Derek (More Plates More Dates) and TRT: What Clinicians Should Tell Patients

Who Is Derek from More Plates More Dates?

Derek, who uses the surname pseudonym associated with his brand, built one of the internet's most-watched pharmacology channels outside of academic medicine. His content spans testosterone replacement therapy, androgenic-anabolic steroids, selective androgen receptor modulators, hair loss drugs, and metabolic health compounds. He has discussed his own bloodwork publicly on hundreds of occasions.

From Fitness Content to Pharmacology Influencer

Derek's channel grew rapidly between 2020 and 2023 by filling a gap: detailed, mechanism-level discussion of compounds that most physicians either avoid discussing or address only briefly during appointments. His breakdown of pharmacokinetics, half-lives, and receptor binding profiles often reads closer to a continuing medical education module than a typical fitness video. That technical depth is exactly why patients trust him, and exactly why clinicians need to understand his reach.

Scale of Influence on Patient Behavior

A 2023 survey published in JAMA Network Open found that 46.2% of men aged 18 to 45 who used social media had encountered content promoting testosterone or anabolic steroid use, and 28.6% reported that social media influenced their decision to pursue hormone therapy [1]. Derek's channel represents one of the highest-traffic single sources within that system. Clinicians at men's health clinics report that patients increasingly arrive with specific dose requests, injection frequency preferences, and ancillary drug expectations shaped by his content.

Where Derek's Content Aligns with Clinical Guidelines

Not everything Derek discusses diverges from evidence-based practice. Recognizing the overlap gives clinicians credibility when they need to push back on the parts that do diverge.

Bloodwork Monitoring Advocacy

Derek has consistently emphasized regular blood panels before, during, and after any hormonal intervention. The Endocrine Society's 2018 clinical practice guideline for testosterone therapy in men with hypogonadism recommends monitoring hematocrit, PSA, lipids, and liver function at 3 to 6 months after initiation and then annually [2]. Derek's repeated insistence that "you need bloodwork" aligns with this standard. Clinicians can affirm this point directly: "Your source is right that bloodwork matters. Let's make sure we're checking the right markers on the right schedule."

Harm Reduction Over Abstinence Messaging

Derek has framed much of his steroid-related content through a harm-reduction lens, acknowledging that people will use these compounds regardless of legality and arguing they should at least understand the risks. This mirrors the approach described in a 2020 British Journal of Sports Medicine analysis of anabolic steroid harm reduction, which concluded that abstinence-only messaging is ineffective for this population and that healthcare providers should engage users without judgment [3]. The Endocrine Society does not endorse non-medical steroid use, but the pragmatic communication style Derek models can be adapted for clinical encounters.

Estrogen Management Awareness

Derek frequently discusses estradiol levels in men on testosterone, including the role of aromatase inhibitors. The Endocrine Society guideline does not recommend routine AI use during TRT, but it does acknowledge that monitoring estradiol can be clinically relevant when gynecomastia symptoms arise [2]. Derek's audience often arrives aware that estrogen matters. That awareness is useful. The correction clinicians need to make is about thresholds and intervention: routine AI use in standard TRT is not supported by high-quality evidence, and aggressive estrogen suppression carries bone density and cardiovascular risks [4].

Where Derek's Content Diverges from Evidence-Based Practice

This is the section that matters most for patient encounters. Three areas require direct, specific correction.

Supraphysiological Dosing and "Blasts"

Derek has publicly documented using testosterone at doses well above replacement levels (typically 100-200 mg/week for TRT) during self-described "blast" phases. The Endocrine Society explicitly recommends against prescribing testosterone to men without clinical hypogonadism and advises targeting serum levels in the mid-normal range (450-600 ng/dL) [2]. A patient who asks for 300-500 mg/week of testosterone cypionate "like Derek uses for a blast" is requesting a bodybuilding protocol, not TRT.

The TRAVERSE trial (N=5,204), published in The New England Journal of Medicine in 2023, evaluated cardiovascular safety of testosterone in hypogonadal men and used doses titrated to achieve levels of 350-750 ng/dL [5]. It found a non-inferior cardiovascular event rate compared to placebo but did not evaluate supraphysiological dosing. No randomized trial supports the cardiovascular safety of doses that push total testosterone above 1,500 ng/dL.

SARMs and Research Chemicals

Derek has reviewed selective androgen receptor modulators (ostarine, LGD-4033, RAD-140) in detail. The FDA has issued multiple warning letters stating that SARMs are not approved for human use and have been associated with liver injury, cardiovascular events, and suppression of endogenous testosterone [6]. No SARM has completed Phase III clinical trials for any indication as of this writing.

Patients who reference Derek's SARM content need a direct statement: these compounds lack the safety data that even testosterone (a Schedule III controlled substance) has accumulated over decades. The assumption that "SARMs are safer than steroids" is not supported by any completed human trial.

Hair Loss Drug Stacking

Derek's content on finasteride, dutasteride, RU58841, and topical anti-androgens has driven significant patient interest in multi-drug hair loss protocols. While finasteride 1 mg daily is FDA-approved for male androgenetic alopecia based on 5-year key trial data [7], and dutasteride has off-label evidence from the ARIA trial [8], compounds like RU58841 are unregulated research chemicals with no human safety or efficacy data from controlled trials.

Clinicians should separate the evidence-based options (finasteride, dutasteride, minoxidil) from the unregulated ones and explain this distinction clearly.

A Framework for the Clinical Conversation

When a patient says "I watched Derek's video on this," the response matters. Dismissing the source damages rapport. Validating it uncritically enables unsafe decisions.

Step 1: Acknowledge the Source Without Endorsing

"I know that channel. He covers pharmacology in more detail than most creators. Let me walk you through how what he discusses applies to your specific labs and history."

Step 2: Separate Entertainment from Prescription

Derek himself has stated in multiple videos that he is not a physician and that viewers should consult their doctors before using any compound. Clinicians can reference this directly: "He says the same thing. His bloodwork is not your bloodwork. His risk tolerance is not a clinical recommendation."

Step 3: Anchor to the Patient's Own Data

Redirect from "Derek takes X dose" to "Your total testosterone is Y, your free testosterone is Z, your hematocrit is W. Here's what those numbers mean for your options." The TRAVERSE trial provides a useful reference point: men with hypogonadism (total testosterone <300 ng/dL) and cardiovascular risk factors showed no excess major adverse cardiovascular events on replacement-dose testosterone over a mean follow-up of 33 months [5].

Step 4: Set Monitoring Expectations

The Endocrine Society recommends: hematocrit at baseline, 3 months, 6 months, and annually; PSA per age-appropriate screening guidelines; lipid panel at baseline and 6-12 months; and bone density if indicated [2]. Patients influenced by Derek often expect more frequent labs. Clinicians can channel that enthusiasm productively by explaining what each marker means and why the monitoring interval is what it is.

The Broader Influencer Problem in Men's Health

Derek is not the only source shaping patient expectations. He is simply the most technically sophisticated one. The broader challenge for clinicians involves a shift in where patients get their baseline health information.

Social Media as a Primary Information Source

A 2024 cross-sectional study in JAMA Internal Medicine found that TikTok and YouTube videos about testosterone therapy had a mean quality score of 2.1 out of 5 on the DISCERN instrument, with only 12% meeting criteria for "good" or "excellent" information quality [9]. Derek's content would likely score higher than average due to its citation of studies and bloodwork data, but the DISCERN framework penalizes content that does not discuss treatment alternatives, shared decision-making, or the option of no treatment.

Anabolic Steroid Use Trends

The 2023 Global Drug Survey found that 3.3% of male respondents aged 18 to 34 reported lifetime anabolic steroid use, with testosterone as the most commonly used compound [10]. The CDC's NHANES data from 2017-2020 showed that testosterone prescriptions in men aged 40 to 69 increased by approximately 300% between 2001 and 2017 [11]. These trends predate Derek's channel but have accelerated alongside the growth of TRT-focused social media content.

Dr. Shalender Bhasin, principal investigator of the TRAVERSE trial and professor of medicine at Harvard Medical School, stated in a 2023 interview with The New England Journal of Medicine: "The decision to prescribe testosterone should be based on a confirmed diagnosis of hypogonadism with symptoms, not on a patient's desired serum level from a social media source" [5].

Distinguishing Influencer Pharmacology from Clinical Pharmacology

The core difference is risk stratification. Derek discusses compounds in terms of their mechanisms, receptor binding affinity, and his own subjective response. Clinical pharmacology layers on population-level safety data, drug-drug interactions, organ-specific contraindications, and regulatory status. A patient who understands the androgen receptor can still be at risk if they do not understand their own hematocrit, sleep apnea status, or family history of prostate cancer.

Specific Claims Clinicians Should Be Prepared to Address

Patients may bring in specific claims from Derek's content. Three appear most frequently in clinical settings.

"More Frequent Injections Give Steadier Levels"

Derek has advocated for every-other-day or daily subcutaneous testosterone injections instead of the traditional weekly or biweekly intramuscular protocol. A 2017 study in Translational Andrology and Urology found that subcutaneous testosterone cypionate produced comparable serum levels to intramuscular injection with potentially fewer hematocrit elevations [12]. The Endocrine Society guideline does not specify injection frequency beyond "every 1-2 weeks" for cypionate/enanthate but acknowledges that pharmacokinetic variability exists [2]. This claim has partial support. Clinicians can work with patients who prefer more frequent dosing while ensuring total weekly dose remains in the replacement range.

"You Need an AI on TRT"

Routine aromatase inhibitor use during TRT is not recommended by the Endocrine Society [2]. A 2016 study in The Journal of Clinical Endocrinology & Metabolism found that anastrozole use in hypogonadal men on testosterone reduced estradiol effectively but was associated with adverse changes in bone turnover markers [4]. AIs should be reserved for documented symptomatic estrogen excess with confirmed elevated estradiol. The reflexive "take an AI with your testosterone" approach common in Derek's older content is not standard of care.

"Hematocrit of 54% Is Fine If You Donate Blood"

Derek has discussed therapeutic phlebotomy as a management strategy for TRT-induced erythrocytosis. The Endocrine Society recommends dose reduction or cessation if hematocrit exceeds 54% [2]. While phlebotomy is used clinically, it treats the consequence, not the cause. A 2020 review in Blood Advances noted that testosterone-induced erythrocytosis increases venous thromboembolism risk, and phlebotomy does not fully mitigate this risk because it does not address the underlying EPO-driven erythropoietic drive [13]. Patients should understand that "just donating blood" is not a complete solution.

What Clinicians Can Learn from Derek's Approach

Dismissing influencer content entirely misses an opportunity. Derek's success reveals a communication gap in clinical medicine.

Patients want mechanistic explanations. They want to see their own lab values in context. They want their provider to talk to them about the "why" behind a dosing choice, not just hand them a prescription. The 2018 Endocrine Society guideline is 30 pages long [2]. Patients rarely read it. Derek's 40-minute video covering similar ground gets millions of views. The format works.

Clinicians who adopt this communication style (specific, mechanistic, grounded in data) without adopting the self-experimentation ethos can build trust with patients who might otherwise manage their own protocols based on YouTube content alone.

The American Urological Association's 2018 guideline on testosterone deficiency recommends shared decision-making as a core component of TRT management [14]. Patients who arrive informed, even imperfectly, are already engaged in that process. Meeting them where they are is the clinical opportunity.