Thinking of trying metformin with TRT

[Vince Carter]

I'd actually and I didn't want to be alarmist but if I had a TSH of ~5 I'd go straight to Antibodies and Hashi's as the cause. Not too many other reasons for a TSH that high.

 

[captain]

Seems like a good piece in the puzzle captain, thanks.

Reading around it now, but I recently self diagnosed (rightly or wrongly) lifelong high cortisol, and subsequently introduced ashwagandha, and the impact has been clear and undeniable. I am a different person on ash.

I also switched from all teas and coffees to a stack of 100mg caffeine, 200mg l-theanine and 200 UMP, which I take 3 times a day. I also use CBD drops occasionally which I can also feel. Overall, during the last month, life has turned around due to this attempt to hack cortisol. The high TSH test was 2-3 months ago, so I am even more interested to check again now.

EDIT: wait, cortisol lowers TSH. Maybe there is no connection? Captain can you explain more why to test cortisol 'before starting thyroid'

The way I understand your cortisol needs to be correct for you to handle taking the Thyroid.
Also if you started taking iodine around the time you did labs it would have caused high TSH. I recall iodine can increase TSH for 6 months when you start using it.

 

[dickielongate]

The way I understand your cortisol needs to be correct for you to handle taking the Thyroid.
Also if you started taking iodine around the time you did labs it would have caused high TSH. I recall iodine can increase TSH for 6 months when you start using it.

No I took iodine after seeing the TSH results

I'd actually and I didn't want to be alarmist but if I had a TSH of ~5 I'd go straight to Antibodies and Hashi's as the cause. Not too many other reasons for a TSH that high.

Reading around earlier, my take is that 5-10 TSH is subclinical, especially with the T4 in range, albeit low. I read more than one study that indicates a single figure percentage rate of progression to full blown hypothyroidism. I read other accounts of elevated TSH into subclinical range where the advice was to monitor over 6 months. I also picked up that 90% of all hypothyroid cases are due to hashimotos, so I do understand why you recommended antibodies. Still at the least, as I already said, I'm going to take the advice to get the full panel and act on that. Happy to be corrected, your real world experience trumps mine by far.

I am not trying to be dismissive, I 100% respect your input and advice. What's been interesting for me though is exploring whether hypothyroidism is truly a root cause issue, and I've learned about the impact of cortisol, and the potential impact of metformin. Seems like the action of metformin is very poorly understood, so I'm open to the possibility that the effect of metformin on gut biome plays a part.

Ultimately I will fight all the way against giving in to life long thyroid medications, but that's just me.

 

[dickielongate]

Hashimotos is associcated with h pylori:

The association of Helicobacter pylori infection with Hashimoto's thyroiditis. - PubMed - NCBI

Metformin is associated with inhibition of h pylori:

Metformin can inhibit Helicobacter pylori growth. - PubMed - NCBI

 

[Vince Carter]

Believe as you want but this is categorically not true

my take is that 5-10 TSH is subclinical

 

[captain]

There are many theories on cause of Hashimotos. One I have read is having iodine deficiency causing build up of hydrogen peroxide leading to the autoimmune attack on the Thyroid. If you have Hashimotos and a H pylori infection metformin is not going to help it. You would have had Hashimotos for years causing your Thyroid to be damaged to the point it can't keep up. You will have to take Thyroid meds to replace what you can't make. It is your choice to use them or not if it comes to that. I would wait till you get proper labs before you go crazy trying to find a miracle cure for it.

 

[dickielongate]

Believe as you want but this is categorically not true

Belief is not involved. I am in the gathering material stage, and no conclusions have been reached. It doesn't take much research to understand this is a polarising subject.

'my take' was arrived at by encountering a number of references stating that TSH between 5-10 and T4 in range is classed as subclinical hypothyroidism. For example:

Subclinical Hypothyroidism – Whether and When To Start Treatment?

"As for patients whose values of TSH are from 4.0 to 10.0 mU/l and who make up 90% of the patients with subclinical hypothyroidism, further research is needed to determine the effects of the disorder and levothyroxine therapy on the health."

Since you are so sure, I have to take that conviction into account, as I have benefited from your input on more than one occasion. But if you can spare the time to explain your statement, I would certainly appreciate it. Just to repeast myself, I am more than happy to be corrected in my interpretation of my findings.

There are many theories on cause of Hashimotos. One I have read is having iodine deficiency causing build up of hydrogen peroxide leading to the autoimmune attack on the Thyroid. If you have Hashimotos and a H pylori infection metformin is not going to help it. You would have had Hashimotos for years causing your Thyroid to be damaged to the point it can't keep up. You will have to take Thyroid meds to replace what you can't make. It is your choice to use them or not if it comes to that. I would wait till you get proper labs before you go crazy trying to find a miracle cure for it.

Well I agree we're not looking for miracles. I also agree we don't know enough and therefore I won't be starting any typical treatments until the labs point at that.

Regarding cortisol and metformin. The cortisol journey has its own drivers and supposed outcomes, but it's something of interest as a potential factor in thyroid health until ruled out. I would argue there is enough science to keep an open mind. Likewise with metformin, which I am motivated to try for different reasons, it seems clear it could be a factor however minor.

For every standard health care message you read stating that the only option is symptom treating drugs for life, there is a counter message claiming that hashimotos went into remission after cutting out gluten or such and such. You have to use experience to look for dogma, snake oil and bias for sure. I don't know the truth yet, but I'm staying open. But my guess is any reversal will involve multiple factors.

 

[captain]

You get into how accurate testing is with this stuff. A person with Hashimotos can test positive for lupus. I would guess someone with celiac disease could test positive for Hashimotos. I have seen it with the lupus test. I am just guessing with celiac disease. I don't know this I am just saying to think about it. Its kind of like someone that recovers from something you can't recover from and that would be because they didn't have it to start with.

 

[dickielongate]

Apparently the antibody test is occasionally misleading because of level fluctuations, and this could also apply to TSH testing. Anyway, I've found a private test. Looks like it has everything but reverse T3:

Thyroid Check Plus | Thyroid Function Blood Test | Medichecks.com

captain I hear what you say about any chronic progression of hashimotos likely having left me with a damaged thyroid. If it's meds it's meds. I will still progress with exploring liver and gut health either way.

 

[Vince]

Apparently the antibody test is occasionally misleading because of level fluctuations, and this could also apply to TSH testing. Anyway, I've found a private test. Looks like it has everything but reverse T3:

Thyroid Check Plus | Thyroid Function Blood Test | Medichecks.com

captain I hear what you say about any chronic progression of hashimotos likely having left me with a damaged thyroid. If it's meds it's meds. I will still progress with exploring liver and gut health either way.

Any doctor should be able to run the test for you, especially because of your high TSH. That way your insurance will cover it.

 

[dickielongate]

Any doctor should be able to run the test for you, especially because of your high TSH. That way your insurance will cover it.

I am in the UK. From what I understand, with the NHS, they start with TSH and T4 only. Then they will maybe do antibodies, and apparently T3 is not usually offered. I could shorten the process by convincing them I've got TSH and T4 results already.

 

[JimBob]

This site was recommended by a boichemist. I have not perused it, yet.
Stop the Thyroid Madness™ - Hypothyroidism and thyroid mistreatment

 

[dickielongate]

This site was recommended by a boichemist. I have not perused it, yet.
Stop the Thyroid Madness™ - Hypothyroidism and thyroid mistreatment

Thanks JimBob. The main point I've picked up from this is something I heard Jay Campbell mention: dessciated thyroid. I had meant to follow this up and find out whether he took it for hypothyroidism or as an adjunct to TRT. Quick read, but here he seems to say as an adjunct:

Is Thyroid Resistance the New Diabetes? - TOT Revolution

Very interesting to say the least. Any thoughts on this?

 

[dickielongate]

I just want to say thanks to everyone who offered their time to help me.

Especially Vince Carter and captain who made me understand the scale of my issue.

Steep learning curve. I have read hundreds of pages since I started this thread. I find my self shocked again that I reached 47 without having a clue how radically important optimum thyroid hormones were to everything.

I was so grateful my TRT provider existed, given the shameful and ridiculous failure of our health systems to free the tools that will radically improve men's lives. But now I'm shocked too that they don't seem to understand that HPT axis issues must be addressed before anything like the full benefits of TRT can be realised.

 

[dickielongate]

Back on topic..

I took 250mg metformin yesterday morning in a well fasted state. No GI issues. Followed up with 250mg after evening meal.

This morning, I upped it to 500mg fasted. Again, no GI reaction whatsoever. I'm on the non-XR ones.

Either I'm not in the affected group, or I have fake metformin. Bought from United Pharmacies, who I have used many many times without issues for other stuff. Who would fake it given it's a cheap med?

If I don't get symptoms, was thinking of going to 750mg twice daily, or even 750mg morning and 1000mg evening. I'm 6'4" & 220lb.

 

[dickielongate]

Metformin and its gastrointestinal problems: A review

Seems it's not so rare to not have any reaction.

GI symptoms Percentage
Diarrhea 62.1%
Heartburn 52.1%
Nausea 47.4%
Abdominal pain 35.5%
Bloating 35.2%
Retching 21.1%

 

[dnfuss]

Back on topic..

I took 250mg metformin yesterday morning in a well fasted state. No GI issues. Followed up with 250mg after evening meal.

This morning, I upped it to 500mg fasted. Again, no GI reaction whatsoever. I'm on the non-XR ones.

Either I'm not in the affected group, or I have fake metformin. Bought from United Pharmacies, who I have used many many times without issues for other stuff. Who would fake it given it's a cheap med?

If I don't get symptoms, was thinking of going to 750mg twice daily, or even 750mg morning and 1000mg evening. I'm 6'4" & 220lb.

Your metformin dose is quite low, and so not surprising that you haven't yet experienced noticeable side effects. You may or may not experience them with increased dosage.

But first things first: should you be taking metformin at all?

Metformin is a drug. It is a relatively benign drug, but only relatively. All drugs have side effects. The therapeutic benefit of a drug should outweigh its risks, both known and potential. Treatment with metformin has been demonstrated to provide meaningful reductions in serum glucose where a patient presents with mild to moderate diabetes and changes in diet and exercise have proven insufficient. I do not believe it should be prescribed for the euglycemic patient for weight loss, etc., where its efficacy is modest at best. Do you have labs that indicate diabetes, even a mild case?

 

[dickielongate]

My use of metformin is 100% off label. Hopefully that should be clear from everything I've put in the thread, but I'm happy to answer any specific questions.

I am satisfied I have done my homework on the risks and benefits, again happy to discuss.

I do not encourage people reading this to identify metformin as a weight loss drug. I do encourage people to put in the time to understand their issues and the options available, and take calculated risks.

Yes I should be taking metformin.

 

[dnfuss]

My use of metformin is 100% off label. Hopefully that should be clear from everything I've put in the thread, but I'm happy to answer any specific questions.

I am satisfied I have done my homework on the risks and benefits, again happy to discuss.

I do not encourage people reading this to identify metformin as a weight loss drug. I do encourage people to put in the time to understand their issues and the options available, and take calculated risks.

Yes I should be taking metformin.

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.

 

[Vince]

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.

A new study explores anti-aging properties of metformin