Derek (More Plates More Dates) TRT: How a Regular Patient Would Get Access

Who Is Derek from More Plates More Dates?

Derek is the pseudonymous Canadian creator behind More Plates More Dates, a YouTube channel and website that has become one of the most-watched independent sources for evidence-based discussion of testosterone, anabolic steroids, peptides, and men's health pharmacology. As of early 2025, his channel carries more than one million subscribers. His content is unusual because he cites primary literature, walks through pharmacokinetic data, and distinguishes between therapeutic and supraphysiological dosing with a level of precision rarely found in fitness media.

What Derek Has Said About His Own TRT Use

Derek has confirmed his TRT use across multiple podcast appearances and YouTube videos. He has described using testosterone cypionate, discussed managing estradiol with aromatase inhibitors, and talked openly about bloodwork interpretation. These are public statements, not private records. His educational commentary on his own protocol has introduced tens of thousands of viewers to the concept of medically supervised TRT rather than unmonitored self-administration.

Because Derek speaks to an audience that often self-medicates, his public discussion of bloodwork, physician oversight, and lab-monitored dosing carries real clinical relevance. His consistent message is that hormone optimization done without physician supervision is riskier than doing it correctly through a clinic.

What He Takes: The Publicly Available Picture

Derek has discussed testosterone cypionate as his primary androgen. He has referenced monitoring total testosterone, free testosterone, and estradiol on cycle. He has also discussed ancillary compounds including anastrozole for estrogen management and human chorionic gonadotropin (hCG) for intratesticular testosterone maintenance and fertility preservation.

These compounds are all legal with a valid prescription in the United States and Canada. None of what Derek describes publicly places him outside the bounds of standard clinical TRT practice when prescribed and monitored by a physician.

What Is TRT and Who Actually Qualifies?

Testosterone replacement therapy is FDA-approved for male hypogonadism, defined as consistently low serum testosterone combined with clinical symptoms. The American Urological Association defines hypogonadism as a total morning testosterone below 300 ng/dL on at least two separate measurements [1]. The Endocrine Society's 2018 clinical practice guidelines specify that both biochemical confirmation and symptomatic presentation are required before initiating therapy [2].

Symptoms That Prompt Testing

Common symptoms include reduced libido, fatigue, depressed mood, loss of muscle mass, increased body fat, and poor morning erections. Not every man with low testosterone is symptomatic, and not every symptomatic man has low testosterone. That is why labs and clinical context both matter.

The Endocrine Society guideline states: "We recommend making a diagnosis of androgen deficiency only in men with consistent symptoms and signs and unequivocally low serum testosterone levels" [2]. A single low reading without symptoms is not sufficient for most prescribers to initiate therapy.

The Lab Work Required

A complete male hormone panel before TRT typically includes:

• Total testosterone (morning draw, 7 to 10 AM)
• Free testosterone (calculated or direct)
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
• Sex hormone-binding globulin (SHBG)
• Estradiol (sensitive assay)
• Complete blood count (CBC) with hematocrit
• Comprehensive metabolic panel (CMP)
• Prostate-specific antigen (PSA) for men over 40
• Prolactin (to rule out pituitary pathology)

Two draws on separate mornings are standard before a diagnosis. Testosterone follows a circadian rhythm, peaking between 6 AM and 10 AM and declining through the afternoon by as much as 35% [3].

The Clinical Evidence Behind TRT

TRT is not experimental. Decades of controlled trials support its use in confirmed hypogonadal men. The FDA has approved multiple testosterone formulations, including testosterone cypionate injection, testosterone enanthate injection, transdermal gels (AndroGel, Testim), and nasal gel (Natesto) [4].

The Testosterone Trials Consortium (TTrials)

The TTrials were a coordinated set of seven placebo-controlled trials in 788 men aged 65 and older with low testosterone (below 275 ng/dL) and age-related symptoms. Published in the New England Journal of Medicine in 2016, the sexual function trial showed significantly improved sexual activity, desire, and erectile function in the testosterone group versus placebo (P<0.001) [5]. The physical function trial showed modest improvements in walking distance. The mood and vitality trial showed improved mood and reduced depressive symptoms.

These were men who qualified clinically. The effects were real but not dramatic outside of sexual function, which is why patient selection matters.

Body Composition and Muscle Mass

A 2013 meta-analysis in the Journal of Clinical Endocrinology and Metabolism reviewed 51 randomized controlled trials and found that testosterone therapy increased lean body mass by a mean of 1.6 kg and reduced fat mass by 1.6 kg compared to placebo [6]. These are clinically meaningful shifts in body composition for hypogonadal men, though they are far smaller than the changes seen with supraphysiological doses discussed in fitness media.

Cardiovascular Considerations

The TRAVERSE trial, published in the New England Journal of Medicine in 2023 (N=5,246), found that testosterone replacement therapy in middle-aged and older men with hypogonadism and elevated cardiovascular risk did not increase the rate of major adverse cardiovascular events compared to placebo over a mean follow-up of 33 months [7]. This finding addressed a long-standing prescribing concern and has influenced how clinicians discuss cardiovascular risk with patients.

The FDA label for testosterone products still carries a warning about cardiovascular risk, but TRAVERSE data have given many clinicians greater confidence in appropriate candidates [4].

How a Regular Patient Gets Access to TRT

Getting TRT as a regular patient follows a defined clinical pathway. Derek's experience, while more extensively documented publicly than most, is not pharmacologically different from what any hypogonadal man would receive through a legitimate clinic.

Step 1: Symptom Screening and Intake

Most TRT clinics, including telehealth platforms, begin with a validated symptom questionnaire. The Aging Male Symptoms (AMS) scale and the ADAM (Androgen Deficiency in Aging Males) questionnaire are both widely used. A score suggesting significant androgen deficiency moves the patient to lab testing.

Step 2: Lab Order and Blood Draw

A physician or nurse practitioner orders a hormone panel. Telehealth platforms typically partner with LabCorp or Quest Diagnostics for nationwide lab access. Most patients receive results within 3 to 5 business days.

The critical draw is total testosterone measured between 7 AM and 10 AM on a morning when the patient has fasted or eaten only lightly. SHBG must also be measured because it determines how much testosterone is biologically active. A man with high SHBG and low-normal total testosterone may have very low free testosterone, which is the fraction that matters physiologically [2].

Step 3: Physician Consultation

A board-certified physician reviews labs and symptoms in a telehealth visit. If total testosterone is below 300 ng/dL on two draws, or free testosterone is below the laboratory reference range with symptoms present, a prescribing physician can initiate TRT.

Absolute contraindications include prostate cancer, breast cancer, hematocrit above 54%, untreated obstructive sleep apnea, and active desire for fertility (since TRT suppresses endogenous LH and FSH, reducing sperm production) [2].

Step 4: Choosing a Formulation

Testosterone cypionate or enanthate injected subcutaneously or intramuscularly is the most common formulation used in TRT clinics. The Endocrine Society's 2018 guidelines recommend starting doses in the range of 75 to 100 mg IM every week or 150 to 200 mg every two weeks for cypionate or enanthate [2].

Weekly subcutaneous injections at lower volumes (0.5 mL) have gained favor because they produce steadier serum levels with smaller peak-to-trough swings than biweekly IM injections [8]. Derek has discussed the pharmacokinetic case for weekly dosing extensively, citing the same principle.

Topical gels are an alternative for men who prefer to avoid injections. AndroGel 1.62% applied daily to the shoulder or upper arm produces average steady-state concentrations in the normal male range for most users [4].

Step 5: Monitoring on Therapy

The Endocrine Society recommends checking testosterone, hematocrit, and PSA at 3 to 6 months after starting therapy, and then annually once stable [2]. Hematocrit above 54% requires dose reduction or temporary discontinuation due to increased viscosity and thrombotic risk.

Estradiol should be monitored in men reporting gynecomastia, water retention, or mood changes. An aromatase inhibitor such as anastrozole 0.25 to 0.5 mg twice weekly may be added if estradiol rises above 40 to 50 pg/mL with symptoms. Derek has discussed this management step publicly and it aligns with standard clinical practice.

What Telehealth Changes

Telehealth TRT platforms have removed the barrier of finding a local endocrinologist or urologist willing to prescribe. A patient in a state that allows telehealth prescribing can complete intake, receive a lab order, get blood drawn at a local LabCorp, consult with a physician over video, and receive a prescription sent to a compounding pharmacy, all within 10 to 14 days.

Compounding pharmacies licensed under state pharmacy boards can produce testosterone cypionate in bacteriostatic saline or oil at prescribed concentrations. The FDA regulates compounded testosterone under 503A and 503B provisions [4].

What Derek's Platform Actually Gets Right Clinically

Derek's educational approach aligns with evidence-based medicine in several important areas. He emphasizes morning lab draws, consistent with the circadian biology of testosterone secretion [3]. He recommends monitoring estradiol rather than ignoring it, consistent with data showing that excessively low estradiol in men on TRT is associated with reduced bone mineral density and libido [9]. He distinguishes TRT doses from bodybuilding doses, which is a distinction many fitness influencers ignore.

Where his content goes beyond standard clinical practice is in his detailed coverage of supraphysiological protocols, peptides outside approved indications, and compounds not FDA-approved for any indication. That content is educational for harm reduction but falls outside the scope of what a telehealth clinic would prescribe.

Risks and Side Effects a Prescriber Will Discuss With You

TRT carries real risks that any prescribing physician is required to explain before initiating therapy. These include:

• Erythrocytosis (elevated hematocrit) in approximately 5.7% of patients per the TTrials data [5]
• Suppression of spermatogenesis and fertility (reversible in most but not all cases)
• Acne and oily skin, particularly in younger men
• Testicular atrophy (mitigated with hCG 500 IU two to three times per week)
• Sleep apnea worsening in predisposed individuals
• Potential for local skin irritation with topical formulations

The TRAVERSE trial found a higher incidence of pulmonary embolism and atrial fibrillation in the testosterone arm compared to placebo, even though major cardiovascular events were not increased [7]. These findings are now part of the standard informed-consent discussion for TRT.

Fertility Preservation on TRT

Men who want to father children should discuss fertility preservation before starting TRT. Exogenous testosterone suppresses LH and FSH through negative feedback on the hypothalamic-pituitary-gonadal axis, reducing intratesticular testosterone and sperm production. This is not permanent in most cases, but recovery can take 6 to 18 months after discontinuation [10].

Options to preserve fertility include:

• hCG monotherapy (maintains intratesticular testosterone without suppressing spermatogenesis as severely)
• Clomiphene citrate (selective estrogen receptor modulator that stimulates endogenous LH and FSH)
• Combination TRT plus hCG

Derek has covered the hCG-on-TRT protocol in detail on his channel. A 2013 study in the Journal of Urology (N=26) confirmed that hCG 500 IU every other day maintained intratesticular testosterone concentrations in men on exogenous testosterone [10].

Choosing a TRT Provider: What to Look For

Not all TRT clinics operate at the same standard. A legitimate TRT provider will:

1. Require two morning testosterone draws before diagnosis
2. Check LH and FSH to distinguish primary from secondary hypogonadism
3. Screen PSA before prescribing in men over 40
4. Monitor hematocrit every 3 to 6 months
5. Discuss fertility impact before prescribing
6. Not prescribe TRT based on symptoms alone without biochemical confirmation

Red flags include clinics that prescribe after a single lab draw, skip LH and FSH, never check hematocrit on follow-up, or advertise "optimization" in men with normal testosterone levels.