Thinking of trying metformin with TRT

[dickielongate]

There is good clinical evidence for prescribing metformin for the diabetic patient.

There is no good clinical evidence that I am aware of for prescribing it for other conditions, only extrapolation (perhaps logical, but extrapolation nonetheless), association, and anecdote.

My view remains that metformin should be prescribed only in cases of mild to moderate diabetes mellitus Type II.

Good luck to you.

The lack of evidence statement can be justified easily when you control the threshold for what constitutes evidence in the same statement. The lack of clinical trials can and often does stem from a lack of financial incentive rather than the lack of prospect for greater good

If I control my threshold then I can be my own judge of what is evidence. Case studies, meta-analysis and anecdotal evidence are perfectly scientific when applied correctly.

Good luck to you too.

 

[dnfuss]

I'm sorry that you disagree, but clinical trials nonetheless are indeed the standard for what constitutes proof of hypothesis in the medical community. Anecdotal evidence, meta-analysis, etc. can be, and often are, used to justify opposing points of view; they are not proof of anything. They can suggest potential hypotheses to be tested by randomized clinical trials (preferably double-blind and placebo-controlled), but that is all. I'm aware that they are often offered up as proof in lay publications. That is unfortunate, but it doesn't change what they are: shoddy science and wishful thinking.

There are many who have concerns about metformin. See, e.g., the post immediately following the one Vince links to above (Post #20 under A new study explores anti-aging properties of metformin). I don't think at present those concerns should stop its being prescribed for Type II diabetes. But that's as far as the present state of the science would seem to go, at least for now.

 

[dnfuss]

A new study explores anti-aging properties of metformin

Vince, the post to which you link describes worm and mouse studies and anecdotal evidence. They are interesting, but not dispositive of anything. There are also some reasons to be wary of going on metformin in the absence of diabetes. See, e.g., the post (#20) immediately following the one to which you've linked. The Targeting Aging with Metformin (TAME) mentioned in your linked Post #19 is, to my knowledge, after at least four years still in the planning and funding stage. If it is ever done, and done properly, the results may support other uses for metformin, or they may not.

 

[dickielongate]

I'm sorry that you disagree, but clinical trials nonetheless are indeed the standard for what constitutes proof of hypothesis in the medical community. Anecdotal evidence, meta-analysis, etc. can be, and often are, used to justify opposing points of view; they are not proof of anything. They can suggest potential hypotheses to be tested by randomized clinical trials (preferably double-blind and placebo-controlled), but that is all. I'm aware that they are often offered up as proof in lay publications. That is unfortunate, but it doesn't change what they are: shoddy science and wishful thinking.

There are many who have concerns about metformin. See, e.g., the post immediately following the one Vince links to above (Post #20 under A new study explores anti-aging properties of metformin). I don't think at present those concerns should stop its being prescribed for Type II diabetes. But that's as far as the present state of the science would seem to go, at least for now.

We are going around in circles a bit, but who knows maybe concentric ones. I think any reasonable person would argue what you refer to as shoddy science, wishful thinking, etc has it's place in the scientific process. Your use of such sweeping pejorative terms looks to me like a smoke screen against reason.

It feels like you are putting 'the medical community' on a pedestal for one. Really? I am fully supportive of our doctors, but their hands are tied by policy, threat of loss of earnings and reputation. The truth is out there if you look with open eyes. How will history regard the great era of SSRIs, opiates and the complete failure of the medical community to recognise the importance of diet and stress during the last century. Do you know how long docs spend studying nutrition?

There are some in the medical community who you claim to speak for who fully acknowledge the value in synthesising the clinical model with the functional and alternative ones, and yes, base some of their treatment practice on reason, not just clinical trials.

You use the word proof, but again, there is no absolute proof. Even from the most robust clinical trial. There are definite problems with double blind placebo studies that don't get mentioned, and they include bias and peculiarities around placebo. Best option? Yes. Perferct? No.

Reason and assigning weight to evidence using your own judgement is the middle way. Denying the existence of things until the next trial 'proves' they exist has taken medicine a long way. People who think like that are needed in science, but so are people who explore possibilities and operate with more freedom of thought. Why can't we tolerate each other without getting bothered if someone doesn't share your world view?

Come back in 20 years and we'll have chipped away at the whack-a-mole approach to symptoms using drugs, and there will be a wealth of practitioners who understand a synergistic approach. Why don't they do comprehensive blood tests on people with depression? They should be doing that instead of writing out another SSRI script. How about mindfulness classes to mediate chronic stress. It works, study or not.

Interestingly, the rise of evidence based medicine as 'the only way' is a relatively new thing, and has tremendous value in some ways, but for some it has become something of an extremist dogma in my opinion.

Now you are pointing out studies to support your position about risks of metformin. These are the same category of studies I have read to form my calculation of risks. Metformin is one of the most prescribed and researched drugs in history, and all you ever hear about in terms of real world outcomes in the media is lactic acidosis. If anyone who doesn't have impaired kidney function, isn't diabetic, morbidly obese or really old thinks they're putting their life on the line taking metformin, don't. You would be wiser to invest your concern taking an extra look before you cross the road. If anyone is interested I will present a reasonable risk analysis of why I say this.

I would be happy to go through the list of dangers raised by Chanlder Marrs, and explain my take on the real world risks, short and long term. I am not against reading rat studies or in-vitro studies, such as some of the material referenced by Marrs.

But it's interesting to balance risks and benefits. I believe metformin is a very strong candidate for something to try in my situation as a short term intervention. There is good evidence it improves gut permeability and supports a microbiome balance that is linked strongly to health outcomes. It's also well documented that although some do not see any real weight loss benefits, there is a definite and substantial cohort with highly resistant visceral fat for whom it can be a very strong trigger. It is known to have positive effect on metabolic syndrome and insulin resistance, and no this effect is not limited to type II diabetics. I do not see any substantial long term risks that would make this a poor decision to try it. Nor do I see it as a cure for anything, but instead a short term tool. Since I've already proven I can maintain diet and training regimes, having done so for 7 years, I have every confidence I will eventually restore balance to my liver, gut and adrenal systems and support this moving forward with a holistic approach.

If anyone wants references to studies, I will happily provide them.

 

[Vince]

Vince, the post to which you link describes worm and mouse studies and anecdotal evidence. They are interesting, but not dispositive of anything. There are also some reasons to be wary of going on metformin in the absence of diabetes. See, e.g., the post (#20) immediately following the one to which you've linked. The Targeting Aging with Metformin (TAME) mentioned in your linked Post #19 is, to my knowledge, after at least four years still in the planning and funding stage. If it is ever done, and done properly, the results may support other uses for metformin, or they may not.

If you read the full thread, it also talks about the negative parts of metformin. Nelson does post threads about the negative effects of metformin. I am one who believes in the positive effects of metformin. I've been on it now for 7 + years, it helps keep my A1C at 5.2. I do believe that under 5 is better, I haven't been able to get there though.

 

[dnfuss]

I was only responding to the post you yourself cited.

Clinical studies provide statistically significant evidence for the use of metformin to reduce serum glucose in cases of mild to moderate Type II diabetes as an addition to diet and exercise. I'm on it myself for that reason. Sounds as if you may be, too.

I simply don't find clinical studies supporting its use for other disorders or in the euglycemic at this time.

 

[drkelp]

Asked my doc for RT3 test but he said free T3 was the bottom line. I'm not convinced. Wonder if it might be part of the reason why I require 280mg test cyp shots weekly.

 

[dickielongate]

I wanted to know if there was anything in Chandler Marrs story on metformin, referenced earlier in this thread.

I did a bit of reading and posted a point of view to the original thread.

 

[dickielongate]

Quick update, after starting metformin and NDT and letting things settle down, I decided to try intermittent fasting again. Finding the NDT dose is interesting. At first going up to 2 grains progressively was great, but if took 2 grains today, I would definitely by hyper. You can feel it. I am guessing it takes time for cellular T3 to build up.

I had also ceased exercise while giving up caffeine to let my adrenal hormones to regulate a bit. There was no weight loss with just the pills, and it wasn't until I started the IF. I am on day 5 now of IF and have lost 3.5Kg (7.7lb).

This is after doing the exact same regime with exercise during a 3 month plateau where I did not lose a pound. Not only that, I felt like crap towards the end of the fast period before, whereas now I feel great.

Going to add exercise back in now, but probably HIIT first rather than my staple of barbell stuff. Despite the weight loss, no substantial impact on the belly circumference yet. But I have given up worrying about muscle loss in favour of really trying to blitz the belly.

Since my first post, where I knew very little, I still know very little, but have continued to read. I've discovered the intrinsic link between insulin resistance and hypothyroidism, along with a ton of other intrinsic links.

Interestingly, at first I could not find much about using metformin and NDT outside of Jay Campbell, but have managed to find a few more clues and voices on this, including Westin Childs, who is one of the only people I've seen recommend IF with hypothyroidism. He does stress the importance of other measures first, like getting medicated adequately. I like his take on things.

I'm not there yet, but these are promising signs, and I will update again in a week or so.

 

[dickielongate]

I settled on 2 grains of NDT, and have been on 750mg Metformin 2x per day.

The weight loss has continued but slowed after the first week, but still fairly dramatic. 19 days since starting and I'm down 6.6 Kg (about 15lb). The belly has started to go down now, but not by much.

I got my full 6 month test results today, and it makes interesting reading.

My testosterone and free T are high, estradiol low, SHBG, and prolactin back in range having been SHBG low and prolactin sky high. T has been unknown until now during treatment due to contaminated tests.

Unsurprisingly on NDT and metformin, my TSH is very low, compared to very high before. It seems like exemestane (aromasin), 12.5mg EOD has radically controlled the E. Does this normally transform SHBG and prolactin numbers as seen below? I have remained throughout my injection treatment on 100mg Sustanon per week, split into two. I am surprised that with the T dose the total T is so high, and despite now having much higher SHBG, that the free T is also so high.

Apologies if units are impossible to read, I'm in the UK. Speaking to the doc for follow up consultation next week, will report back what he says. I feel great by the way, everything I hoped for from TRT finally. Might add HCG now, perhaps this will up my E a notch. Will probably ditch the aromasin once the belly's gone and see what happens. Probably about 8kg to go.

Jan 19: (Been on testogel only for a few weeks, finger test was contaminated with T):

Oestradiol 92 41 - 159 pmol/L
Testosterone H >520 8.64 - 29 nmol/L
SHBG 25 18.3 - 54.1 nmol/L
Free-Testosterone(Calculated) N/A 0.2 - 0.62 nmol/L
Prolactin H 612 86 - 324 mU/L
TSH H 6.21 0.27 - 4.20 mIU/L
Free T4 17.80 12.0 - 22.0 pmol/L
PSA (Prostate) 0.993 <2 ug/L

March 19: (Been on sustanon injections for a few weeks, finger test was contaminated with T, mysteriously):

Oestradiol H 194 41 - 159 pmol/L
Testosterone H 205.00 8.64 - 29 nmol/L
SHBG 21 18.3 - 54.1 nmol/L
Free-Testosterone(Calculated) H 8.500 0.2 - 0.62 nmol/L
Prolactin H 632 86 - 324 mU/L
TSH H 5.27 0.27 - 4.20 mIU/L
Free T4 13.80 12.0 - 22.0 pmol/L
PSA (Prostate) 1.740 <2 ug/L

July 19 (Went for IV clinic test this time, paranoid about contamination, since last test, have added in aromasin, cialis, NDT and metformin, T dose the same)

Oestradiol L 38 41 - 159 pmol/L
Testosterone H 42.00 8.64 - 29 nmol/L
SHBG 52 18.3 - 54.1 nmol/L
Free-Testosterone(Calculated) H 0.783 0.2 - 0.62 nmol/L
Prolactin 221 86 - 324 mU/L
TSH L 0.11 0.27 - 4.20 mIU/L
Free T4 17.80 12.0 - 22.0 pmol/L
PSA (Prostate) 0.936 <2 ug/L

 

[dickielongate]

Hi guys, I really would love some help with this if anyone can spare the time to look. I appreciate it. I feel pretty close to finding my best baseline after 7 months.

The doctor wants me to lower my T and go from sustanon to to enanthate. He said that sustanon causes a higher aromatisation effect than enanthate.

Converting my numbers to ng/dl, I'm at 22 for free T and 1210 for total from 100mg/week sustanon. Test was 24 hours after my bi-weekly shot

I am going to space out the AI a bit (12.5 every 4 days instead of 2) and introduce HCG and see if these brings the E2 up to range. Not my primary reason for HCG, but I understand it will possibly marginally increase E2. I would like to phase out the AI ASAP. As I said with my current E2/free T, I feel just great.

I have read that while some TRT practices want a free T no more than 17, people like life extension maintain that 20+ is good. If, once I phase out the AI, my E2 is controlled at higher free T, and hematicrit and PSA remain good, is there any downside to high total and free T if I feel good? By the way, I am going to do what the doctor advises me, as I do have faith in him.

Link Removed

"The current Life Extension optimal level of free testosterone is 20-25pg/mL. "

I am confused about this line, because I understand my reading of 0.78 nmol/l to be 22 ng/dl, and to be 220 pg/ml. Right or wrong?

The doc couldn't explain why my SHBG has risen so dramatically (21 to 52, bottom to top end of normal), and vaguely stated AIs can lower prolactin as E2 comes down. But I looked into exemestane, and it looks like it lowers SHBG not raises it.

The only things that've changed apart from exemestane (aromasin) are NDT, metformin and cialis. Is it bad to have top end of normal SHBG at 47? I could cut out the metformin to see if that is influencing things. I have seen evidence that this might be the case in studies, but don't really know enough.

 

[eyeheartny]

@dickielongate How are you doing now? It's been a few months. How's the weight loss? Blood work? To clarify, did you self-Rx the metformin and NDT or did a doctor give you the NDT? No judgment, just curious. Update us when you can please.

 

[Nelson Vergel]

Unless you cannot control your glucose and triglycerides with diet and exercise, then Metformin may be a good option. If you are healthy and trying to make gains at the gym, then I would recommend against using it.

Metformin Blocks Benefits of Aerobic Exercise on Insulin Sensitivity and VO2 max

An Anti-Aging Pill? Think Twice

After a few weeks on it, I got really tired and lost my "muscle pump" at the gym. It was too bad since my IBS related gut issues had improved (some people have GI problems on metformin but it was the opposite for me)

 

[Robotics]

My SHBG increased 20 points from just 10mcg of T3. I have also read if you get too much T3 it will induce insulin resistance. Cortisol should be tested before you start Thyroid.

interesting. I had a temporary increase from 11 to 16, then it went back down to 13 with 5 mcg of t3.

Were you on t4 as well? did the increase last and what was your initial shbg?

 

[captain]

Not on T4 and SHBG is back close to initial. Initial SHBG was 40 and was 43 on last labs.