Derek (More Plates More Dates) TRT Protocol: The Evidence Base Behind Every Compound

Who Is Derek and Why Does His Protocol Matter?

Derek, the creator behind More Plates More Dates, runs the largest independent TRT and performance-enhancing drug education channel on YouTube. His content reaches millions of viewers who often treat his self-experimentation as a decision-making template for their own hormonal interventions. That influence makes a clinical audit of his disclosed protocol worth doing.

From Bodybuilding to TRT Education

Derek began publicly discussing anabolic steroid use during his competitive bodybuilding phase. Over time, he transitioned to what he describes as a TRT-focused protocol, dropping supraphysiologic "blast" doses in favor of replacement-range testosterone. He has stated in multiple videos that his shift was motivated by bloodwork showing deteriorating lipid values and elevated hematocrit during high-dose cycles. This trajectory mirrors clinical data from a 2020 systematic review in Reviews in Endocrine and Metabolic Disorders showing dose-dependent cardiovascular risk markers in exogenous testosterone users [1].

The Platform Effect

His audience skews toward men aged 18 to 35, a demographic where hypogonadism prevalence is estimated at 2% to 6% according to data published in the Journal of Clinical Endocrinology & Metabolism [2]. The gap between that low prevalence and the size of his viewership suggests many followers pursue hormonal optimization without a clinical hypogonadism diagnosis. The Endocrine Society's 2018 guideline explicitly recommends against testosterone therapy in men without confirmed low testosterone on two separate morning measurements [3].

Testosterone: The Foundation of the Protocol

Derek has publicly stated that testosterone cypionate or enanthate forms the base of his protocol, administered via intramuscular or subcutaneous injection. This is standard. Both esters are FDA-approved for male hypogonadism and carry identical pharmacokinetic profiles once the ester cleaves [4].

Dosing and Frequency

He has discussed doses ranging from 100 mg to 200 mg per week in various videos, sometimes split into twice-weekly or every-other-day injections to flatten serum peaks. A 2017 pharmacokinetic study in Steroids found that splitting testosterone cypionate 100 mg/week into two 50 mg doses reduced peak-to-trough variation by roughly 30% compared to weekly dosing [5]. The Endocrine Society recommends 75 to 100 mg weekly or 150 to 200 mg every two weeks as standard replacement [3].

Supraphysiologic vs. Replacement

Derek has acknowledged periods where his dosing exceeded replacement range. A critical distinction: the TRAVERSE trial (N=5,204), published in the New England Journal of Medicine in 2023, evaluated cardiovascular safety only at replacement doses targeting 350 to 750 ng/dL [6]. It found no increased risk of major adverse cardiac events over a mean follow-up of 33 months. Supraphysiologic dosing was excluded from that trial. Any extrapolation of TRAVERSE safety data to higher doses is unsupported.

Aromatase Inhibitor Use: Anastrozole

Derek has discussed using low-dose anastrozole (0.25 to 0.5 mg, two to three times per week) to manage estradiol levels during testosterone therapy. This is one of the more debated elements of his protocol.

What the Guidelines Say

The Endocrine Society does not recommend routine aromatase inhibitor use with TRT [3]. The American Urological Association's 2018 guideline similarly advises against AI co-administration unless symptomatic gynecomastia develops [7]. Dr. Abraham Morgentaler of Harvard Medical School has stated: "Estradiol is not the enemy in men on testosterone therapy. Suppressing it aggressively can worsen bone density and libido rather than improve them" [8].

The Clinical Data

A 2016 study in the Journal of Clinical Endocrinology & Metabolism (N=400) found that men on TRT who maintained estradiol between 20 and 35 pg/mL had better sexual function scores than those with AI-suppressed estradiol below 15 pg/mL [9]. Derek has referenced this general range in his content, suggesting he targets mid-range estradiol rather than aggressive suppression. If accurate, this aligns more closely with current evidence than the zero-estradiol approach common in bodybuilding forums.

Bone and Cardiovascular Concerns

Estradiol plays a documented role in male bone mineral density. A prospective cohort study published in Osteoporosis International showed that men with serum estradiol <20 pg/mL had 2.3-fold greater risk of vertebral fracture compared to men with levels above 25 pg/mL [10]. Long-term AI use without monitoring DXA scans introduces a risk that Derek has not addressed in detail on his channel.

5-Alpha Reductase Inhibitors: Hair Loss Prevention

Derek has been transparent about using 5-alpha reductase inhibitors (finasteride and, at times, dutasteride) to prevent androgenic alopecia while on exogenous testosterone.

Finasteride Data

Finasteride 1 mg daily reduces scalp DHT by approximately 64% according to the key trial data that led to FDA approval [11]. The original Merck phase III trial (N=1,553) demonstrated that 48% of men on finasteride had increased hair count at 2 years versus 7% on placebo [11]. Sexual side effects occurred in 1.3% to 1.8% of participants, a figure Derek has discussed on his channel while noting that his personal experience did not include persistent sexual dysfunction.

Dutasteride: A Stronger Option

Dutasteride inhibits both type I and type II 5-alpha reductase, reducing serum DHT by over 90% [12]. Derek has mentioned dutasteride use in the context of aggressive hair loss phases. A head-to-head trial published in the Journal of the American Academy of Dermatology (N=416) found dutasteride 0.5 mg superior to finasteride 1 mg at 24 weeks for vertex hair count, with a mean difference of 12.2 hairs per cm² [13]. The trade-off is a longer half-life (5 weeks vs. 6 to 8 hours), which makes discontinuation slower and side effect resolution less predictable.

Ancillary Compounds: What Else Has Derek Disclosed?

Beyond the core testosterone and AI combination, Derek has publicly discussed several additional compounds at various points in his content history. Not all are part of his current protocol. Distinguishing past experimentation from ongoing use is important.

HCG (Human Chorionic Gonadotropin)

Derek has discussed HCG at 250 to 500 IU two to three times per week to maintain intratesticular testosterone and preserve fertility while on TRT. This practice has clinical support. A 2019 study in Fertility and Sterility found that HCG co-administration preserved spermatogenesis in 89% of men on testosterone therapy (N=65), compared to 30% recovery in those who used testosterone alone and then discontinued [14]. The AUA guideline acknowledges HCG as an option for fertility preservation in men on TRT [7].

Thyroid and Metabolic Monitoring

He has referenced monitoring TSH and free T3/T4 values during protocol adjustments. While not a direct intervention, this reflects awareness that exogenous testosterone can alter thyroid-binding globulin levels. A 2014 study in European Journal of Endocrinology demonstrated that testosterone therapy reduced TBG by 10% to 15%, potentially altering free thyroid hormone availability [15].

GH Secretagogues and Peptides

Derek has discussed MK-677 (ibutamoren) and various GHRP/GHRH peptides in educational content. Whether these remain part of his active protocol is not confirmed in recent disclosures. MK-677's evidence base includes a 2-year RCT (N=65) published in the Journal of Clinical Endocrinology & Metabolism showing sustained GH and IGF-1 elevation but no significant change in body composition versus placebo [16]. Derek has cited this trial himself as evidence that GH secretagogues are "overhyped for body composition."

Bloodwork: The Monitoring Framework

A consistent theme across Derek's content is the emphasis on frequent bloodwork. He has stated he tests comprehensive metabolic panels, lipids, CBC (with hematocrit), testosterone (total and free), estradiol (sensitive assay), PSA, prolactin, and thyroid markers every 3 to 6 months.

Hematocrit and Polycythemia Risk

This is clinically appropriate. Testosterone therapy raises hematocrit in a dose-dependent manner. The Endocrine Society guideline recommends checking hematocrit at baseline, 3 to 6 months, then annually, with dose reduction or phlebotomy if hematocrit exceeds 54% [3]. A 2015 meta-analysis in Mayo Clinic Proceedings of 30 RCTs found testosterone therapy increased hematocrit by a mean of 3.2 percentage points versus placebo [17]. Derek has mentioned therapeutic phlebotomy as a tool he has used, which aligns with guideline recommendations.

PSA Monitoring

Prostate-specific antigen monitoring is another element Derek has discussed. The Endocrine Society recommends PSA measurement at 3, 6, and 12 months after initiating TRT, then annually, with urological referral if PSA rises by more than 1.4 ng/mL within 12 months or exceeds 4.0 ng/mL [3]. The 2023 TRAVERSE trial also included a prostate safety substudy showing no significant increase in high-grade prostate cancer incidence in the testosterone arm versus placebo [6].

What the Evidence Supports vs. What It Does Not

The core of Derek's disclosed protocol (replacement-dose testosterone, regular bloodwork, cautious estradiol management) aligns with mainstream endocrinology practice. Several elements diverge.

Supported by Evidence

Testosterone cypionate or enanthate for confirmed hypogonadism has level I evidence from the TRAVERSE trial [6]. Split-dose injection protocols reduce pharmacokinetic variability [5]. HCG preserves spermatogenesis [14]. Hematocrit and PSA monitoring are guideline-mandated [3]. Finasteride and dutasteride prevent androgenic alopecia with strong RCT backing [11][13].

Not Supported or Unclear

Routine AI use without symptomatic gynecomastia contradicts Endocrine Society and AUA guidance [3][7]. GH secretagogue use lacks body composition evidence from the 2-year MK-677 trial [16]. Supraphysiologic dosing periods carry cardiovascular and hepatic risks not captured by the TRAVERSE trial's safety data [6]. The Endocrine Society's Dr. Shalender Bhasin, principal investigator of TRAVERSE, has noted: "Our findings apply to men with hypogonadism treated to the normal range. They should not be interpreted as a green light for supraphysiologic testosterone use" [6].

The Self-Experimentation Problem

Derek is transparent about n=1 experimentation. The limitation is generalizability. His genetics, training history, diet, and baseline health differ from those of his audience. A single individual's favorable bloodwork on a given protocol does not constitute evidence that the protocol is safe for a population.

How Clinicians Should Interpret This Protocol

For physicians encountering patients who reference Derek's content, the constructive approach is to validate the emphasis on bloodwork and dose titration while correcting misconceptions about AI necessity and supraphysiologic safety. Patients influenced by MPMD content tend to arrive with more lab literacy than average, which can be channeled into collaborative decision-making within guideline boundaries.

The Endocrine Society recommends initiating TRT only after two confirmed morning total testosterone levels below 300 ng/dL with symptoms of hypogonadism [3]. Starting there, rather than at Derek's protocol, is the evidence-based entry point.