it might become our next practitioner question of the month.