Derek from More Plates More Dates is arguably the most credible voice in TRT education. He doesn't exaggerate, he cites research, and he's thought deeply about protocol design. His audience is primarily American, which means his recommendations assume US healthcare access, US pharmaceutical availability, and US pharmaceutical pricing.
If you're in the UK considering TRT, most of his core principles transfer directly. But the implementation requires translation. This guide takes his framework and makes it UK-applicable.
Why MPMD's Approach Works
Derek's TRT philosophy centres on a few key principles: minimal effective dose, consistent dosing, frequent blood work, and individual protocol adjustment based on actual bloodwork rather than dogma.
This is sound. TRT isn't a one-size-fits-all intervention. A dose that optimises one man's testosterone and health markers might be excessive for another. Derek's emphasis on titration, monitoring, and adjusting based on response is exactly right.
His typical starting recommendation is 100-150mg per week of testosterone, with adjustments based on trough testosterone levels, symptoms, and side effect profile. This is conservative compared to underground TRT communities, which often recommend 200mg+ as a starting point.
Why this matters: Starting low and adjusting up based on bloodwork produces better outcomes and fewer side effects than starting high and hoping you don't develop problems. Derek understands this.
The Compound Translation Problem
More Plates More Dates discusses testosterone cypionate extensively. Derek's preference for cypionate is based on its half-life (8 days) and stability, plus its prevalence in US pharmaceutical supply.
The UK issue: Testosterone cypionate is essentially unavailable on the NHS. UK pharmaceutical supply predominantly uses testosterone enanthate (half-life approximately 10.5 days) or testosterone undecanoate (much longer acting, less frequently dosed).
For practical purposes, enanthate and cypionate are interchangeable. Enanthate is slightly longer-acting, but the difference is negligible for protocol design. You'll maintain slightly smoother levels on cypionate, but enanthate performs identically for TRT purposes.
What this means: Derek's dose recommendations translate directly. 100mg testosterone cypionate per week = 100mg testosterone enanthate per week. The pharmacology is essentially identical.
The advantage of enanthate: it's available through UK private TRT clinics (more on those below) and can be accessed through carefully selected GPs who understand TRT. Compounding pharmacies can also source it.
UK TRT Access: The Clinical Landscape
This is where significant differences emerge.
NHS Access: The NHS officially treats testosterone deficiency in symptomatic men, but access is restrictive. You require two separate testosterone tests (ideally morning, before 11am), documentation of symptoms, and evidence of clinical hypogonadism. Once approved, NHS prescriptions are usually slow-acting testosterone undecanoate injections (given as Nebido, 1000mg every 10-14 weeks). This is effective but offers minimal flexibility for protocol adjustment.
Private UK TRT Clinics: Three options dominate:
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Optimale — the largest UK TRT provider. Offers remote consultations, bloodwork coordination, and testosterone enanthate or cypionate at roughly £150-200/month depending on dose. They're well-integrated with UK labs (Medichecks, Monitor My Health). Protocol philosophy is similar to Derek's: start low, adjust based on bloodwork. Regular monitoring included.
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Balance My Hormones — similar model, slightly lower cost (£120-150/month), also uses enanthate. Similar monitoring approach.
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Leger Clinic — more expensive but offers comprehensive endocrine review. Good if you have complicating factors (thyroid issues, oestrogen concerns).
What Derek's approach translates to: You'd start with a private clinic consultation, baseline bloods, then 100-150mg enanthate weekly. After 4-6 weeks, repeat bloods. Adjust based on response. This is almost identical to MPMD's recommendation, just with UK compounds and UK clinics.
Cost comparison: Derek often doesn't address cost. US TRT with insurance can be £20-50/month. UK private TRT is £120-200/month. This is important context if you're implementing his protocol.
Bloodwork Protocol Translation
Derek emphasises consistent bloodwork: baseline, 4-6 weeks into protocol (trough), then ongoing monitoring (typically 8-12 weeks depending on stability).
US lab options: Derek discusses Quest, LabCorp, and sometimes specialty endocrine labs. These are low-cost (often £30-50 for a testosterone panel) and widely available.
UK equivalents: Medichecks and Monitor My Health are the primary private labs. Cost is higher (£50-100 for comprehensive hormone panels), but they're NHS-recognized and results are accepted by private clinics.
What to test:
- Total testosterone (primary marker)
- Free testosterone (useful for interpreting total testosterone in context of SHBG)
- SHBG (Sex Hormone Binding Globulin — influences how much testosterone is "active")
- LH/FSH (to assess pituitary suppression, relevant if you care about fertility)
- Oestradiol (Derek emphasises this — aromatisation varies individually)
- Haematocrit (TRT can increase red blood cell count; monitoring prevents polycythaemia)
- Liver enzymes, lipids, kidney function (safety baseline)
Timing: Trough samples are essential. If injecting weekly enanthate on Monday, test on Friday or Saturday morning (just before next injection). This shows your lowest level and is the standardised way to assess if you're in range.
Derek's targets: Total testosterone 800-1200 ng/dL (roughly 28-42 nmol/L in UK units). Free testosterone in upper-normal range. Oestradiol 20-30 pg/mL.
UK context: NHS reference ranges are typically 10.5-31.4 nmol/L for total testosterone. TRT typically aims for the upper-normal to slightly-above-normal range (20-28 nmol/L). This is lower numerically than Derek's US recommendations, but it's equivalent — the unit conversion is the difference.
Oestradiol Management: Where Derek's Detail Matters
More Plates More Dates devotes significant attention to oestradiol management, as many men on TRT develop elevated oestradiol. This manifests as water retention, gynecomastia risk, and reduced sexual function.
Derek's approach: avoid aromatase inhibitors (AIs) as a first-line tool. Instead:
- Verify oestradiol is actually elevated (don't assume)
- Reduce testosterone dose if possible
- Consider weight loss (fat tissue aromatises testosterone to oestradiol)
- Only use AIs (typically anastrozole) if the above fail
This is more nuanced than typical steroid forum advice, which jumps to AIs immediately.
The UK context: AIs like anastrozole are available through private clinics, but GPs won't prescribe them off-label for TRT-related oestradiol management. If you need an AI on UK TRT, you'll source it through your private clinic or privately.
Derek's philosophy here is sound: oestradiol isn't always a problem on TRT, and lowering it excessively creates new problems (joint pain, mood changes, erectile dysfunction).
DHT and Prostate Considerations
Derek discusses DHT (dihydrotestosterone) occasionally, as some men on TRT experience prostate-related side effects or androgenic effects (acne, hair loss). He mentions 5-alpha reductase inhibitors (like finasteride) but doesn't routinely recommend them.
Worth noting: If you have a personal or family history of prostate issues, discuss this with your UK TRT clinic before starting. Baseline PSA testing is standard. Some clinics will recommend 5AR inhibitors; others won't. The evidence on prostate safety during TRT is reassuring for men with normal baseline PSA, but individualisation matters.
UK access: finasteride is available through GPs for male pattern baldness, making it accessible if you need it. Cost is roughly £5-10/month on standard prescriptions.
Protocol Implementation: Derek's Framework, UK Execution
Here's how you'd implement a MPMD-style protocol in the UK:
Month 1:
- Consult with a UK private TRT clinic (Optimale or Balance My Hormones, roughly £200-300)
- Full baseline bloodwork through Medichecks (£70-100)
- Start 100mg testosterone enanthate weekly (divided into two 50mg injections if preferred, though weekly is standard)
Week 4-6:
- Repeat bloodwork (trough sample, pre-injection)
- Clinic adjustment based on results
- If total testosterone 20-28 nmol/L and you feel good: maintain dose
- If below 20 nmol/L: increase to 120-140mg weekly
- If above 28 nmol/L and experiencing side effects: reduce dose
Months 2-3:
- Continue same protocol
- Monthly bloodwork isn't necessary; typical interval is 6-8 weeks
- Assess symptoms: energy, mood, sexual function, joint pain, acne, hair loss
Month 3+:
- Stable state; bloodwork every 12 weeks
- Annual comprehensive health panel (bloods, blood pressure, cardiovascular markers)
- Adjust dose only if symptoms indicate need
Cost: Roughly £300 for clinic setup, then £150-200/month for medication, £60/month for periodic bloodwork. Total first year roughly £2500-3000; ongoing £2400-3000 annually.
Derek's Red Flags: What He Gets Right
MPMD is notably cautious about several things worth noting:
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Very high doses: Derek doesn't endorse the 300-500mg/week protocols common in underground communities. His philosophy is minimal effective dose. This reduces side effects and long-term health risks.
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Aromatase inhibitors as defaults: Rather than jumping to AIs, he recommends dose reduction and monitoring first. This is sound clinical thinking.
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Fertility: If you care about maintaining fertility during TRT, Derek discusses this directly. TRT suppresses LH/FSH, which can impact sperm production. If this matters to you, discuss with your clinic — some options exist (HCG concurrent with TRT, though this complicates the protocol).
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Individual response: Derek emphasises repeatedly that people respond differently to TRT. Your dose might be 120mg weekly; someone similar to you might need 150mg. Bloodwork reveals individual response; protocol should adjust to individual, not average.
Where Derek's US-Centrism Shows
A few things to note:
- Cost assumptions: Derek rarely discusses cost, probably because US insurance makes TRT accessible cheaply. UK private TRT is expensive. This is a real consideration.
- Pharmaceutical pricing: He mentions specific medications cheaply available in the US. UK equivalents often cost more. Budget accordingly.
- Provider relationships: Derek's US audience can shop around extensively; UK options are more limited.
The Honest Comparison
If you've watched More Plates More Dates and want to implement his philosophy in the UK, here's what translates:
- His core principles (start low, monitor, adjust) are directly applicable
- His dosing recommendations (100-150mg starting) translate with unit conversion
- His bloodwork emphasis is essential and matches UK clinical best practice
- His supplement and lifestyle recommendations are entirely portable
What changes:
- Compounds: enanthate instead of cypionate (interchangeable)
- Clinics: Optimale/Balance My Hormones instead of US telehealth
- Cost: significantly higher in the UK
- Access: less flexibility, more structured
Bottom line: Derek's TRT philosophy is evidence-based and cautious. Follow his principles through a UK clinic, and you'll have a solid protocol. The implementation details differ from his US recommendations, but the underlying logic is identical.
Recommended Resources
UK TRT Clinics:
Bloodwork:
Further Reading:
About the Author
Seb writes about evidence-based TRT and testosterone optimisation at Male Optimal. He's reviewed Derek's content extensively and appreciates his emphasis on individual response and frequent monitoring — an approach that translates well to UK clinical contexts.