Case Study over 7 yrs

[Wilson6]

Finally have enough data on this client to post something useful for informative purposes and there's some good info here. Currently 57 yrs old, 5'5". One jpeg has a timeline of labs that are generally of interest to this group along with body comp and also a couple current pics. All other labs were normal, ECG and physicals have been fine. She was a masters physique, stopped competing primarily bc of time and work, and had really nasty allergic rxn to any tanning dye. Finally said fuck it. Just "stays in shape now" and likes being hard and lean. Trains 4 -5 days a week, cardio 3 days on a slow stepper 20 min, two steps at a time, and 2 days of walking on a tread 30 min. Very busy at work on her feet all day and that helps. No other cardio, consumes about 2300 kcal/d, 50% PRO, 30% CHO and 20% FAT. One pizza and a couple beers Friday night and she'll carb load if I think she's getting flat, otherwise sticks to the plan but enjoys food and eats what she likes. Takes one Stimerex a day am for energy and her thermo. Her downfall is M&Ms and this is where semaglutide (0.25 mg twice a week before bed) has helped curb that craving. High BP and T2D runs in the family so she has to be careful overall. Prior to 2020 she would run Winny 10 mg/d for a couple 12 weeks cycles a year, but would soften up and lose too much between cycles, and I don't like Winny (more toxic than Var and drys out the joints, but that was her call bc her BB friends said Winny was better than Var). In 2000 she started test cyp and ND, titrated up to 120 mg/wk of TC and 60 mg/week ND in split doses MWF. Has run that since 2000 as her base. No problems with acne, hair loss or deep voice (some change but not James Earl Jones). Increased body hair and some facial but easily managed. Loves the way she feels esp no menopausal Sx and off the chart bone density. Runs Var splits a 25 mg cap daily (12.5 mg/d) for a couple 10 - 12 week cycles a year. The base of TC/ND however allows to keep most of the gains between cycles. For competitions she would add in Mast P and proviron per her BB coach, effects were minimal IMO. Primo does little for her (it's real Primo, her BB coach uses the same batch and loves it and had it tested). The only time she runs Mast and/or Primo is 3 weeks before her labs for testosterone levels as primo and mast do no cross react to a standard or free T assay. Has to keep her T below 100 total and free less than 5 or her doc freaks out. Was discuss labs and body comp below.

 

[Wilson6]

Regarding the labs. Once she started running TC/ND year round, she was always below 12 % body fat, really without trying, just keeping dietary intake consistent and walking/training. The only time her BF went up in the past 5 years was when her doc put her on metformin for HbA1c over 5.6%. Within a month she increased body fat and decreased lean mass, felt like shit and her LDL went up. Went flat in 2 weeks. Metformin while great first line to drop HbA1c but will suppress mTOR and increase myostatin. The effects in her were rapid and profound. She stopped the metformin and switched to semaglutide, titrated to 0.25 mg twice a week and there was a increase in HbA1c to 5.9 during the change but dropped back to 2017 levels in a month. Add in a bout of COVID in Jan 2024 and bed rest, that probably didn't help either. Started 12.5 Var first week Jan 2024 and ran it until this past week. Best Var she has ever used. If you look at her labs, on and off Var, there is some decrease in HDL on, but not what one would expect. No effect on LFTs (on or off). Jan 2024 her LFTs were in the 20's, that was after a week off of lifting (bedrest from COVID). Note Oct 2023 her creatinine was 1.29 eGFR 52, suggests she is headed to renal failure. Compare to her Cystatin C eGFR of 104, perfectly normal. That's why creatinine in lifters is not a good way to access renal function. This is the leanest and most muscular she has been to date and wasn't even trying. Her legs have a grainy look she's so lean. Got there without any pre contest anything.

Happy to answer any questions if I can. Some things she controls, pre contest was done by someone else and has other outside input as well. I try to manage keeping her sane and on a lowest possible risk path.

 

[Bigtex]

Regarding the labs. Once she started running TC/ND year round, she was always below 12 % body fat, really without trying, just keeping dietary intake consistent and walking/training. The only time her BF went up in the past 5 years was when her doc put her on metformin for HbA1c over 5.6%. Within a month she increased body fat and decreased lean mass, felt like shit and her LDL went up. Went flat in 2 weeks. Metformin while great first line to drop HbA1c but will suppress mTOR and increase myostatin. The effects in her were rapid and profound. She stopped the metformin and switched to semaglutide, titrated to 0.25 mg twice a week and there was a increase in HbA1c to 5.9 during the change but dropped back to 2017 levels in a month. Add in a bout of COVID in Jan 2024 and bed rest, that probably didn't help either. Started 12.5 Makine Var first week Jan 2024 and ran it until this past week. Best Var she has ever used. If you look at her labs, on and off Var, there is some decrease in HDL on, but not what one would expect. No effect on LFTs (on or off). Jan 2024 her LFTs were in the 20's, that was after a week off of lifting (bedrest from COVID). Note Oct 2023 her creatinine was 1.29 eGFR 52, suggests she is headed to renal failure. Compare to her Cystatin C eGFR of 104, perfectly normal. That's why creatinine in lifters is not a good way to access renal function. This is the leanest and most muscular she has been to date and wasn't even trying. Her legs have a grainy look she's so lean. Got there without any pre contest anything.

Happy to answer any questions if I can. Some things she controls, pre contest was done by someone else and has other outside input as well. I try to manage keeping her sane and on a lowest possible risk path.

Good information here. However I do have some questions and concerns as well as add to this discussion for those who might be considering either drug. Great to see that you are keeping such great records and insisting on blood work.

I know a lot of bodybuilders who use metformin in gaining mass because they claim it repartitions carbohydrates and help avoid fat storage. The rapid weight loss from taking GLP-1 medications like Ozempic and Wegovy can cause a decrease in muscle mass, lessen bone density, and lower your resting metabolic rate, leading to sarcopenia. Of course a much higher protein intake could slow this down, right? No doubt resistance training and even adding hGH could also prevent muscle loss and lessening of bone density and hopefully prevent the resting metabolic rate from crashing. No doubt anabolic steroids also greatly help. I think current research has show that Semaglutide etc caused total lean body mass to decreased from baseline. However, mass:fat mass ratio improved.

Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed

Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.

pubmed.ncbi.nlm.nih.gov

In a recent podcase Dr. Peter Attia warned an Ozempic user could lose 20 pounds of mostly lean mass — a profoundly unhealthy change in body composition. https://peterattiamd.com/the-downside-of-glp-1-receptor-agonists/

In 2021’s STEP 1 trial – the first trial demonstrating the efficacy of semaglutide as a treatment for adult obesity – a subset of 140 patients underwent DEXA scans for body composition analysis. Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial.

Now here is something I am very concerned with in athletes using Semaglutide.....the modulation of digestive speed by Semaglutide has significant implications for both nutrient absorption and the efficacy of orally administered medications. Slower digestion could alter the timing and extent of nutrient uptake, potentially impacting overall nutritional status. Probably a very good idea to test blood nutrient levels.

The modulation of digestive speed by Semaglutide has significant implications for both nutrient absorption and the efficacy of orally administered medications. Slower digestion could alter the timing and extent of nutrient uptake, potentially impacting overall nutritional status.​

​

Most already know that Metformin interferes with vitamin B12 absorption in the small intestine and supplement B12. Metformin metformin doesn't directly increase muscle mass or strength. It operates primarily by enhancing insulin sensitivity and glucose metabolism. This helps bodybuilders by potentially reducing fat accumulation and improving energy utilization. While Metformin may theoretically decrease mTOR signaling, Factors such as training, diet, drug use, and even the consumption of certain amino acids are all capable of activating mTOR to various degrees. When BBers use Metformin in a bulking phase, they are also eating more carbohydrates, more calories and also doing much heavier weight. Combine that with hGH and the dramatic increases in mTOR will far exceeds the inhibitory influence. Because Metformin is an insulin receptor site sensitizer, glucose uptake into the muscle cell is much more efficient. Metformin can be used in the off-season to help you manage glucose transport, glucose production, and glycemic control when bulking. As I mentioned it helps to repartition carbs. Not to mention helping to control insulin resistance while using high doses of hGH.

But the bottom line is finding what works. Great job!

 

[Wilson6]

Good information here. However I do have some questions and concerns as well as add to this discussion for those who might be considering either drug. Great to see that you are keeping such great records and insisting on blood work.

I know a lot of bodybuilders who use metformin in gaining mass because they claim it repartitions carbohydrates and help avoid fat storage. The rapid weight loss from taking GLP-1 medications like Ozempic and Wegovy can cause a decrease in muscle mass, lessen bone density, and lower your resting metabolic rate, leading to sarcopenia. Of course a much higher protein intake could slow this down, right? No doubt resistance training and even adding hGH could also prevent muscle loss and lessening of bone density and hopefully prevent the resting metabolic rate from crashing. No doubt anabolic steroids also greatly help. I think current research has show that Semaglutide etc caused total lean body mass to decreased from baseline. However, mass:fat mass ratio improved.

Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed

Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.

pubmed.ncbi.nlm.nih.gov

In a recent podcase Dr. Peter Attia warned an Ozempic user could lose 20 pounds of mostly lean mass — a profoundly unhealthy change in body composition. https://peterattiamd.com/the-downside-of-glp-1-receptor-agonists/

In 2021’s STEP 1 trial – the first trial demonstrating the efficacy of semaglutide as a treatment for adult obesity – a subset of 140 patients underwent DEXA scans for body composition analysis. Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial.

Now here is something I am very concerned with in athletes using Semaglutide.....the modulation of digestive speed by Semaglutide has significant implications for both nutrient absorption and the efficacy of orally administered medications. Slower digestion could alter the timing and extent of nutrient uptake, potentially impacting overall nutritional status. Probably a very good idea to test blood nutrient levels.

The modulation of digestive speed by Semaglutide has significant implications for both nutrient absorption and the efficacy of orally administered medications. Slower digestion could alter the timing and extent of nutrient uptake, potentially impacting overall nutritional status.​

​

Most already know that Metformin interferes with vitamin B12 absorption in the small intestine and supplement B12. Metformin metformin doesn't directly increase muscle mass or strength. It operates primarily by enhancing insulin sensitivity and glucose metabolism. This helps bodybuilders by potentially reducing fat accumulation and improving energy utilization. While Metformin may theoretically decrease mTOR signaling, Factors such as training, diet, drug use, and even the consumption of certain amino acids are all capable of activating mTOR to various degrees. When BBers use Metformin in a bulking phase, they are also eating more carbohydrates, more calories and also doing much heavier weight. Combine that with hGH and the dramatic increases in mTOR will far exceeds the inhibitory influence. Because Metformin is an insulin receptor site sensitizer, glucose uptake into the muscle cell is much more efficient. Metformin can be used in the off-season to help you manage glucose transport, glucose production, and glycemic control when bulking. As I mentioned it helps to repartition carbs. Not to mention helping to control insulin resistance while using high doses of hGH.

But the bottom line is finding what works. Great job!

BT I fully agree. My ex (a national level BB) had tried Metformin years ago for the reasons you mentioned, she didn't note much of anything other than she just didn't feel good on Metformin, but everyone is different and unless you try something, theoretical outcomes are just that. I tell clients, only use a dose of the GLP-1 drugs that take the edge off of cravings and only if you have cravings that are uncontrollable. You still need resistance exercise and diet. Docs are too eager to increase the dose just because. That ended up putting one of my clients in the hospital with gastroparesis on tirzepatide. I think the commercially available starting doses of these drugs is too high. My pref is Retatrutide, the 3 receptor agonist because it has reduced GLP-1 agonist activity compared to a pure GLP-1 drug. Two clients that have switched find that they don't have GI sides in lower doses (nausea, slowed digestion, constipation), but it curbs cravings just enough to be able to manage and sustain the fat loss without compromising lean. One is fighting genetics, her mother looks like Jabba. She could never understand why her mother would head right to the kids snack cabinet when she visited, now as she gets older she is developing the same cravings, they are very strong. Her mothers genetics are fighting to come out as I tell her. In the client described here, the goal is to keep her HbA1c below 5.6% without compromising lean or the way she feels and Metformin doesn't work for her so we're trying to find the right balance. Will update in a couple months with more data (lab and bod pod) after 6 - 8 weeks off the Var, all else the same. The other client (overweight) that switched from SEMA to RETA is prone to and has been treated for depression. She found the SEMA made her Sx worse along with the GI issues. She is losing weight on the RETA but no additional issues with depression along with no GI sides. So much to learn with these drugs. I think they are a tool in the box, but one has to understand what they are doing with them and how and if they should add them in.

 

[tommyguns2]

Lots of really good info here. Thanks! The one thing that jumped out at me was the TC and ND dosing. Am Ir right in reading 120mg and 60mg per week, respectively? That's almost HRT doses for men. And she's been running that for 15 years with very little virilization? That's surprising to me.

 

[Wilson6]

Lots of really good info here. Thanks! The one thing that jumped out at me was the TC and ND dosing. Am Ir right in reading 120mg and 60mg per week, respectively? That's almost HRT doses for men. And she's been running that for 15 years with very little virilization? That's surprising to me.

It has been about 5 years. Prior to that it was a couple 10 mg 10 - 12 wk cycles of winny a year. I have a number of women on T pellets, not competitors and their T levels are in the low range for older guys. The one BCa survivor total T runs between 250 - 700 depending on the timing of the pellet. The virilization is highly variable. Some women just a little T and they have issues, others not as much or way less than expected, even over years of continuous use. Certainly not a recommendation as this would easily turn most women, but not her and the impact on labs is minimal whereas others have more profound effects on lipids in particular.

 

[Bigtex]

It has been about 5 years. Prior to that it was a couple 10 mg 10 - 12 wk cycles of winny a year. I have a number of women on T pellets, not competitors and their T levels are in the low range for older guys. The one BCa survivor total T runs between 250 - 700 depending on the timing of the pellet. The virilization is highly variable. Some women just a little T and they have issues, others not as much or way less than expected, even over years of continuous use. Certainly not a recommendation as this would easily turn most women, but not her and the impact on labs is minimal whereas others have more profound effects on lipids in particular.

Wilson6, my wife seems to be a slow responder with anabolic steroids. When she won the nationals she was on some very heavy androgen doses. Still she love the Trenabol 25mg. She has had some virilization early in her career, but nothing that can't easily be solved. She also tried the Ozempic at doses recommended and had little success. She has trouble controlling her appetite. But again, high protein, low carb seems to help keep the fat off. My wife is using 500mg of Metformin now at bed time. My wife was also doing a transdermal test base going 15mg/d. Seemed to work pretty well. I think the extreme short acting testosterones cut down on the side effects with women.

Thanks for putting this information up. It is very informative. I had no idea any one was as anal as I am with this stuff.

 

[Rottenrogue]

Wilson6, my wife seems to be a slow responder with anabolic steroids. When she won the nationals she was on some very heavy androgen doses. Still she love the Trenabol 25mg. She has had some virilization early in her career, but nothing that can't easily be solved. She also tried the Ozempic at doses recommended and had little success. She has trouble controlling her appetite. But again, high protein, low carb seems to help keep the fat off. My wife is using 500mg of Metformin now at bed time. My wife was also doing a transdermal test base going 15mg/d. Seemed to work pretty well. I think the extreme short acting testosterones cut down on the side effects with women.

Thanks for putting this information up. It is very informative. I had no idea any one was as anal as I am with this stuff.

Interesting info.I don't think the test dose is too high .Times have changed with dosage.

 

[Wilson6]

Wilson6, my wife seems to be a slow responder with anabolic steroids. When she won the nationals she was on some very heavy androgen doses. Still she love the Trenabol 25mg. She has had some virilization early in her career, but nothing that can't easily be solved. She also tried the Ozempic at doses recommended and had little success. She has trouble controlling her appetite. But again, high protein, low carb seems to help keep the fat off. My wife is using 500mg of Metformin now at bed time. My wife was also doing a transdermal test base going 15mg/d. Seemed to work pretty well. I think the extreme short acting testosterones cut down on the side effects with women.

Thanks for putting this information up. It is very informative. I had no idea any one was as anal as I am with this stuff.

BT, another that was too large to post. https://pubmed.ncbi.nlm.nih.gov/34725961/

One of our female members is the same way, slow responder. She could run 300 mg/wk as a base of TC/ND and a little Mast and you'd think she was on a low dose pellet and her stuff is legit, T is prescription. Responds very well to Var, but one can't run that year round. You might want to look at Retatrutide for the wife, PS offers it. The girls are running 0.25 and 1 mg twice a week. No sides, but enough for what they need in conjunction with some discipline and exercise.

 

[Wilson6]

Wilson6, my wife seems to be a slow responder with anabolic steroids. When she won the nationals she was on some very heavy androgen doses. Still she love the Trenabol 25mg. She has had some virilization early in her career, but nothing that can't easily be solved. She also tried the Ozempic at doses recommended and had little success. She has trouble controlling her appetite. But again, high protein, low carb seems to help keep the fat off. My wife is using 500mg of Metformin now at bed time. My wife was also doing a transdermal test base going 15mg/d. Seemed to work pretty well. I think the extreme short acting testosterones cut down on the side effects with women.

Thanks for putting this information up. It is very informative. I had no idea any one was as anal as I am with this stuff.

IMO you have to understand mechanisms of actions to be able to put pieces of a puzzle together. Most MDs do not unless they have a PhD as well or are taught to think that way. We have a wealth of potential information on this board, things that will never be studied or published. We have to leverage that to educate, inspire new thinking, bust myths and bro science, reduce risk, increase benefits and get others to think about labs, body comp, etc. to figure out exactly what is going on in themselves and stay as safe as possible while achieving their goals.

 

[969C1]

Finally have enough data on this client to post something useful for informative purposes and there's some good info here. Currently 57 yrs old, 5'5". One jpeg has a timeline of labs that are generally of interest to this group along with body comp and also a couple current pics. All other labs were normal, ECG and physicals have been fine. She was a masters physique, stopped competing primarily bc of time and work, and had really nasty allergic rxn to any tanning dye. Finally said fuck it. Just "stays in shape now" and likes being hard and lean. Trains 4 -5 days a week, cardio 3 days on a slow stepper 20 min, two steps at a time, and 2 days of walking on a tread 30 min. Very busy at work on her feet all day and that helps. No other cardio, consumes about 2300 kcal/d, 50% PRO, 30% CHO and 20% FAT. One pizza and a couple beers Friday night and she'll carb load if I think she's getting flat, otherwise sticks to the plan but enjoys food and eats what she likes. Takes one Stimerex a day am for energy and her thermo. Her downfall is M&Ms and this is where semaglutide (0.25 mg twice a week before bed) has helped curb that craving. High BP and T2D runs in the family so she has to be careful overall. Prior to 2020 she would run Winny 10 mg/d for a couple 12 weeks cycles a year, but would soften up and lose too much between cycles, and I don't like Winny (more toxic than Var and drys out the joints, but that was her call bc her BB friends said Winny was better than Var). In 2000 she started test cyp and ND, titrated up to 120 mg/wk of TC and 60 mg/week ND in split doses MWF. Has run that since 2000 as her base. No problems with acne, hair loss or deep voice (some change but not James Earl Jones). Increased body hair and some facial but easily managed. Loves the way she feels esp no menopausal Sx and off the chart bone density. Runs Var splits a 25 mg cap daily (12.5 mg/d) for a couple 10 - 12 week cycles a year. The base of TC/ND however allows to keep most of the gains between cycles. For competitions she would add in Mast P and proviron per her BB coach, effects were minimal IMO. Primo does little for her (it's real Primo, her BB coach uses the same batch and loves it and had it tested). The only time she runs Mast and/or Primo is 3 weeks before her labs for testosterone levels as primo and mast do no cross react to a standard or free T assay. Has to keep her T below 100 total and free less than 5 or her doc freaks out. Was discuss labs and body comp below.

Sorry to ask this, but this has been an interesting read and I am following it, but, still learning, 120mg/week of Test C and 60 mg/week of ND. What is ND?? Yes, I am a rookie.

 

[969C1]

My wife is currently taking 20mg week of Test C. She is 54 and has been on it since October. It has changed her so much for the better. We are both 4-5 days a week in the gym, training together. Yes she is post menopause. It is such a small dose that she takes, and she has question upping her dose to possibly 40 mg/week. But all I can say at this point, it was one of the best decisions she made to go down this path.