Subject: Discussion on Potential Metabolic & Hormonal Interventions – Balancing Medical Oversight & Personal Agency

Dear Dr. Dreijerink,

I appreciate your time and expertise, and I’d like to have an open discussion regarding several potential interventions that may contribute to long-term metabolic stability, cognitive resilience, and overall well-being. Given my unique medical profile, I want to carefully differentiate between:

  • (A) Areas where I might self-source interventions (acknowledging that this occurs outside the traditional medical framework).
  • (B) Areas where I believe there are compelling clinical arguments for these interventions that warrant discussion.
  • (C) Areas that, in my understanding, fall squarely within your domain of expertise and conventional medical oversight.

Additionally, if I were to self-source any of these interventions off the books, I would like to understand whether you, as a clinician, are at liberty to provide insight, best practices, or at least general guidance on monitoring and risk mitigation, even if these do not fall under standard prescriptions.

Points of interest – Metformin, Testosterone, Selgiline, DHEA, GH, Anavar

1. Metformin for Metabolic Optimization & Longevity

(C) Falls Squarely in Your Domain

✔ Widely prescribed for metabolic regulation, even in non-diabetic individuals.
✔ Well-documented benefits in insulin sensitivity, mitochondrial function, and reducing age-related inflammation.
✔ Potential longevity benefits studied in the TAME trial (Targeting Aging with Metformin).

  • Request: Would you be open to evaluating a low-dose Metformin regimen in my case?
  • Follow-up: If not indicated for direct prescription, would periodic metabolic monitoring still be feasible
 

2. Testosterone Optimization – More Effective Delivery Method

(C) Falls Squarely in Your Domain

✔ Androgel has been suboptimal in absorption & regulation for me.
✔ Alternative delivery methods (injectable T, stronger transdermal formulas) may provide better hormonal stability.
✔ This is a fundamental aspect of hormonal maintenance in trans individuals, and finding an optimal regimen is critical.

  • Request: Could we discuss adjustments in delivery for more stable and effective results?
  • Follow-up: If we modify the method, what monitoring approach would be best to fine-tune it?

 

3. Selegiline (L-Deprenyl) for Dopaminergic & Neuroprotective Support

I have access. I start taking twice weekly 1.25mg Selegiline per week, FYI. This is a very low (safe) dosage compared to the usual prescription to treat specific order disorders. It may be practical you know this. 

(B) There Are Solid Arguments for This Intervention

✔ Selective MAO-B inhibition at low doses (e.g., 2.5-5mg weekly) has been studied for dopaminergic resilience, neuroprotection, and cognitive longevity.
✔ Unlike stimulants, it does not cause artificial dopamine spikes but instead preserves endogenous dopamine levels.
✔ Studies suggest it may have mood-enhancing properties and protect against neurodegeneration.

(A) If Self-Sourced, What Are the Boundaries for Medical Guidance?
  • If I were to self-source Selegiline, would you be at liberty to offer monitoring, discuss interactions, or provide general guidance?
  • If outright prescription is not an option, are there alternative medical approaches you would suggest instead?
 

4. DHEA for Androgenic & Adrenal Function Support

(B) There Are Solid Arguments for This Intervention

✔ DHEA is a precursor hormone for testosterone and estrogen, playing a key role in energy, mood, and metabolic balance.
✔ Low-dose supplementation (e.g., 25mg/day) is commonly used in hormonal aging therapies.
✔ Some trans women experience adrenal insufficiency or hormone imbalances post-HRT, which DHEA could theoretically help mitigate.

(A) If Self-Sourced, What Are the Boundaries for Medical Guidance?
  • If I were to explore this independently, could we monitor hormonal levels to avoid excessive estrogen conversion?
  • Would you recommend any alternative medical approaches that achieve similar benefits?

5. Growth Hormone (GH) & GH Peptides for Regeneration & Longevity

(B) There Are Solid Arguments for This Intervention

✔ GH decline with age contributes to fat accumulation, cognitive slowing, and reduced recovery capacity.
✔ Low-dose GH therapy (0.5-1 IU/day) or GH secretagogues (e.g., Ipamorelin, CJC-1295) have been explored as safer, controlled interventions.
✔ GH-related therapies are already clinically used in anti-aging and metabolic treatment settings.

(A) If Self-Sourced, What Are the Boundaries for Medical Guidance?
  • If I were to explore GH-related interventions, would you be willing to monitor IGF-1 and metabolic markers for safety?
  • If direct GH therapy is not feasible, are there medically available pathways you might recommend?

6. Anavar (Oxandrolone) or Safer Anabolic Alternatives

(B) There Are Solid Arguments for This Intervention

✔ Anavar is one of the mildest anabolic agents, often used for muscle retention and metabolic regulation.
✔ Its low androgenic effects and relatively mild liver impact make it a safer anabolic option compared to more aggressive compounds.
✔ Some clinical cases justify low-dose anabolic support in lean mass preservation and metabolic function optimization.

(A) If Self-Sourced, What Are the Boundaries for Medical Guidance?
  • If I were to self-source Anavar, would you be at liberty to offer liver function monitoring and periodic health assessments?
  • If not, are there clinically approved alternatives for anabolic support that you would recommend instead?
Final Thoughts & Next Steps

I recognize that some of these interventions are not part of standard medical practice, while others are within clinical discussion territory. My goal is to balance personal autonomy with professional oversight where appropriate.

Would you be open to discussing:

  1. Metformin as a metabolic stabilizer
  2. Testosterone delivery optimization
  3. Potential GH-related pathways
  4. Boundaries for guidance on self-sourced interventions

I greatly appreciate your expertise, and I respect any limitations in terms of what can be formally prescribed. I’d just like clarity on whether monitoring, risk mitigation, or medical insights can be provided in cases where I take personal initiative.

Looking forward to your thoughts,