February 8, 2023

Metformin and TRT? Should you add metformin to your testosterone replacement Therapy? How does metformin interact with testosterone. Is there any benefit to the combination. In this video on Metformin and Testosterone, I go over research pertaining to testosterone, metformin and the combination of the two in obese males and the effects that these drugs had on insulin resistance, weight loss and testosterone levels.

Hi guys welcome back to the channel i’m dr downey and today we’re going to look at metformin and trt more specifically we’re going to look at whether or not metformin has a role in trt and we’ll be looking at an interesting study and we’ll draw some conclusions using this study so it’s quite an overlooked aspect of trt but a lot of males looking to start trt are

Experiencing hypogonadal symptoms tend to fit into this category of men who aren’t necessarily obese but are overweight and they don’t have type 2 diabetes a lot of these males then start trt are not disappointed in the fact that they don’t lose weight because it’s thought that trt automatically results in weight loss whilst trt can assist in weight loss it doesn’t

Cause weight loss so i want to discuss whether or not metformin has a role in these individuals and just in general whether or not metformin should be considered when starting trt if there is a benefit to adding it to your trt so i will be looking at the study called metformin testosterone or both in men with obesity and low testosterone a double-blind parallel group

Randomized control trial and i’d just like to thank the author for sending me this article i really appreciate it it was just released on the 11th of august and they kindly sent it to me this paper is very interesting and i recommend you go read it for yourselves if you are interested so essentially this study was conducted over one year it was a single centered

Trial which kind of goes against the quality of evidence but i still think it’s very high in quality and what they looked at were they chose young men between 18 and 50 with obesity so a bmi above 30 and these men also had to have reduced serum concentrations of testosterone so this was either defined by having low total testosterone levels less than 230 or 8

For uk viewers or having free testosterone levels less than 70 or 240 for the english viewers the exclusion criteria was diabetes because we already have enough data on diabetes and testosterone’s role in diabetes and improving insulin resistance and its effect on those diabetic men these men were then split up into four groups there was placebo there was a group

Taking metformin only then a group taking testosterone only and then another group taking metformin plus testosterone and they looked at a variety of different outcomes from insulin resistance to changes in body fat erectile dysfunction and other symptoms again these men did not have type 2 diabetes but they did want to look at insulin resistance and whether or not

Metformin or metformin plus testosterone or testosterone could improve insulin resistance in these men who are not diabetic because as we know insulin resistance and hyperinsulinemia they all kind of contribute to low testosterone in obese individuals because obese individuals tend to have a degree of insulin resistance and this itself impairs like gonadotropin

Release secretion and eventually decreases testosterone levels so they wanted to test this hypothesis about insulin resistance and testosterone and obesity and see how they all interact together so in the metformin group they were they took 850 milligrams twice daily but in the testosterone group it was testosterone undecanoate that was injected initially then at

Six weeks and then 12 weeks thereafter and then in the combination group it was 850 milligrams of metformin twice daily plus the testosterone under canal weight so they looked at a variety of results and let’s just look through them and discuss the implications so the primary outcome was insulin resistance and let’s see how the different growth drug groups impacted

This and from these results it’s in fact displayed that all groups of metformin testosterone or combination group all resulted in improvement in insulin resistance to the same degree which is very interesting neither was better than the other which meant that the testosterone only group had an improvement in insulin resistance as much as the metformin only and the

Combination group and the combination group whilst thought it they might have an even greater effect or benefit because they have both metformin and testosterone had a very similar outcome so this would suggest that testosterone itself is important in the role of insulin resistance and that there isn’t really much of a benefit in this regard to adding metformin so

Another outcome they looked at was testosterone concentrations this is where it kind of gets interesting uh there were papers in the past that showed that metformin could decrease testosterone levels and i think in the case of a normal male individual without insulin resistance that could be true however if you have a degree of insulin resistance metformin might

Improve testosterone levels or not change them what’s interesting to note in this study is metformin had no effect on testosterone it didn’t lower them and neither did the testosterone only group only in the combination group did they have a significant increase in test testosterone levels in comparison to placebo and let’s look at another outcome they looked at

And that was their body weight and composition this is also interesting to note as i outlined in my introduction to this video is that trt never really results in weight loss and this was displayed in the study the group on testosterone only didn’t have any significant change in body weight however in the metformin only group in the metformin plus testosterone

Group there was a similar weight reduction and that was 1.8 kilograms in both groups so essentially in the combination group it’s the metformin that’s causing this fat loss and this reduction in weight was completely from fat mass in terms of erectile dysfunction and quality of life there wasn’t too much of an impact from any of the groups and of course one of

The side effects from testosterone was an increase in hematocrit but what is also interesting to note is the effect of testosterone and metformin on lh concentrations or suppressions it’s quite commonly or at least i’ve seen it being mentioned somewhere that adding that form into testosterone may decrease suppression because metformin is a potent antioxidant and

Thus it assists with maintaining testicular function whilst on testosterone unfortunately in this trial the metformin made no impact on that and in both the testosterone and testosterone plus metformin group the there was a significant decrease in luteinizing hormone in both groups and luteinizing hormone is important in this case because it usually indicates

Intratesticular testosterone production and function so in this case metformin did not help so it’s just important to note that the subjects in this trial were obese and thus their results might not replicate your results however if you’re an individual similar to these men there could be an added benefit to metformin the reason metformin might be useful for these

Individuals is that the addition of metformin or metformin by itself resulted in significantly more fat loss but again i’m not suggesting that metformin causes fat loss by itself because studies on individuals without type 2 diabetes or obesity actually have not displayed that any one really loses a significant amount of weight however in individuals with insulin

Resistance and obesity it shows that metformin can help with fat loss and in these circumstances then metformin could be beneficial for your trt regimen also important to note is that metformin and testosterone had a synergistic effect on total testosterone levels and this was shown by the fact that testosterone by itself didn’t actually increase testosterone

Levels to a significant level however the combination of the two did in these males so it just further highlights this complicated interaction between hyperinsulinemia insulin resistance and the gonadotropic axis but again just to summarize it if you are thinking about starting trt and you do fit into this category of males who are obese and you think trt will

Result in weight loss these results suggest it won’t result in weight loss by itself there’s a high chance you have a degree of insulin resistance and adding metformin might be the answer to ho assist you in weight loss so let me know what you think about this article in the comments down below what your thoughts about metformin and trt are and i will catch you in the next video you

Transcribed from video
Metformin and TRT….is it better? | More fat loss? | Metformin and Testosterone | Doctor's Analysis By Nicholas Downey