High Free T? also Q on Metformin for me

Great forum. Thank you in advance for answering my questions.

I'm on TRT since mid summer. Feel pretty good. Still dialing in the dosage. Got some numbers back

Free T is at 32. Pretty much double the upper end of the range per the test report. Total T is around 1050. I know why I got so high (made some dosing mistakes on my end then got tested 2 days later). Im also on an AI.

Question 1) what are the potential issues with high Free T? I've tried searching here and everywhere and can't really find any good info. I'm not concerned but would like to know a little more.

Additionally I've been concerned about my fasting blood sugar levels hovering around 100 and jumping up to 130 on black coffee alone. The best I've seen is 95 on a 24 hour fast although I once saw 65 after a 5 day water fast. I was considering Metformin but my recent HbA1C test showed a really decent number at 5.2. MY PC is a great guy who understands a lot of this and says he cant explain fasting glucose being that hovering around 100 if my HbA1C is so good.

Question 2) am I a candidate for Metformin? Im trying to drop some stubborn body fat. Currently at 17.7% and 211 lbs (6'1" tall, 47 years old). Would there be unintended consequences from say 500mg x 2 per day? Would I see any benefit?

Best Regards
Ken

With that low of A1c you're apparently not having lots of spikes. Do you know what your average glucose reading is, on some Labs it will tell you after the A1c. I believe metformin is a very good and benign drug, very beneficial for longevity. I wouldn't be concerned about your free T, I like mine high, did you have your shbg and DHT check. Also how is your HCT.

I think it is 103 (Mean Bld Glucose). HCT is 48. I do not think we tested for SHBG this time nor DHT. My PC Dr is really just getting into hormone replacement therapy. I went to a specialist for initial TRT but now moving back to my PC because he is invested in learning more about this and will listen to me. We did what tests were allowed by insurance. Ill ask to include these on the next test. I have older tests from September that show SHBG at 20 and DHT at 32 but my T after pellet use was only at 500 and Free T only at 100pg/ml. We're now using injections of Cypionate (100mg per week) but my T levels were read after two weeks of playing with off market testosterone enanthate at what I later realized was 187mg per week. I've gone back to regular dosage of Cypionate by prescription jus to be safe.

Check out “dawn phenomenon” in regards to your fasting glucose. I’m seeing the same thing and I’m doing LCHF /keto and recently stumbled onto this.

Would you say your numbers were similar? That's probably whats going on. My liver is releasing glucose in the morning. Could be stress via cortisol since I wake up and check emails every morning at 5. Metformin might help but I don't see any info on what they mean numerically by "high"

There's no downside to high free t that I'm aware of, very common thing with your SHBG at 20 but given your inconsistent TRT use who knows...you need to be on a steady rptocol for at least 6 weeks then pull labs in your trough.

This morning it was 110 (ranges 99 to 111) and decreases throughout the day to usually 84-90. My last a1c was 5.1 so I know I’m not spiking for long periods of time.

fascinating. Thank you!

Because your labs were taken at the wrong time (do as Vince Carter suggests) the numbers are of no value. Therefore you are making poor assumptions based upon inaccurate numbers. With your A1C I would suggest you start at 500mg daily. That would help your morning glucose.

You're talking about my testosterone numbers correct? I'm comfortable there and not really making changes - just wondering if there were any known issues with high free T. Total is fine and also recognizing when the test were taken.

My real concern is with blood sugar disregulation and I think from the replies here and what I've researched I may actually play with Metformin to see how I do.

What your saying is your feeling good on TRT. Yet you don't know what your real numbers are. Yes no worries with Free T. You can't over dose on metformin according to their literature. I take 1000mg daily. In my case which I'm sure is different than others, I found that when I lowered my dosage of testosterone my A1C went from 5.4 to 5.0. That was a big change. If you take huge doses of testosterone your blood sugar will rise. We know this because many body builders have to inject insulin to get their BS low because they dose testosterone so high.

This was a very good podcast.

https://www.excelmale.com/forum/showthread.php?12306&p=84831#post84831

This is exactly the podcast that got me thinking about Metformin. I need to watch it though as I only listened in my car. Good stuff. I actually shared this with my PC to remind him about the drug and what it can do for a huge part of his patient population. We are probably going to have to start using it for a large number of people if we have any hope of dealing with the coming disease epidemic (already here really).

klawler9 said:

Additionally I've been concerned about my fasting blood sugar levels hovering around 100 and jumping up to 130 on black coffee alone. The best I've seen is 95 on a 24 hour fast although I once saw 65 after a 5 day water fast. I was considering Metformin but my recent HbA1C test showed a really decent number at 5.2. MY PC is a great guy who understands a lot of this and says he cant explain fasting glucose being that hovering around 100 if my HbA1C is so good.

Question 2) am I a candidate for Metformin? Im trying to drop some stubborn body fat. Currently at 17.7% and 211 lbs (6'1" tall, 47 years old). Would there be unintended consequences from say 500mg x 2 per day? Would I see any benefit?

Click to expand...

HgbA1c is often not as directly correlated with average serum glucose as shown in the charts. There are some outliers who have higher average serum glucose than such charts indicate, some lower. Having said that, an HgbA1c of 5.2 is is correlated to an average serum glucose of between 103 and 108, depending on the study used. Excluding the aforementioned outliers, the HgbA1c of those with consistently truly normal blood sugars is under 5.0%, notwithstanding what the ADA says.

Fasting blood sugars consistently over 100 are also cause for concern.

Metformin is a great drug for pre-diabetes, but it must be combined with a low-carb diet to be effective. The extended release version (XR or ER) taken at night is especially effective in combating dawn phenomenon. The usual titration is to start with 500 mg. each night, give it two weeks to adjust to it and avoid possible gastric distress, and then go up by 500 mg. Maximum dose is 2000 mg. of the extended release version per day. Most people don't see real benefit below 1500 mg./day.