Glucose, Held Steady
Reduces glucose production in the liver.
Prescription · Clinical Monograph
Metformin
FDA-approved for type 2 diabetes. Prescribed off-label for longevity, on evidence thinner than its reputation.
Metformin has been prescribed since the 1950s and is among the most-taken drugs in the world. Its safety profile is one of the best documented in medicine, and it's inexpensive. The FDA approves it for type 2 diabetes. Prologue prescribes it off-label as part of Glucose Foundation.
The longevity case is more contested than its reputation suggests, and if you train seriously there's a specific tradeoff to weigh.
1950s
Decades on the Record
Prescribed since the 1950s and among the most-taken drugs in the world.
Off-Label, Stated Plainly
The FDA approves it for type 2 diabetes. Prologue prescribes it off-label as part of Glucose Foundation.
What getting it involves
A consultation
A consultation and recent lab results, before anything is prescribed.
A physician reads it
Your kidney function and your B12, against your history and your medications.
Prescribed off-label
FDA-approved for type 2 diabetes. Prescribed off-label for longevity.
Dispensed
Oral, daily with food, compounded by a licensed pharmacy partner.
Where the evidence stands
Striking
Researchers compared people with type 2 diabetes taking metformin against matched controls without diabetes, and the diabetics lived slightly longer.
Bannister · 2014
Observational
The people taking metformin differed from the controls in ways matching can’t fully capture, and the finding has drawn sustained methodological criticism since.
Unfunded
The trial designed to settle it has never enrolled a participant. Metformin is generic, so no company profits from proving it works.
TAME · proposed, never enrolled
Exercise is the most evidence-backed longevity intervention there is. If you train seriously, metformin may be working against the thing that’s already working.
Metformin and exercise
Two randomized trials found metformin blunting the adaptations training gives you.
Konopka and colleagues put older adults through aerobic training in 2019. The metformin group gained less VO2max and less mitochondrial respiration than placebo.
The MASTERS trial did the same for resistance training. Double-blind, placebo-controlled, multicenter. The metformin group built less muscle.
Exercise is the most evidence-backed longevity intervention there is. If you train seriously, metformin may be working against the thing that's already working. Your physician will bring this up before prescribing.
What your physician screens for
Kidney function
Metformin clears renally, and impaired clearance is the setting where lactic acidosis, its rare serious risk, actually happens. Your physician checks your eGFR before prescribing.
B12
Metformin depletes B12 over time. The American Diabetes Association recommends periodic B12 testing for anyone taking it. Your physician tracks it, and B12 is in the catalog if your levels call for it.
Also on B12These two risks are specific to metformin. The consultation also covers your full medical history, and your physician may ask for recent lab results depending on what they find.
How it's prescribed
Oral, daily, with food.
Diabetic dosing is well documented. Whether that's the right dose for someone without diabetes taking it for a different reason is unsettled, and there's no established longevity dose. Your physician sets it against your lab results.
Compounded by a licensed pharmacy partner and tested for potency, sterility, and endotoxin levels before shipment.
PotencySterilityEndotoxin
Disclosures
Metformin is FDA-approved for the treatment of type 2 diabetes. Prologue prescribes it off-label for longevity indications. It is compounded by a licensed pharmacy partner and tested for potency, sterility, and endotoxin levels before shipment. Treatment is not appropriate for every patient, and outcomes vary. Talk with your physician about whether this fits your situation.
Begin
How to get it.
Metformin requires a consultation and recent lab results.
Everyone else starts by joining the practice.
Members can bring it up at their next consultation.
Questions
Nothing is charged when you join. Billing begins only after a physician has approved your plan. If they decide treatment isn't appropriate for you, you are not charged.
Standard shipping for oral medications. Cold-chain shipping for injectables.
Protocol adjustments happen as your response shows up. If the dose or cadence changes, your next shipment reflects the change. There is no additional fee for protocol adjustments within your existing protocol.
Refills go out on the cadence your physician sets, without you having to ask.
Not listed here? Read the full FAQ.