Thank you for this! I think you're the person who understood my point the best. That's exactly what I'm aiming for: using (small dose) Metformin to directly activate the AMPK pathway and target that cellular sensitivity + a small dose of a GLP so it can handle the hunger hormones. I have no intention of using high doses of either medication; I just want to give my body that little push so the machine can start working properly again.
I'm 23 years old, which I hope plays in my favor. I have a high amount of muscle mass bc of genetics + I was very active during my teenage years, did strength training for years, and always kept a relatively high-protein diet. But in the last few years, my cortisol levels went completely out of control, antidepressants made it worse. It was crazy to see how I started accumulating fat and gaining weight, even though my daily habits weren't thaaat much worse than when I weighed 30 kg/66 lbs less.
Since September 2025, I managed to lower my fasting glucose (it was 99 before, now 88), cut my total and LDL cholesterol in half, and reduced my inflammation (ESR) to the bare minimum (thanks berberine+myo-inositol combo), but despite all that internal progress, I only lost about 3 kg (7 lbs). That's why I'm considering these combined options now to finally see the physical results of that effort while healing insulin resistance 🙂)
You’re actually describing something a lot more nuanced than “I just want appetite suppression and fast weight loss,” and I think that’s why some people are misunderstanding your approach.
At 23, with a strong muscle base and years of resistance training history, you probably
do have a lot working in your favor metabolically. And the fact that you’ve already improved fasting glucose, LDL, inflammation markers, etc. tells me your body
is responding to the changes you’ve made internally.... even if the scale hasn’t reflected it much yet.
That disconnect between “my biomarkers improved” and “why does my body composition still feel stuck?” is actually really common in significant insulin resistance and chronic stress states. Elevated cortisol, antidepressants, disrupted sleep/stress signaling, and hyperinsulinemia can absolutely shift where and how the body stores fat, independent of someone suddenly becoming sedentary or eating wildly differently.
And honestly, a HOMA-IR of 7.9 at your age is exactly why your doctor is looking at this proactively instead of waiting until your A1C becomes abnormal years from now.
Your explanation about using:
metformin more for insulin signaling/AMPK activation and improving sensitivity
GLP-1 more for appetite and hormonal regulation
while keeping doses conservative
…is a very reasonable framework medically. Especially since you’re pairing it with lifestyle changes you’ve already proving you can sustain.
Also, people can tend to oversimplify weight regulation into calories in/calories out, but endocrine signaling matters a lot. Two people can eat the same and respond very differently depending on insulin levels, stress hormones, medications, sleep, inflammation, muscle mass, and genetics.
The other thing I’d point out is this: losing only 7ish lbs while dramatically improving metabolic markers does not mean your efforts failed. In many cases, it means you’ve been improving the underlying physiology first. Sometimes the visible body comp changes lag behind the internal metabolic improvements.
And honestly? The fact that you’re approaching this thoughtfully, conservatively, and with long term metabolic health in mind at 23 probably gives you a much better chance of success than people who jump straight into aggressive dosing without addressing the underlying picture.
