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The Men’s Optimization Protocol at Refine by Tulsi Step 1: Comprehensive labs — full hormone panel (total and free testosterone, estradiol, SHBG, thyroid, cortisol, DHEA-S), metabolic panel (fasting insulin, HbA1c, lipids), inflammatory markers (hs-CRP), IGF-1, and nutrient status Step 2: Testosterone optimization if indicated — restoring levels to the upper physiological range with proper monitoring of estradiol, hematocrit, and PSA Step 3: Targeted peptide layering based on residual symptoms — CJC/Ipamorelin for recovery and body composition, BPC-157 for inflammation and joints, Selank for cognitive support, DSIP for sleep Step 4: Supporting therapies — NAD+ IV therapy for cellular energy, IV nutrient therapy for depleted micronutrients, GLP-1 therapy if metabolic optimization is needed Step 5: Ongoing monitoring through our concierge medicine program — labs every 12 weeks, protocol adjustments based on data and response Real Patient Experiences I’d been on TRT for two years and felt good but not great