Derek (More Plates More Dates) TRT: What It Would Cost a Non-Celebrity

Who Is Derek from MPMD and Why Does His TRT Matter to Everyday Patients?

Derek (More Plates More Dates) runs one of the largest testosterone, PED-education, and men's health channels on YouTube, with more than 1.5 million subscribers as of early 2025. He has publicly discussed his own testosterone replacement therapy on multiple podcast appearances and YouTube videos, describing subcutaneous testosterone injections, estradiol management, and ancillary medications including HCG. Because he speaks in clinical detail and cites primary literature, his audience frequently asks whether a regular patient could follow a similar protocol and what it would realistically cost.

This article answers that question directly. It uses Derek's publicly stated disclosures as a reference point and layers in FDA-approved dosing ranges, Endocrine Society clinical guidelines, published trial data, and current U.S. Telehealth and pharmacy pricing.

Why Derek's Disclosures Are Clinically Useful

Derek consistently cites peer-reviewed sources on his channel, which makes his self-reported protocol more verifiable than most celebrity health claims. His described approach closely mirrors the Endocrine Society's 2018 clinical practice guideline on testosterone therapy in men, which recommends testosterone to men with consistently low serum testosterone (generally below 300 ng/dL on two morning measurements) combined with symptoms of hypogonadism. [1]

He is not a licensed physician. His disclosures are educational, not prescriptive. Any patient considering TRT must obtain a formal diagnosis and prescription through a licensed provider.

What Derek Has Said Publicly

In multiple YouTube videos and podcast appearances, Derek has described:

• Weekly subcutaneous testosterone cypionate injections, often split into twice-weekly doses to smooth out peaks and troughs
• Anastrozole or aromasin (exemestane) use during periods of higher testosterone dosing to manage estradiol conversion
• HCG use to maintain testicular function and endogenous LH signaling
• Regular blood panel monitoring including complete blood count, comprehensive metabolic panel, and hormone panels

These elements map directly onto a clinical TRT protocol a U.S. Physician would prescribe.

What a Standard TRT Protocol Actually Looks Like

The Endocrine Society guideline recommends testosterone cypionate or enanthate 75 to 100 mg intramuscularly weekly, or 150 to 200 mg every two weeks, as a standard starting dose for hypogonadal men. [1] Many clinicians now prefer once-weekly or twice-weekly injections to reduce peak-to-trough variability, which aligns with what Derek has described publicly.

Diagnosis Requirements Before Starting

A patient cannot simply order testosterone. FDA regulations classify testosterone as a Schedule III controlled substance, requiring a legitimate diagnosis of hypogonadism. [2]

The Endocrine Society specifies the following minimum diagnostic criteria:

• Two separate morning serum total testosterone measurements below 300 ng/dL (some guidelines use 264 ng/dL)
• Documented symptoms: low libido, fatigue, reduced muscle mass, depressed mood, or poor morning erections
• Exclusion of secondary causes such as hyperprolactinemia or pituitary pathology [1]

The American Urological Association 2018 guideline echoes this threshold and adds that free testosterone should be measured when total testosterone is borderline. [3]

Injection Routes and Frequency

Testosterone cypionate is available as a multi-dose vial (200 mg/mL is the most common concentration). Subcutaneous injections, typically into abdominal or thigh fat, produce slower absorption than intramuscular injections and may reduce estradiol conversion slightly, though evidence on this difference remains mixed. [4] A 2021 study in the Journal of Clinical Endocrinology and Metabolism confirmed that subcutaneous testosterone produced equivalent serum levels to intramuscular dosing at the same weekly dose in hypogonadal men. [4]

Split twice-weekly dosing (for example, 50 mg on Monday and Thursday) reduces peak testosterone levels and has been associated with lower hematocrit elevation compared with single weekly injections in some clinical reports. [5]

Cost Breakdown: Medication, Labs, and Physician Oversight

This is where the non-celebrity picture diverges from what many assume. A well-run TRT protocol has three cost layers: medication, laboratory monitoring, and physician oversight. Each is priced differently depending on pathway.

Testosterone Cypionate: Pharmacy Cost

Generic testosterone cypionate 200 mg/mL (10 mL vial, 2,000 mg total) is available at:

• GoodRx cash price: approximately $30, $55 per 10 mL vial at major retail pharmacies as of January 2025
• Compounding pharmacy (if prescribed a custom concentration): $40, $90 per vial depending on concentration and volume
• Telehealth platform pharmacy (bundled): often $50, $80 per month for a standard weekly 100 to 150 mg dose

A 10 mL vial at 200 mg/mL lasts approximately 10 to 20 weeks at 100 to 200 mg per week, making monthly medication cost roughly $15, $45 when purchased through retail pharmacy with a GoodRx coupon.

The FDA has approved several testosterone formulations, including cypionate, enanthate, undecanoate (Aveed), and topical gel (AndroGel). [2] Injectable cypionate remains the lowest-cost option by a wide margin.

Laboratory Monitoring Costs

The Endocrine Society recommends checking serum testosterone 3 to 6 months after starting therapy, then annually once stable. [1] Hematocrit must be monitored because testosterone stimulates erythropoiesis and can raise hematocrit above 54%, the threshold at which phlebotomy or dose reduction is typically required. [6]

A standard TRT monitoring panel includes:

• Total testosterone and free testosterone
• Estradiol (sensitive assay, LC-MS/MS preferred)
• Complete blood count (hematocrit, hemoglobin)
• Comprehensive metabolic panel (liver enzymes, kidney function)
• Lipid panel (testosterone can reduce HDL cholesterol)
• PSA (men over 40 or with risk factors per AUA guideline) [3]
• LH and FSH (to assess suppression of the hypothalamic-pituitary-gonadal axis)

Cash-pay lab cost at a direct-pay lab (LabCorp or Quest without insurance): $150, $350 per comprehensive panel. Amortized over a 6-month monitoring interval, that adds $25, $58 per month to protocol cost.

Some telehealth platforms include labs in a quarterly subscription fee, which can reduce out-of-pocket lab costs to $0 per draw beyond the subscription price.

Physician Oversight Costs

Telehealth TRT platforms operating in the U.S. Typically charge:

• Initial consultation: $75, $199 (one-time)
• Monthly subscription (includes ongoing prescribing access and asynchronous messaging): $75, $150 per month
• Some platforms bundle medication, shipping, and labs into a single monthly fee of $150, $250

For comparison, a traditional endocrinologist or urologist visit for TRT management bills $200, $400 per visit without insurance, with two to four visits recommended in the first year. [1]

Total Monthly Cost: All-In Estimate

| Cost Component | Low Estimate | High Estimate | |---|---|---| | Testosterone cypionate (retail/compounding) | $15 | $80 | | Labs (amortized monthly) | $25 | $58 | | Physician / telehealth fee | $75 | $150 | | Syringes, alcohol swabs, sharps disposal | $5 | $15 | | Total per month | $120 | $303 |

Most patients on a straightforward protocol fall in the $130, $200 per month range once stable. This is meaningfully different from the $400, $800 per month some patients report when using concierge or direct-pay men's health clinics with premium pricing.

Ancillary Medications Derek Has Discussed: HCG, Anastrozole, and Enclomiphene

Derek has publicly discussed HCG, anastrozole, and enclomiphene in the context of TRT, fertility preservation, and estradiol management. These are not universal TRT add-ons; they require specific clinical indications.

HCG for Testicular Function and Fertility

Exogenous testosterone suppresses LH and FSH, causing testicular atrophy and azoospermia in most men within 3 to 6 months of use. [7] HCG (human chorionic gonadotropin) mimics LH and stimulates intratesticular testosterone production and spermatogenesis.

The Endocrine Society recommends offering HCG or gonadotropin therapy to hypogonadal men on TRT who desire fertility preservation. [1] A 2013 study by Hsieh et al. In the Journal of Urology demonstrated that HCG co-administration (500 IU every other day) maintained intratesticular testosterone in men on exogenous testosterone. [8]

Cost: Compounded HCG (post-FDA 503A compounding pathway) typically runs $40, $90 per month. Brand-name Pregnyl or Novarel (if covered by insurance) may cost less with a copay.

Anastrozole: Estradiol Management

Testosterone aromatizes to estradiol via the aromatase enzyme. Supraphysiologic testosterone doses or high aromatization rates can raise estradiol to levels that cause gynecomastia, water retention, or mood disturbance. [9]

Anastrozole (Arimidex), an aromatase inhibitor, is sometimes prescribed at low doses (0.25 to 0.5 mg twice weekly) to control estradiol in men on TRT. The 2018 Endocrine Society guideline states that routine aromatase inhibitor use is not recommended, but it may be appropriate for symptomatic men with confirmed elevated estradiol. [1]

Cash price for generic anastrozole: approximately $20, $40 per month at retail pharmacy.

Enclomiphene as an Alternative

Enclomiphene citrate, a selective estrogen receptor modulator, stimulates endogenous LH and FSH secretion, raising intratesticular and serum testosterone without suppressing the HPG axis. A 2013 phase III trial (N=182) showed enclomiphene 12.5 mg daily increased serum testosterone from a mean of 205 ng/dL to 412 ng/dL while maintaining sperm counts above baseline, compared with testosterone gel which suppressed sperm counts in 93% of subjects. [10]

Derek has referenced enclomiphene in multiple videos as a fertility-sparing alternative to TRT for men in certain clinical situations. Cost: approximately $60, $120 per month via compounding pharmacy (enclomiphene is not FDA-approved as a standalone drug for hypogonadism as of January 2025, though Androxal received FDA fast-track designation).

Required Lab Monitoring: What Derek's Protocol Would Require Clinically

Any responsible TRT protocol, whether run by a content creator or a new patient, requires structured laboratory surveillance. The Endocrine Society 2018 guideline specifies the following schedule: [1]

Baseline Labs (Before First Injection)

• Two morning total testosterone measurements (drawn between 7 and 10 a.m.)
• Free testosterone (calculated or equilibrium dialysis method)
• LH, FSH, prolactin (to rule out secondary causes)
• Estradiol (sensitive assay)
• Complete blood count
• Comprehensive metabolic panel
• PSA (men age 40+ or those with family history of prostate cancer)
• Lipid panel
• Thyroid-stimulating hormone (to exclude hypothyroidism as a cause of symptoms)

On-Therapy Monitoring

At 3 months after starting:

• Total and free testosterone (drawn at trough, before next injection)
• Hematocrit
• PSA

At 6 to 12 months, and then annually:

• Full panel repeated
• Bone mineral density considered at 1 to 2 years in men with baseline osteopenia [1]

The American Association of Clinical Endocrinology (AACE) similarly recommends hematocrit monitoring every 3 to 6 months for the first year of therapy. [11]

If hematocrit exceeds 54%, the Endocrine Society recommends stopping testosterone until hematocrit normalizes, then restarting at a lower dose or switching to a formulation with less erythropoietic effect. [6]

Safety Profile: What the Clinical Data Show

TRT's safety in appropriately selected hypogonadal men is now supported by a substantial body of evidence. The TRAVERSE trial (N=5,246), published in the New England Journal of Medicine in 2023, found that testosterone replacement in middle-aged and older men with hypogonadism and pre-existing cardiovascular risk did not increase major adverse cardiovascular events (MACE) compared with placebo over a mean follow-up of 33 months (hazard ratio 0.96, 95% CI 0.78 to 1.17). [12] This was the largest cardiovascular safety trial of TRT conducted to date.

Erythrocytosis Risk

Testosterone-induced erythrocytosis (elevated red blood cell mass) is the most common adverse effect requiring dose adjustment. The TRAVERSE trial reported hematocrit above 54% in 5.7% of testosterone-treated men versus 0.8% in the placebo group. [12] Twice-weekly dosing and subcutaneous injection route may reduce this risk modestly. [5]

Prostate Risk

The TRAVERSE trial found no increase in prostate cancer incidence or high-grade prostate events in the testosterone group at 33 months. [12] PSA surveillance every 3 to 6 months in the first year remains standard. [1]

Cardiovascular Lipids

Testosterone can lower HDL cholesterol by 5 to 10% at standard replacement doses. [13] A 2020 meta-analysis of 39 randomized controlled trials (N=3,109) published in the European Journal of Endocrinology found no significant change in LDL or total cardiovascular events, but a modest HDL reduction at higher doses. [13] Baseline and annual lipid panels are therefore included in standard monitoring.

Infertility

Exogenous testosterone reliably suppresses spermatogenesis. A 2019 review in the Journal of Urology found that 65 to 90% of men on TRT develop azoospermia within 6 months. [7] Recovery of sperm production after stopping TRT takes a median of 3 to 6 months but can take longer. Men who want biological children should discuss HCG co-administration or enclomiphene before starting TRT.

How Telehealth Has Changed TRT Access and Pricing

Before 2015, most men seeking TRT had to see a urologist or endocrinologist in person, then fill a prescription at a retail pharmacy. The rise of telehealth men's health platforms (Defy Medical, Maximus, Fountain TRT, and similar) changed that access curve substantially.

A 2022 analysis in Telemedicine and e-Health found that telehealth platforms reduced time-to-prescription for testosterone by a median of 18 days compared with traditional outpatient pathways. [14] For patients in rural areas or those without access to an endocrinologist, this is a meaningful difference.

Current telehealth platforms vary in what they include in their monthly fee. Patients should verify whether the quoted price includes:

• Physician consultation and prescribing authority
• Medication (testosterone vials, syringes, needles)
• Shipping
• Lab requisitions and lab costs
• Follow-up messaging and dose adjustment consultations

Some platforms advertise $99 per month but bill labs separately, pushing real monthly cost to $175, $250 once lab draws are included.

What HealthRX Includes

HealthRX's TRT program includes initial and follow-up physician consultations, lab requisitions through a national reference lab network, and pharmacy coordination for testosterone cypionate and ancillary medications. Pricing details are available on the program page. Patients prescribed testosterone receive structured monitoring at 3 months, 6 months, and 12 months per Endocrine Society guidelines. [1]

Comparing Protocol Complexity: Derek vs. A Standard Patient

Derek's described protocol, based on his public statements, sits at an intermediate-to-advanced level of hormone optimization. He has discussed:

• Split twice-weekly injections (reducing peak-to-trough ratio)
• Sensitive estradiol assays rather than standard immunoassay (more accurate at low E2 levels)
• Tracking free testosterone using equilibrium dialysis rather than calculated free T
• Periodic bloodwork intervals shorter than annual

A standard TRT patient starting de novo typically begins at 100 mg testosterone cypionate per week, monitors at 3 months, and adjusts dose based on trough levels and symptom response. This simpler protocol costs less and requires fewer ancillary medications initially.

The table below outlines the cost difference between a baseline protocol and a more comprehensive monitoring approach:

| Protocol Level | Monthly Medication | Monthly Labs (amortized) | Monthly Physician Fee | Monthly Total | |---|---|---|---|---| | Standard (100 mg/wk T cyp, labs Q6 months) | $20, $45 | $25, $45 | $75, $120 | $120, $210 | | Comprehensive (split dosing, sensitive E2, free T by dialysis, HCG) | $80, $150 | $50, $80 | $100, $150 | $230, $380 | | Advanced (above + anastrozole or enclomiphene, quarterly labs) | $120, $200 | $70, $100 | $120, $180 | $310, $480 |

Most non-celebrity patients who are appropriately diagnosed and monitored sit in the standard-to-comprehensive tier, spending $130, $250 per month.

Practical Starting Steps for a Non-Celebrity Patient

A patient who resonates with Derek's education and wants to evaluate whether TRT is appropriate for them should follow these steps:

1. Get two fasting morning (7 to 10 a.m.) total testosterone blood draws on separate days. A reading consistently below 300 ng/dL combined with symptoms qualifies as hypogonadism per Endocrine Society criteria. [1]
2. Complete a full baseline panel including LH, FSH, prolactin, estradiol, CBC, CMP, lipids, PSA (if over 40), and thyroid panel.
3. Consult a licensed physician, either through telehealth or in person, to review results and discuss treatment options including TRT, enclomiphene, or lifestyle intervention.
4. If TRT is prescribed, begin at 100 mg testosterone cypionate per week (or 50 mg twice weekly subcutaneously).
5. Recheck trough testosterone, estradiol, and hematocrit at 6 to 8 weeks after the first injection, then follow the Endocrine Society monitoring schedule. [1]

The FDA label for testosterone cypionate specifies that the dosing goal is to achieve serum testosterone in the mid-normal range (400 to 700 ng/dL at trough) rather than supraphysiologic levels. [2] Any provider titrating testosterone above this range without documented clinical rationale is operating outside labeled guidance.