Derek (More Plates More Dates) TRT: The Private-Clinic Pathway They Likely Used

Who Is Derek from More Plates More Dates?

Derek is a Canadian content creator who built MPMD into the most-watched English-language channel covering testosterone, anabolic steroids, GLP-1 receptor agonists, and general men's health pharmacology. As of early 2025, the channel exceeds 1.5 million YouTube subscribers. Derek has a background in competitive natural and enhanced bodybuilding and has been public about receiving a hypogonadism diagnosis in his mid-twenties.

Why His Protocol Matters Clinically

His public content is remarkably detailed. Viewers frequently cite his explanations of testosterone pharmacokinetics, estrogen management, and bloodwork interpretation as more accessible than most clinical summaries. That specificity makes reverse-engineering his likely treatment pathway more straightforward than for most public figures.

He has confirmed, across multiple videos and podcast appearances, that he uses exogenous testosterone under physician supervision. He has not confirmed the exact prescribing clinic by name, but the protocol he describes is consistent with what the leading private men's health telehealth platforms in North America routinely offer.

The Broader Context of Young-Adult Hypogonadism

Hypogonadism in men under 40 is not rare. Data from the European Male Aging Study showed that biochemical hypogonadism (total testosterone below 11 nmol/L, roughly 317 ng/dL) affected approximately 2.1% of men aged 40 to 49, rising to 5.1% in men aged 50 to 59, but symptomatic cases with onset in the mid-twenties do occur, particularly in men with a history of intense caloric restriction or competitive bodybuilding [1]. The Endocrine Society defines hypogonadism as total testosterone consistently below 300 ng/dL on two morning samples, confirmed with a reliable assay [2].

The Standard Private-Clinic Diagnostic Pathway

Before any prescription is issued, a reputable private TRT clinic runs a diagnostic panel that goes substantially beyond what a busy GP typically orders.

Initial Bloodwork Panel

A private clinic typically orders the following on two separate mornings (blood drawn before 10 a.m., per Endocrine Society guidance):

• Total testosterone (LC-MS/MS preferred over immunoassay for accuracy)
• Free testosterone (calculated or equilibrium dialysis)
• Sex hormone-binding globulin (SHBG)
• LH and FSH (to distinguish primary from secondary hypogonadism)
• Estradiol (sensitive assay, not standard assay)
• Complete blood count including hematocrit
• Comprehensive metabolic panel
• PSA (in men over 40 or with risk factors)
• Prolactin (to rule out pituitary adenoma)
• Thyroid panel

Derek has discussed all of these markers in his content. His emphasis on SHBG, in particular, reflects a clinically sound understanding: a man with low-normal total testosterone but very low SHBG may have adequate free testosterone and not require treatment, while a man with low total testosterone and high SHBG has a double deficit [3].

Confirming Secondary Hypogonadism

Derek's case appears consistent with secondary (hypothalamic-pituitary) hypogonadism, where LH and FSH are low or inappropriately normal despite low testosterone. Secondary hypogonadism in otherwise healthy young men is frequently idiopathic or related to prior anabolic steroid use, obesity, or chronic energy deficit. The Endocrine Society guideline recommends MRI of the pituitary in men with secondary hypogonadism to rule out structural lesions before initiating TRT [2].

Testosterone Cypionate: The Anchor of the Protocol

Testosterone cypionate injected once or twice weekly is the workhorse of North American private TRT. The FDA approved testosterone cypionate (Depo-Testosterone, Pfizer) for male hypogonadism decades ago, and generic versions are widely available [4].

Dose and Frequency

Standard starting doses at private clinics run 100 to 200 mg per week, often split into two injections of 50 to 100 mg to minimize estradiol peaks and hematocrit rises. Derek has discussed twice-weekly injection protocols at length and consistently favors that approach over single weekly injections for the reason that smaller, more frequent doses blunt the testosterone surge-and-trough cycle.

Pharmacokinetically, testosterone cypionate has an elimination half-life of approximately 8 days, meaning steady-state serum levels are reached around 4 to 5 weeks into a fixed-dose protocol [5]. Splitting the dose shortens the effective inter-dose half-life and produces a flatter serum curve.

Subcutaneous vs. Intramuscular Injection

Derek has discussed subcutaneous (subQ) injection as an alternative to traditional intramuscular (IM) injection. A 2017 study in the Journal of Urology (N=44) found that subQ testosterone cypionate produced consistent serum testosterone levels comparable to IM injection, with the added benefit of reduced injection-site discomfort and the ability to self-inject into abdominal fat [6]. Many private clinics now recommend subQ as the default for self-administering patients.

Target Serum Levels

Private clinics typically target total testosterone in the 600 to 900 ng/dL range, with free testosterone in the upper quartile of the normal male reference range. The Endocrine Society guideline states: "We suggest aiming for mid-normal range testosterone levels" [2]. Derek has publicly argued for targeting the higher end of the physiologic range, citing quality-of-life and body composition data, which aligns with what many private clinics offer when patients are well-monitored.

Estrogen Management: Anastrozole or No Aromatase Inhibitor?

One of the most debated elements of private TRT protocols is estrogen management. Exogenous testosterone aromatizes to estradiol. Elevated estradiol can cause gynecomastia, water retention, and mood changes, but estradiol is also essential for bone density, cardiovascular health, and libido in men [7].

When Aromatase Inhibitors Are Appropriate

Anastrozole 0.25 to 0.5 mg twice weekly is the most commonly prescribed aromatase inhibitor (AI) in private TRT settings. The FDA approved anastrozole (Arimidex) for breast cancer, but physicians prescribe it off-label for TRT-related hyperestrogenism. A randomized crossover study in 58 older men found that anastrozole significantly reduced estradiol while raising testosterone, but it also lowered bone formation markers, illustrating the tradeoff of over-suppressing estrogen [7].

Derek has been vocal that routine AI use without documented elevated estradiol is a clinical mistake. That position is supported by the Endocrine Society guideline, which states: "We suggest against routinely treating men with testosterone deficiency with estrogen-blocking drugs" [2]. AI prescribing should be reserved for symptomatic hyperestrogenism with documented elevated estradiol on a sensitive assay.

Monitoring Estradiol Correctly

The standard estradiol immunoassay is calibrated for women and overestimates estradiol in men. Private clinics that do this correctly use the Endocrine Society-recommended sensitive (LC-MS/MS) estradiol assay, also called the "ultrasensitive" or "male" estradiol test. Male physiologic estradiol on TRT typically runs 20 to 40 pg/mL on the sensitive assay.

HCG: Preserving Testicular Function and Fertility

Human chorionic gonadotropin (HCG) mimics LH, directly stimulating Leydig cells to produce intratesticular testosterone. When a man starts TRT, exogenous testosterone suppresses LH via negative feedback, causing intratesticular testosterone to fall and the testes to atrophy. HCG prevents most of this atrophy and is the primary tool for preserving fertility on TRT.

Typical HCG Dosing in Private Protocols

Standard private clinic dosing runs 500 to 1,500 IU of HCG administered two to three times per week by subcutaneous injection, timed alongside testosterone injections. A study in the Journal of Clinical Endocrinology and Metabolism (N=29) confirmed that 500 IU HCG every other day maintained intratesticular testosterone levels during exogenous testosterone suppression, compared to a 94% fall in the placebo group [8].

Derek has discussed HCG extensively, particularly for men who want to maintain spermatogenesis or preserve testicular volume for cosmetic reasons. This is exactly the kind of nuance that separates a private men's health clinic from a standard GP visit.

HCG Availability After FDA Compounding Changes

The FDA removed HCG from the list of approved bulk compounding ingredients in 2020, which disrupted supply from compounding pharmacies. Brand-name HCG (Pregnyl, Novarel) remains available by prescription [9]. Some clinics have shifted to kisspeptin-10 or gonadorelin as alternatives to stimulate LH release, though the evidence base for these alternatives in TRT is thinner than for HCG.

The Private-Clinic Model: How It Actually Works

The private TRT clinic pathway Derek likely used differs from a standard primary care visit in four concrete ways.

Step 1: Online Intake and Bloodwork Order

Most private men's health telehealth platforms begin with an online symptom questionnaire and then issue a requisition to a national laboratory (Quest Diagnostics or LabCorp in the United States, LifeLabs in Canada). The patient visits a draw site at their convenience. No physician face-to-face visit is required at this stage.

Step 2: Physician or Nurse Practitioner Consultation

After labs return, a licensed physician or nurse practitioner reviews the results on a video call. If hypogonadism is confirmed (two morning total testosterone readings below 300 ng/dL, with symptoms), a prescription is issued. Reputable platforms require two confirmatory draws, consistent with Endocrine Society guidance [2].

Step 3: Medication Delivery

Testosterone cypionate, syringes, needles, and any adjunct medications are shipped directly to the patient's address. Some platforms bundle in remote injection training via video.

Step 4: Quarterly Monitoring

Bloodwork is repeated every 3 to 6 months, covering at minimum total testosterone, estradiol, hematocrit, PSA, and a metabolic panel. A hematocrit above 54% requires dose reduction or therapeutic phlebotomy per the Endocrine Society guideline [2]. The American Heart Association has flagged polycythemia as the most common adverse event of TRT in the context of cardiovascular risk monitoring [10].

Clinical Evidence for TRT in Young Symptomatic Men

The strongest TRT trial data come from the Testosterone Trials (T-Trials), a coordinated set of seven double-blind, placebo-controlled studies conducted in 788 men aged 65 and older with confirmed hypogonadism (mean baseline testosterone 234 ng/dL). Testosterone gel (1.62%) used daily over 12 months produced significant improvements in sexual desire, erectile function, and physical activity compared to placebo, with a mean serum testosterone rise to approximately 450 ng/dL in the treatment group [11].

Younger men under 50 are underrepresented in trial data, partly because guideline committees historically considered TRT most appropriate for older patients. A 2023 meta-analysis in JAMA Network Open examined 17 RCTs and found that testosterone therapy in men with hypogonadism improved body composition (lean mass gain, fat mass reduction) and sexual function across all age groups studied, though cardiovascular signal data remained mixed and required ongoing surveillance [12].

The TRAVERSE trial (N=5,204), published in the New England Journal of Medicine in 2023, found that testosterone replacement in men aged 45 to 80 with hypogonadism and elevated cardiovascular risk did not increase major cardiovascular events compared to placebo over a mean follow-up of 33 months, though the incidence of atrial fibrillation, pulmonary embolism, and acute kidney injury was higher in the testosterone group [13]. Clinicians managing younger, lower-risk patients like Derek would likely weigh these findings differently than they would for older men with established cardiovascular disease.

What Derek Gets Right About TRT Education

Derek's public content consistently aligns with guideline-based clinical practice on several points. He emphasizes confirming low testosterone on two separate morning draws before starting treatment, a position identical to the Endocrine Society recommendation. He argues against chasing supraphysiologic levels on TRT, and his commentary on estradiol monitoring using the sensitive assay is clinically accurate.

His most clinically valuable contribution may be his insistence that symptoms alone, without documented low testosterone on a validated assay, do not justify TRT. That position echoes the Endocrine Society: "We recommend against making a diagnosis of androgen deficiency in patients with acute or subacute illnesses. Confirm the laboratory diagnosis with two testosterone measurements" [2].

Where Derek's content ventures outside standard clinical guidelines, he is generally transparent about the distinction between what he does personally (which may include off-label or investigational approaches) and what he recommends for a general audience. That transparency is an ethical position not all influencers in this space adopt.

Monitoring and Safety Benchmarks on TRT

Every man on TRT needs systematic follow-up. The key safety parameters are:

• Hematocrit: Target below 54%. TRT raises erythropoiesis via EPO stimulation; hematocrit above 54% increases clot risk. Blood draw or therapeutic phlebotomy brings it down.
• PSA: Baseline before starting, then at 3 to 6 months and annually thereafter in men over 40. A rise of more than 1.4 ng/mL from baseline within 12 months warrants urology referral per Endocrine Society guidance [2].
• Estradiol (sensitive assay): Target 20 to 40 pg/mL. Values above 60 pg/mL in symptomatic men may warrant low-dose anastrozole.
• Lipid panel: Testosterone can modestly reduce HDL cholesterol; monitoring is warranted every 6 to 12 months.
• Testicular size / fertility: If fathering children is a future goal, HCG adjunct therapy or a formal fertility consultation is appropriate before starting TRT.

A 2021 review in the Journal of Clinical Endocrinology and Metabolism confirmed that the most common adverse effects of TRT requiring clinical intervention are erythrocytosis (hematocrit above 54%), acne, and reduced sperm production, all of which are manageable with dose adjustment and adjunct therapy [14].

Is This Pathway Available to the Average Man?

Yes, with appropriate caveats. Private TRT telehealth platforms have made the diagnostic and prescribing pathway Derek likely used accessible to most men in the United States and Canada. Out-of-pocket costs for testosterone cypionate typically run $30, $80 per month for the medication itself. Lab work at the initial visit adds $150, $300 depending on the panel. Clinic fees vary from $99 to $199 per quarter at telehealth-first platforms.

The standard of care, per the Endocrine Society, still requires physician oversight, confirmed biochemical hypogonadism on two morning draws, and systematic follow-up monitoring. A private clinic that skips confirmatory labs and ships testosterone after a single intake questionnaire is operating outside guideline recommendations.

Derek has been explicit in his content that he pursued physician-supervised treatment and had his bloodwork documented before starting. That matters clinically. Self-administered testosterone without a diagnosis, monitoring, or physician oversight carries substantially higher risk for erythrocytosis, testicular atrophy, and inadvertent fertility loss.

Men with a serum total testosterone consistently below 300 ng/dL, confirmed on two separate morning draws using a validated LC-MS/MS assay, and with at least three of the classical hypogonadism symptoms (low libido, fatigue, reduced muscle mass, depressed mood, or erectile dysfunction), meet the Endocrine Society's threshold for initiating a clinical conversation about TRT [2].