I have never been obese (BMI >=30) but I have certainly been overweight (BMI>=25).
There are many PCa papers associating "obesity" with poor survival. BMI is a surrogate for visceral adiposity (not always very accurate). Mortality risk with a BMI of 29 is presumably not much different than for a BMI of 30. I feel that use of the term "obesity" has been unfortunate, and that many men at risk are unaware.
When I was on testosterone continuously I had a decent muscle: fat ratio. And even during my years of 3 months castrate / 3 months high T, things were not so bad. But with my "LongBAT" regimen (>80% of every 3 months castrate), I was concerned that I would gain weight & perhaps become diabetic, but that hasn't happened.
The reason is certainly due to the 2,000 mg Metformin I take every day. But perhaps I could do better?
There has been a certain amount of hype over Semaglutide & other diabetic drugs that are being prescribed off-label for weight loss. One doesn't have to be a Hollywood actor to be interested in weight loss. The actor is merely interested in his livelihood. Men on ADT should be concerned about their longevity, imo.
The new diabetes drugs: Your best shot for weight loss?
Injectable medications that mimic natural gut hormones may also lower heart-related risks. Here’s what you need to know about these revolutionary drugs.
March 1, 2023
By Julie Corliss, Executive Editor, Harvard Heart Letter
-Patrick
Written by
pjoshea13
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Semaglutide injection may increase the risk that you will develop tumors of the thyroid gland, including medullary thyroid carcinoma (MTC; a type of thyroid cancer). Laboratory animals who were given semaglutide developed tumors, but it is not known if this medication increases the risk of tumors in humans. Tell your doctor if you or anyone in your family has or has ever had MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2; condition that causes tumors in more than one gland in the body). If so, your doctor will probably tell you not to use semaglutide injection. If you experience any of the following symptoms, call your doctor immediately: a lump or swelling in the neck; hoarseness; difficulty swallowing; or shortness of breath.
Keep all appointments with your doctor and the laboratory. Your doctor may order certain tests to check your body's response to semaglutide injection.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with semaglutide injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (fda.gov/Drugs/DrugSafety/uc... or the manufacturer's website to obtain the Medication Guide.
Talk to your doctor about the risks of using semaglutide injection.
Of course, Metformin should be the logical choice. I would also suggest the purchase of one of the weight scales that when stepped on sends a weak electrical charge through the body that provides not only weight, but BMI, BMR, Bone Mass, Muscle Mass, Visceral Fat, Subcutaneous Fat, and more. I realize that these scales have a bad rap for being inconsistent and inaccurate but I have been using one for five years and find it consistent and accurate. It's a good way to keep track of weight gain or loss. If I have gone off my regimen (pizza, Mexican food) it will show up on the next day's reading. Before use, one fills in information such as height, weight, age. It will even provide a Metabolic Age.
Efforts to hack the human body's metabolism don't have a history of working out so well. Everyone is looking for a pill or injection, so they can eat crap food and sit on their butts all day long. Might as well just turn it all over to AI now and save ourselves the trouble. JMHO, Kaptin K9
BTW, even though it is obviously estimating a lot of the data output, that scale still sounds like a cool device. (I just thought to add: maybe it could be modified/upgraded to give a strong electrical jolt to you when you breach certain health thresholds?)
Okay. I just replied to this and my reply disappeared. So here goes again:
The GLP-1 agonists are the most amazing modulators of metabolic status for Type II diabetes (T2DM), pre-diabetes or metabolic syndrome and for obesity. Any here who have abdominal (visceral) obesity and glucose intolerance, metabolic syndrome or other form of obesity from ADT should strongly consider these and discuss with your doctors. Wegovy is the brand name for semaglutide approved for obesity. Even better is Mounjaro, a brand for T2DM treatment with the strongest in this class: tirzepatide. It will probably be FDA approved later this year in a higher dosage and a different brand name. The thyroid cancer concerns in lab animals appears very weak and should not dissuade most from the benefits of these, especially given a real and present diagnosis with APC and the metabolic derangements of ADT. Just my opinion, discuss with your doctors who are knowledgeable in this area. (Might not be your MO). Paul/ MO
MB - As an aside, you might be interested to know that the author of Patrick's article, Julie Corliss, is the daughter of Jack Corliss of deep-sea hydrothermal-vent fame noted in Nick Lane's Transformer book. If you are going to be a science writer, I guess it doesn't hurt to have a famous scientist for a father?
And here is a more cautionary look at GLP-1 agonists linked from a MedPage Today post:
Social Media Is Fueling Enthusiasm for New Weight Loss Drugs. Are Regulators Watching?, KFF Health News, By Darius Tahir and Hannah Norman, April 18, 2023
I've just been re-reading Ending Medical Reversal, by Dr. Vinayak K. Prasad and Dr. Adam S. Cifu. I'm pretty sure they would suggest that there is a more than 50% chance for a medical reversal for GLP-1 agonists over time. In addition to being expensive meds, according to the linked article, it also seems to have the same yo-yo weight-gain+ effect when stopped. Hacking Mother Nature is tricky business for sure.
my urologist Rx’d wygovy injection because my A1 c got up to 6.1 a few months back . He believes cancer is a metabolic condition and maintaining low blood sugar is a vital part of his approach form my cancer . I apply Metformin transdermal cream and another cream that blocks glutamine and I take “ metronomic chemo therapy “drugs by placing pellets under my tongue . These are just some aspects of my current regimen . The injections would cost around 800 monthly with a coupon supplied by the pharmacist . I opted for the pill form which costs $ 47 monthly after insurance coverage .
I haven’t started taking the pills yet because my nutritionist said I could lower A1 c and lose weight by changing my diet . The idea being I need to have a sustainable way to eat long term instead of trying to go Zeke to and failing and ending up yo-yo dieting , losing and reshaping the same 25 -30 lbs for the last 45 years ( literally ! I read aDr Atkins in 1977!and lost from 215 to 160 )I recently got a CGM , Freestyle Libra 3 , to check my response to different foods and I try to avoid spikes over 140 after meals . I’ve lost about 13 lbs ( I was 5’7 “ 185 to start ) and my A1 c is down to 5.6.
I went from 160 to 185 on ADT and Zytiga for 9 months and haven’t t been able to lose it since I stopped hormone therapy in June if 2022 .
I’m tempted to take the pills to get my BMI down quickly.
We could all probably benefit by wearing a CGM (Continuous Glucose Monitor) to discover how we respond to different foods. I've been thinking of getting a finger stick monitor to get at least some idea of foods that I might want to avoid. That seems a much better place to start than a new (unpredictable long-term) pharma product - at least it does to me.
Agree K9 that a month experimenting with a CGM would be a very good source of personal metrics. May try it myself. Peter Attia strongly endorses.
Semaglutide and Tirzepatide only appropriate for those requiring long term management refractory to dietary and exercise refinements. The weight returns and metabolic benefits disappear when discontinued. Not for short term slimming for the summer vacation! And still uncertainties remain about long term use. About half of the weight loss seemed to be lean muscle mass in one study. 🤔
Definitely not the silver-bullet/holy-grail every pharma co. and weight-loss clinic would love to have. Done properly, eating less and moving more can work pretty well, when used with a diet that reasonably matches one's individual metabolism.
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