Thinking of trying metformin with TRT

[dickielongate]

Hi,

I would say after 6 months on TRT I am close to dailled in, or at least the best I've been.

Pre-TRT and during TRT I've had periods where I've trained every day, seen my strength and fitness go up (benching bodyweight, squad and deadlift 2x bodyweight, completed tough mudder, found it easy). In parallel I've been able to sustain disciplined intermittent fasting (16:8), and measuring calories and macros to created a deficit.

I have an issue with belly fat not going down. SubQ fat levels are fine, just the mass of visceral fat. I admit I haven't been able to ratchet up the program, due to life with kids, not been a total spartan etc. My BP is in the pre-hyper range (134/84). I haven't checked fasting blood sugar or triglycerides, but I feel it's likely I'm in the territory of insulin resistance/metabolic syndrome.

Seems to me if I can add metformin and stick on plan with the IF/HIIT/weights, having AMPK switched on might help, or at least worth a try. I have read and watched everything I can find, including the video where Jay and Nelson give their views.

Anyone else been through this and had any luck with it?

Forgot to mention, I am 47 years old. Also I do know that metformin will do very little by itself. I am also planning to cut carbs further than before (fruit, starches) and stop taking whey shakes (insulin spike). I never touch added sugar foods, and I'm 6 months into alcohol abstention. I've taken a year off booze before, but that didn't help that much.

 

[captain]

I started metformin 3 months ago and will be doing labs in a week or so. I don't seem to have the energy I used to and no change in fat that I can tell. Maybe the labs will show something good when I get them. I read it takes a long time to see the change in fat.

 

[Vince Carter]

Hi,

I would say after 6 months on TRT I am close to dailled in, or at least the best I've been.

Pre-TRT and during TRT I've had periods where I've trained every day, seen my strength and fitness go up (benching bodyweight, squad and deadlift 2x bodyweight, completed tough mudder, found it easy). In parallel I've been able to sustain disciplined intermittent fasting (16:8), and measuring calories and macros to created a deficit.

I have an issue with belly fat not going down. SubQ fat levels are fine, just the mass of visceral fat. I admit I haven't been able to ratchet up the program, due to life with kids, not been a total spartan etc. My BP is in the pre-hyper range (134/84). I haven't checked fasting blood sugar or triglycerides, but I feel it's likely I'm in the territory of insulin resistance/metabolic syndrome.

Seems to me if I can add metformin and stick on plan with the IF/HIIT/weights, having AMPK switched on might help, or at least worth a try. I have read and watched everything I can find, including the video where Jay and Nelson give their views.

Anyone else been through this and had any luck with it?

Forgot to mention, I am 47 years old. Also I do know that metformin will do very little by itself. I am also planning to cut carbs further than before (fruit, starches) and stop taking whey shakes (insulin spike). I never touch added sugar foods, and I'm 6 months into alcohol abstention. I've taken a year off booze before, but that didn't help that much.

Have you delved thru Thyroid? Because that can be a source of the problems your describe.

 

[dickielongate]

I started metformin 3 months ago and will be doing labs in a week or so. I don't seem to have the energy I used to and no change in fat that I can tell. Maybe the labs will show something good when I get them. I read it takes a long time to see the change in fat.

I am lead to believe that other things being equal there will be an average of 6lb over the first year. What I am thinking though is it might be different if you are pushing the diet and exercise but not seeing results from it.

Have you delved thru Thyroid? Because that can be a source of the problems your describe.

I am glad you asked Vince. When I got labs from my TRT provider, it showed high TSH and borderline low T4:

TSH H 5.27 0.27 - 4.20 mIU/L
Free T4 13.80 12.0 - 22.0 pmol/L

Also high E2 and low SHBG:

Oestradiol H 194 41 - 159 pmol/L
SHBG 21 18.3 - 54.1 nmol/L

When I asked them what it means, I didn't really get an answer, they just said it could be a number of things. I've had two blood tests since I started treatment and both were apparently contaminated because the T values were 10x over the range. I have an IV test booked with a clinic now, but have been advised to wait until I've had 4 weeks on HCG. I've received the HCG but haven't started the regime yet because I'm not sure it's the right next step.

Doing my own reading around my TSH/T4, I came across the T-Nation forums and the thyroid thing is big over there, so I bought a rectal thermometer and did temp testing, and I am definitely not low. No low energy and no coldness either. The opposite in fact, I am usually hot.

I did start taking a few drops of lugols every day, but after a month didn't feel any different, so discontinued. So the numbers to point to thyroid, and I am thinking the lower SHBG fits with my metabolic syndrome symptoms.

Honestly I don't know how to interpret the thyroid symptoms and numbers. Suggestions welcome.

Currently on 100mg Sustanon split into two shots per week, 12.5mg exemestane / aromasin EOD and recently introduced Cialis 5mg / day.

 

[Vince Carter]

If you want to delve in to that Thyroid, those numbers are very poor, and your tests are incomplete. We recommend these 5 as those two you have are a tiny part of this and an incomplete picture:

TSH
Free T4
Free T3
Reverse T3
Antibodies

Body temp is a fashionable Thyroid thing but it's a very poor diagnostic tool.

 

[dickielongate]

Interesting, so if I understand, thyroid imbalance is a potential root cause for resistant fat, low t like symptoms, and relates to SHBG levels. And SHBG levels CAN relate to insulin resistance? Is it circular? For instance If I managed to shed the gut, aromatise less and lower my insulin resistance (presumed) will it impact the thyroid function?

What is the intervention otherwise? Lifelong thyroid medication? Can it be brought back to a state of alignment where permanent lifestyle changes will keep it in balance?

I agree an out of whack thyroid could explain a lot in my case. I will see if I can get those tests (I'm in the UK btw)

 

[Vince]

You have very high TSH, it looks like you do have hypothyroidism. I agree with Vince Carter, I would have a complete thyroid panel. Make sure you have your reverse T3 checked, along with both antibodies.

 

[dickielongate]

Any thoughts on the T-nation mantra of take a sh*t load of iodine?

 

[Vince Carter]

I think by the numbers you do have here that you're past Iodine and other supplements.

 

[dickielongate]

There is so much conflicting information out there on this. Taking my numbers alone having read further it seems I have 'subclinical hypothyroidism', and I do see that the other tests will shine more light on what's behind it.

So I will take the tests, although I've been reading that UK docs don't normally call for the antibody tests unless there are potential hashimotos symptoms present. Seems I don't have the classic symptoms of that or hypothyroidism. I believe if I go to the doc they will start with a TSH test, which I already have two results showing high. Maybe I need to go private.

This article explains that TSH results between 5.5 and 10 should not be treated as a case for levothyroxine, which it seems is highly over prescribed.

3 Reasons You May NOT Need Thyroid Hormone

 

[captain]

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.

 

[dickielongate]

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 *** 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'

 

[dickielongate]

Damnit, which is it?

Cortisol raises TSH:

ELEVATED CORTISOL RAISES TSH LEVELS - The Conscious Pod

Cortisol lowers TSH:

Cortisol and Thyroid Hormones | Hypothyroid Mom

 

[dickielongate]

Taking the conversation full circle, since many sources claim metformin promotes healthy gut bacteria, and gut health is implicated in hypothyroidism by some, is it a stretch to ask if metformin might even help?

Rand Mcain, Jay Campbel and Nelson all seem to say that people with GI distress from metformin might be the ones in greatest need of gut flora re-balancing.

 

[dickielongate]

Even more intrigue, there seems to be a different pathway for metformin interaction with thyroid hormones:

Metformin and the thyroid: An unexplored therapeutic option Kalra S, Dhamija P, Unnikrishnan AG - Thyroid Res Pract

If I understand correctly, metformin lowers tsh, but not in isolation. I couldn't derive if lowered TSH was due to feedback from T3/T4 levels, but since the article mentions therapeutic benefit I assume the lowered TSH was not accompanied by lower T4/T3.

I am covering lots of ground and will slow down and process it all. My metformin will arrive soon. I am impatient (being honest) and can't see any reason not to try it.

Edit: Clarification here that lowered TSH from metformin did not produce changes in T3/T4, therefore the impact seems to be on TSH efficiency I guess?:

https://joe.bioscientifica.com/view/journals/joe/233/1/R43.xml

 

[Vince]

There is so much conflicting information out there on this. Taking my numbers alone having read further it seems I have 'subclinical hypothyroidism', and I do see that the other tests will shine more light on what's behind it.

So I will take the tests, although I've been reading that UK docs don't normally call for the antibody tests unless there are potential hashimotos symptoms present. Seems I don't have the classic symptoms of that or hypothyroidism. I believe if I go to the doc they will start with a TSH test, which I already have two results showing high. Maybe I need to go private.

This article explains that TSH results between 5.5 and 10 should not be treated as a case for levothyroxine, which it seems is highly over prescribed.

3 Reasons You May NOT Need Thyroid Hormone

I would have to agree, treating someone with just synthetic T4 does very little. It usually increase is their reverse T3. People I know that are just on synthroid feel no improvement.

 

[Sean Mosher]

Doesn't hurt to supplement with iodine, but as said above, I doubt that's going to resolve your issues.
Full thyroid panel and then treat accordingly.

And yes, Metformin may need a week or 2 of discomfort while it's cleansing everything.
You can use the Sustained Release version, but try and stick with it if it's a little uncomfortable in the beginning.
That's natural.

 

[Guided_by_Voices]

Visceral fat is a difficult issue. Besides everything you are doing and need to do per the above, you might investigate Telmisartan which apparently has an anti-fat affect. Longer fast might also be an option once you get the thyroid issues resolved.

 

[Guided_by_Voices]

Also, people on the Carnivore diet (meatheals.com) frequently report dramatic reduction in bloat and midsection fat, so that is also something you might investigate, at least as a way to get to rid of the fat.

 

[Dansk]

Taking the conversation full circle, since many sources claim metformin promotes healthy gut bacteria, and gut health is implicated in hypothyroidism by some, is it a stretch to ask if metformin might even help?

Rand Mcain, Jay Campbel and Nelson all seem to say that people with GI distress from metformin might be the ones in greatest need of gut flora re-balancing.

Yup, I bet you will have antibodies if and when you do a complete thyroid panel as suggested by Vince. Otherwise your driving down the highway with mud on your windshield without a complete set of labs.