PRP TREATMENT CONSENT FORM

Pregnenolone is an endogenous steroid and is a prohormone or precursor to the production of other steroid hormones, including progestogens, androgens, oestrogens, glucocorticoids, and mineralocorticoids. Within the nucleus of the cell, Pregnenolone has no progestogenic, corticosteroid, oestrogenic, androgenic, or antiandrogenic activity. It is made within the mitochondria of the adrenal glands. It can help the body to maintain normal hormone levels, which in turn may be useful for:

  • Fatigue
  • Arthritis
  • Aging
  • Depression
  • Declined cognitive function – it is recognized as a Nootropic – may improve cognition and memory
Do not take Pregnenolone if:
  • You have impaired liver function
  • You have an untreated adrenal gland condition
  • In the case of potential allergy to Pregnenolone
  • You are pregnant or breast feeding
  • You have or have had any of the following medical conditions:
    • Breast cancer
    • Prostate cancer
    • Heart disease
    • Low “good” cholesterol (HDL)
Taking other medications:

If you are taking bio-identical hormone replacement therapy (BHRT) or Menopausal Hormone Therapy (MHT) in the form of – oestradiol, progesterone, testosterone, or DHEA – your doses may be adjusted as Pregnenolone use may augment this. The dose of hormones most likely will need to be adjusted, a lower dose in your BHRT / MHT can be simply adjusted on follow up.

If you forget a dose – do not double up. Skip the missed dose and resume the next scheduled day.

Potential Side Effects:

Pregnenolone may cause side effects, please notify your doctor if you have any of the following.

  • Overstimulation
  • Insomnia
  • Irritability
  • Anger
  • Anxiety
  • Acne
  • Headache
  • Negative mood change
  • Facial hair growth
  • Hair loss
  • Irregular heart rhythm
  • Joint pains or aching – suggests the dose is too high or inappropriate

Serious side effects are rare. Please notify your doctor if you notice anything else that is making you feel unwell and stop taking it.

Do not be alarmed by this list of side effects and you may not experience any of them.

In signing this consent form I, (print name) acknowledge and have read the above information.

I understand the potential risks and benefits for using Pregnenolone. I have discussed the use of Pregnenolone with my doctor and understand why she, Dr Maria Mackey, has recommended the use of Pregnenolone.

I understand that the use of this medication is outside the jurisdiction of the TGA.

I accept the risks and unknowns of taking Pregnenolone therapy and wish to have my doctor prescribe this for me.

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