Nurse practitioner, clinic owner, and founder of HRT University. I teach providers the physiology behind hormone therapy, so they’re not piecing it together on their own.
GLP-1s are doing something else
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Morning friends. I'll tell you, at this point in my own research, the weight loss might be the least interesting thing GLP-1s do... I know how that sounds. Stay with me :) There's a new systematic review in the Journal of Clinical Medicine on GLP-1 agonists in hidradenitis suppurativa, and it quietly undercuts the story we've all been telling about this drug class. Quick background for those who don't see much HS. It's a chronic inflammatory skin disease, and a miserable one too. Painful nodules, abscesses, and sinus tracts in the skin folds. It tracks tightly with obesity and metabolic syndrome, with up to half of these patients meeting criteria for metabolic syndrome. Treatment has always been... lackluster. But the idea behind GLP-1 use was simple. If HS is particularly sensitive to obesity, and a GLP-1 drops weight. Weight loss should help HS - right? Here's the part that makes it interesting. The review pulled ten small studies. And we saw an encouraging pattern: less pain, fewer flares, less suppuration, better quality of life, lower cardiovascular event rates. They looked at whether the drop in BMI actually correlated with the clinical improvement. It didn't. No correlation between weight change and Hurley stage, pain, depression score, or inflammatory markers. That points at something the weight-loss theory doesn't explain. Now, let's think about the mechanism. I've talked about this before, but there's a growing signal that these drugs blunt inflammatory signaling directly, TNF-alpha and IL-6 among them, which happen to be central to HS. In this review the one marker that moved significantly was ultrasensitive CRP. Almost everything else stayed flat. Fascinating! So the weight is the confounder for sure here. But the metabolic and anti-inflammatory effects are the variables we keep failing to measure well. Higher dose tracked with better response, which is a real signal, though it's tangled up with who gets titrated higher in the first place. And the cardiovascular benefit showed up again, consistent with everything else we're seeing from this drug class. What this does not mean. It doesn't mean GLP-1s are proven anti-inflammatory agents and a cure-all, of course. But, in my opinion, it does mean we need to start considering broader off-label use-cases. We keep framing these drugs as "weight-loss" tools, then we act surprised when the benefit doesn't map onto the pounds. That's the same mistake we made with hormones for years. Just because it's supposed to work for X doesn't mean it can't help with Y and Z too. And I think that reframe is the difference between a good provider and a great provider. -Nico PS This is the whole reason mechanism comes before protocol in the way I teach. When you understand why a molecule works, the surprising findings stop being surprising. That's the backbone of the HRTU Master Course, now 30 CEUs. You can see what it covers at hrtuniversity.com/hrtcourse. PPS Check out the latest HRT University Podcast episode where I explain why cortisol is almost always a downstream signal of a broken metabolic environment, not the root problem to chase. Listen now on Spotify, YouTube, and Apple Podcasts. |
HRT University
Nurse practitioner, clinic owner, and founder of HRT University. I teach providers the physiology behind hormone therapy, so they’re not piecing it together on their own.
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