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.

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?

Sources:

  1. Metformin as a Tool to Target Aging
    This article from Cell Metabolism explores Metformin’s potential to influence aging processes and its implications for healthspan and lifespan.

  2. Benefits of Metformin in Attenuating the Hallmarks of Aging
    Published in Cell Metabolism, this study examines how Metformin may impact various biological markers associated with aging.

  3. A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan
    This review in Frontiers in Endocrinology critically assesses the evidence supporting Metformin’s role as an anti-aging agent.

  4. Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study
    Featured in Diabetes Care, this study investigates Metformin’s effects on mortality and its potential benefits beyond glucose regulation.

  5. Metformin: A Hopeful Promise in Aging Research
    This article from Cold Spring Harbor Perspectives in Medicine discusses Metformin’s promise in aging research and its potential mechanisms of action.

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?

Sources:

1. Limitations of Androgel (Transdermal Testosterone) Delivery:

  • Pharmacokinetics of Testosterone:

    This article discusses the challenges associated with transdermal testosterone delivery, including the need for large application areas and daily replacements due to variable absorption rates. ​en.wikipedia.org

  • Testosterone Undecanoate:

    This source highlights the limitations of non-scrotal testosterone patches, which were initially ineffective in raising testosterone levels, leading to the development of scrotal patches and later, non-scrotal patches with permeation enhancers. ​en.wikipedia.org

2. Benefits of Testosterone Augmentation in Older Transgender Individuals with Low Testosterone Levels:

  • Masculinizing Hormone Therapy:

    This comprehensive overview explores the effects of testosterone therapy in transgender men, including the development of masculine secondary sexual characteristics and the alleviation of gender dysphoria. ​en.wikipedia.org

  • Gender-Affirming Hormone Therapy:

    This article discusses the safety and psychosocial benefits of hormone therapy in transgender individuals, emphasizing improvements in well-being and reductions in distress. ​en.wikipedia.org

  • Hormone Therapy:

    This source provides an overview of hormone therapy applications, including androgen replacement therapy in individuals with low testosterone levels due to aging or medical conditions. ​en.wikipedia.org

3. General Information on Testosterone Levels Across the Lifespan:

  • What You Need To Know About Testosterone Levels Across the Lifespan:

    This article outlines how testosterone levels vary with age, peaking during puberty and early adulthood, and gradually declining from the 40s onwards. ​health.com

  • Testosterone Therapy Is Trending—for Women. Here’s What to Know:

    This piece examines the increasing interest in testosterone therapy among women, particularly during perimenopause and menopause, and discusses its potential benefits and risks. ​time.com

  • Kate Winslet, 48, Reveals She Had Testosterone Replacement Therapy to Boost Her Sex Drive:

    This article highlights actress Kate Winslet’s personal experience with testosterone replacement therapy to enhance libido, shedding light on its applications beyond traditional uses. ​pagesix.com

These sources provide comprehensive insights into the limitations of transdermal testosterone delivery methods, the benefits of testosterone augmentation in older transgender individuals, and general information on testosterone levels across the lifespan.

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?

Sources:

  1. Selegiline: A Review of Its Clinical Efficacy in Parkinson’s Disease and Other Neurodegenerative Disorders
    This comprehensive review from Drugs & Aging examines Selegiline’s efficacy in treating Parkinson’s disease and explores its potential neuroprotective properties in other neurodegenerative conditions.

  2. Selegiline as a Neuroprotective and Anti-Aging Agent: A Review
    Published in Current Aging Science, this article discusses Selegiline’s potential as a neuroprotective and anti-aging agent, highlighting its mechanisms of action and therapeutic implications.

  3. The Role of Selegiline in the Treatment of Alzheimer’s Disease: A Systematic Review
    This systematic review from Journal of Neural Transmission evaluates the efficacy of Selegiline in Alzheimer’s disease, focusing on cognitive improvement and disease progression.

  4. Selegiline and Life Extension: The Debate Continues
    Featured in Annals of the New York Academy of Sciences, this article delves into the ongoing debate regarding Selegiline’s potential to extend lifespan and its implications for aging research.

  5. Selegiline: Beyond Parkinson’s Disease—Exploring Its Potential in Depression and Cognitive Disorders
    This review from CNS Drugs explores Selegiline’s applications beyond Parkinson’s disease, particularly its use in treating depression and cognitive disorders.

These sources provide comprehensive insights into Selegiline’s potential applications in neuroprotection, cognitive enhancement, and anti-aging interventions.

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,