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Clinical Studies One of the first in vivo studies investigating the potential effect of metformin on platelets showed a significant decrease in maximum ADP-induced platelet aggregation with this agent ( in vivo (Table 1, among the platelet effects of all other anti-diabetic molecules evaluated in this review

From a pathophysiological perspective, my first thought is that this could reflect an indirect effect on peripheral nerve sensitivity, possibly related to: rapid shifts in glucoselipid metabolism, changes in nerve conduction due to electrolyte fluctuations, or even a centrally mediated effect, considering GLP-1 receptor expression in the CNS

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They can also increase androgen receptor synthesis, which worsens the clinical presentation of hyperandrogenism with hirsutism, acne, seborrhea, and androgenic alopecia