David K.
From 302 lbs and a testosterone of 212 to 230 lbs, reversed prediabetes, and a restored marriage — in 12 months.
72 lbs lost. Prediabetes reversed without metformin. NAFLD resolved. Total testosterone from 212 to 850 ng/dL — using TRT, GLP-1, and the FLOA fasting protocol working together.
The Man in the Mirror
David is a 48-year-old regional sales director at an industrial equipment company — married 22 years, father of two teenagers, and logging more than 100 travel nights per year. At 44, he was a lean, active 220 lbs. By 48, four years of career escalation, constant client dinners, and sedentary travel had pushed him to 302 lbs. He had stopped exercising entirely two years prior, telling himself he was simply too tired to start.
His testosterone had fallen from an estimated 650 to 212 ng/dL over the same period. His primary care physician's response: start metformin for prediabetes, add a statin for his lipids, and "address the testosterone after you lose weight." David knew that wasn't a plan — it was a waiting room.
He had tried three rounds of restrictive dieting — keto, intermittent fasting, low-calorie — and regained every pound each time. He had abandoned multiple gym memberships. He had nearly signed up with a predatory online TRT mill before backing out. He came to FLOA looking for something that would actually treat the whole picture at once.
What He Came In With
- 80 lbs gained over 4 years — progressive, compounding, diet-resistant
- Total testosterone critically low at 212 ng/dL; free T at 4.1 pg/mL
- Elevated estradiol at 38 pg/mL — excess adipose tissue converting testosterone into estrogen
- Marked insulin resistance: HOMA-IR 5.9, fasting insulin 22, HbA1c 6.0% (prediabetic)
- Severe fatigue — had given up exercise entirely ("too tired to start")
- Near-complete libido loss and erectile dysfunction creating marital strain
- Brain fog affecting closing calls in a high-stakes sales role
- Significant dyslipidemia: triglycerides 218, HDL 32
- Early NAFLD pattern: ALT 48
- Systemic inflammation: hs-CRP 4.6 mg/L
- Borderline functional hypothyroidism: free T3 2.7, TSH 3.1
- Diagnosed obstructive sleep apnea with inconsistent CPAP compliance
- AM cortisol 19 µg/dL — high-normal, consistent with chronic occupational stress
What FLOA Designed for David
Full hormone, metabolic, thyroid, inflammatory, and liver panels. All four metabolic locks flagged simultaneously: insulin resistance (HOMA-IR 5.9), inflammation (hs-CRP 4.6), cortisol (AM 19, chronic stress pattern), and borderline thyroid function (free T3 2.7). Sleep apnea status and CPAP compliance reviewed. Coaching team travel-pattern intake completed.
100 mg/week split twice weekly (Monday/Thursday). Lower starting dose than standard given elevated E2 from adipose aromatization — the expectation was that E2 would self-correct as fat mass decreased. E2 monitored monthly; anastrozole reserved unless E2 remained elevated as weight dropped. HCG declined — family complete.
Started at 2.5 mg, held at 5 mg by month 8 — intentionally avoiding dose escalation beyond what produced results. Goal: eliminate food noise, reduce appetite, and improve insulin sensitivity as the primary fat-loss driver in months 1–4, before fasting protocols were introduced.
The Metabolic Two-Piece: GLP-1 reduces demand (appetite, food noise, caloric intake); AOD-9604 supports supply-side fat mobilization. Added once the first 27 lbs were lost and the system was ready to accelerate lipolysis without muscle loss.
Progressive fasting introduced once metabolic flexibility was restored: 16:8 → 24-hour fasts → 48-hour weekly fasts. The GLP-1 made the transition to extended fasting dramatically easier by eliminating the hunger spikes that had derailed every previous diet attempt.
Protein-first nutrition built specifically for restaurant and hotel eating — no meal prep dependency. Resistance training program executable in hotel gyms with minimal equipment. CPAP compliance accountability restored by month 2. Full body composition support through the entire 12-month arc.
Phase by Phase
Food Noise Silenced — First 8 lbs Gone
GLP-1 quieted appetite and food noise immediately. David described the constant background craving that had defined his eating on the road as simply disappearing. Down 8 lbs. Energy beginning to return as testosterone climbed toward 480 ng/dL. Libido beginning to stir for the first time in over a year.
→ Down 8 lbs; T at 480; appetite control established
CPAP Compliance Restored — Brain Fog Lifting
Down 18 lbs total. Consistent CPAP use resumed — the combination of reduced inflammation, improving sleep quality, and rising testosterone made compliance feel achievable rather than punishing. Brain fog noticeably better. Total T at 620 ng/dL. E2 beginning to drop as adipose tissue decreased.
→ Down 18 lbs; T at 620; CPAP compliance restored
AOD-9604 Added — Libido & Function Restored
Down 27 lbs. AOD-9604 introduced to accelerate fat mobilization on the supply side. Libido fully returned. Erectile function fully restored — a turning point for David's marriage. HOMA-IR dropped from 5.9 to 3.8. HbA1c improved to 5.7%.
→ Down 27 lbs; libido/ED resolved; HOMA-IR 3.8
Resistance Training Back Online — Fasting Introduced
Down 42 lbs. Resistance training restarted — hotel gym protocol executable on the road. FLOA fasting protocol introduced (16:8 to start). Total T at 780 ng/dL. E2 normalized to 28 pg/mL — no anastrozole needed. Triglycerides dropped to 142; ALT improved to 28.
→ Down 42 lbs; T 780; lipids and liver markers improving
48-Hour Fasts Established — Protocol at Full Velocity
Down 58 lbs. Weekly 48-hour fasts now established as a sustainable rhythm — the GLP-1 making extended fasting manageable where previous diets had always broken down. Total T stable at 850 ng/dL on minimum effective dose. Tirzepatide held at 5 mg. HOMA-IR 1.6.
→ Down 58 lbs; T 850; HOMA-IR 1.6; fasting protocol locked
72 lbs Lost — Prediabetes Reversed — Marriage Restored
302 → 230 lbs. HbA1c 5.2% — no metformin ever needed. Lipids fully normalized. ALT 22 — NAFLD resolved. Marriage and intimacy described as fully restored. Long-term plan confirmed: TRT minimum effective dose + microdose tirzepatide + FLOA monthly fasting protocol.
→ Down 72 lbs; prediabetes reversed; NAFLD resolved; marriage restored
"His PCP wanted to treat the downstream consequences — metformin for prediabetes, a statin for his lipids — while leaving the root cause untreated. Obesity-driven aromatization was actively converting what little testosterone he had into estrogen. You cannot diet your way out of that hormonal environment. You have to fix the system first, then let the fat loss follow."
What Changed at 12 Months
Body Composition
302 → 230 lbs — 72 lbs of fat lost over 12 months, with lean mass gained through resistance training. Abdominal fat reduction visible by month 3.
Hormonal Restoration
Total T from 212 → 850 ng/dL on minimum effective dose. E2 self-corrected from 38 → 28 pg/mL as adipose tissue decreased — no aromatase inhibitor required.
Metabolic Reversal
HbA1c from 6.0 → 5.2% — prediabetes reversed without metformin. HOMA-IR from 5.9 → 1.6. Fasting insulin normalized. No statin prescribed.
Cardiovascular & Liver
Triglycerides from 218 → 138. HDL from 32 → 48. ALT from 48 → 22 — early NAFLD pattern fully resolved. hs-CRP from 4.6 → 1.2 mg/L.
Travel-Proof Lifestyle
Protocol designed entirely around 100+ travel nights per year — hotel gym training, restaurant-compatible nutrition, and a fasting rhythm that works without meal prep.
Marriage & Intimacy
Libido and erectile function fully restored by month 3. Marital intimacy described as fully restored by month 12 — an outcome David named as the most important of all.
| Category | What Changed |
|---|---|
| Energy | From "too tired to start" exercising to resistance training 3x/week on the road |
| Food Noise | Constant background cravings on the road eliminated within the first month of GLP-1 |
| Libido | Near-zero → fully restored by month 3; relationship quality transformed |
| Erectile Function | Sildenafil no longer needed; function fully restored without pharmaceutical support |
| CPAP Compliance | Inconsistent → fully compliant by month 2; sleep quality dramatically improved |
| Brain Fog | Sales performance improving by month 2; closing calls sharper and more confident |
| Prediabetes | Reversed without metformin — HbA1c 6.0 → 5.2% in 12 months |
| Liver Health | Early NAFLD pattern fully resolved — ALT normalized from 48 → 22 |
| Marriage | Described as fully restored — intimacy, confidence, and emotional presence all returned |
"I'd tried everything. Keto, fasting, low-calorie — I'd do it for a few months and put every pound back on. My doctor wanted to put me on metformin and a statin and deal with the testosterone later. I knew that wasn't right. FLOA treated all of it at once. Twelve months later I've lost 72 pounds, my wife and I are closer than we've been in years, and I'm training in hotel gyms while I travel. I didn't think this was possible for me anymore."
Clinical Takeaways
David's case illustrates why treating obesity and hypogonadism sequentially — weight first, then hormones — is a clinical error. His low testosterone was not separate from his obesity; it was caused by it. Excess adipose tissue was actively aromatizing his remaining testosterone into estrogen, creating a self-reinforcing hormonal environment that made fat loss physiologically harder. The sequence had to be reversed: fix the hormonal environment first, then let the fat loss accelerate.
The combined TRT + GLP-1 approach worked because each intervention addressed a different mechanism simultaneously. TRT began correcting the hormonal suppression driving fatigue, low libido, and mood. Tirzepatide eliminated the food noise and insulin dysregulation that had made every previous diet attempt unsustainable. AOD-9604 added fat mobilization on the supply side once the system was ready. The FLOA fasting protocol then became the long-term engine once metabolic flexibility was restored.
Critically, no medication was used above its minimum effective dose. David ended the 12-month protocol on 100 mg/week testosterone, 5 mg tirzepatide — the same starting dose — and a fasting rhythm that required no pharmaceutical support to maintain. The goal was never dependence. It was recalibration.
Ready to Start Your Own Journey?
David's story isn't about willpower — he had plenty of that. It's about finally having a protocol that matched the actual biology. If you've tried everything and regained it every time, the answer may not be more discipline. It may be the right diagnosis.
Individual results vary. This case study is for educational purposes only. © Dr. Jones DC — FLOA Protocol.