A physician-led reading room for patients in Jupiter and Palm Beach County. Every guide here separates what the evidence supports from what it does not, names the guidelines behind the recommendations, and links back to the clinical guidance on this site. It is education, not a diagnosis — care decisions are made by a physician after an evaluation.
Two ways in, depending on how much you want to read.
Each volume is a full course on one subject — diagnosis, options, evidence, risks, and monitoring, in order. Read it when you are deciding whether to start treatment at all.
Six rooms below collect every page and article on this site for a subject, alongside the guidelines and trials they draw on. Go here when you have one specific question.
Nothing here is a prescription or a protocol. Bring what you read to a consultation, where labs and history decide what is appropriate for you.
Long-form, interactive patient guides. Five of the six are published; Volume 3 is in production, and its topic room below is already complete.
Thirteen chapters on how low testosterone is actually diagnosed, who is and is not a candidate, the formulations in use, what happens to fertility, and what TRAVERSE and the 2025 FDA label changes did and did not settle. Includes the reasoning behind monitoring hematocrit, estradiol, and PSA.
Thirteen chapters on the language (HT, HRT, BHRT), why perimenopause is its own phase, what estrogen and progesterone each actually do, the timing window for benefit, how to read the Women's Health Initiative honestly, where "bioidentical" is a formulation and not a safety claim, and why testosterone in women is a separate and narrower discussion.
How GLP-1 and dual GLP-1/GIP medicines work, what the STEP and SURMOUNT trials measured, why muscle preservation belongs in the plan from week one, what changed when the shortage lists closed, and which compounds are approved versus investigational.
Eleven chapters on what the label actually covers, why PRP is not a stem-cell product, the federal framework patients need (361 vs. 351 and the same-surgical-procedure exception), what Florida's 2025 stem-cell law permits and what it makes a felony, the consent and advertising it requires, and the orthopedic evidence without the brochure.
Twelve chapters that treat each peptide as its own medicine rather than a category: the three regulatory buckets, what the July 2026 FDA advisory vote did and did not do, sermorelin and ipamorelin without the marketing, tesamorelin's actual indication, the thin human evidence behind BPC-157 and TB-500, and why an athlete should read chapter 11 before injecting anything.
Twelve chapters for men who want a physician-led plan rather than a gas-station pill: the causes worth naming out loud, what a fair trial of a PDE5 inhibitor actually looks like, where compounded sublingual options and off-label PT-141 fit, why low testosterone and ED are not the same disease, the nitrate rule that is not fine print, and what this clinic refers to urology instead of improvising.
Each room opens with a plain-language overview, then lists the NovaGenix pages and articles on that subject followed by the outside guidelines and trials behind them. Use the search box or the filter chips above to narrow the whole page.
Low testosterone is a clinical diagnosis, not a single number. It requires symptoms that fit — low libido, loss of morning erections, fatigue that sleep does not fix, falling strength or mood — and at least two morning blood draws that come back low. The AUA's 300 ng/dL threshold is a decision point for discussion, not a switch. Plenty of men below it feel fine, and some men above it have a real problem worth investigating.
Before any prescription, two conversations matter. The first is why the level is low: sleep apnea, opioids, obesity, thyroid disease, and pituitary problems all cause it, and some are reversible. The second is fertility. Exogenous testosterone suppresses the body's own production and sperm output, so if you may want children, that has to be settled before the first injection, not after.
On safety, TRAVERSE found testosterone noninferior to placebo for major cardiac events in men with hypogonadism and cardiovascular risk — reassuring, but not the same as risk-free. The same trial and the 2025 FDA label changes flagged atrial fibrillation, pulmonary embolism, and blood-pressure increases. That is why monitoring is part of treatment, not an upsell.
Physician-led, self-pay, Florida telehealth for eligible patients. NovaGenix uses injectable, topical, and oral testosterone along with hCG, enclomiphene, and clomiphene where appropriate — and does not offer pellets, patches, nasal, or buccal testosterone.
Perimenopause and menopause are not the same thing. Perimenopause is the years of fluctuating — not simply falling — hormones before the final period, and it is often when symptoms are worst and testing is least useful, because a single estradiol level on a swinging curve tells you very little. Menopause is diagnosed retrospectively, twelve months after the last period.
On treatment, The Menopause Society's 2022 position statement is the clearest anchor: hormone therapy remains the most effective treatment for vasomotor symptoms and for the genitourinary syndrome of menopause, and for women under 60 or within ten years of menopause onset who have no contraindications, the benefit-risk profile is favorable. That is a real statement about symptom relief in a defined group — it is not a claim that hormone therapy prevents heart disease or reduces breast-cancer risk.
Two practical points. If you have a uterus and take systemic estrogen, you need adequate progesterone to protect the endometrium; that is not optional. And "bioidentical" describes a molecule's structure, not its safety record — compounded bioidentical preparations are not automatically safer than FDA-approved ones, and ACOG has said so directly.
Evaluation includes a comprehensive panel — CBC, CMP, free and total testosterone, estradiol, TSH, and progesterone, with FSH, IGF-1, and cortisol added when the history calls for it.
GLP-1 and dual GLP-1/GIP medicines changed what medical weight loss can accomplish. In the STEP and SURMOUNT trials, semaglutide and tirzepatide produced average weight reductions far beyond anything earlier drugs managed. That is a genuine advance. It is also, on its own, not a program.
Two things decide whether the result lasts. The first is body composition: rapid weight loss takes lean mass along with fat unless protein intake and resistance training are deliberately built into the plan, and that matters more, not less, as you get older. The second is what happens after. These are treatments for a chronic condition, and stopping usually means regain — so the conversation about duration belongs at the start, not at month nine.
A note on what is and is not available. Approved products are prescribed as approved products. Compounded versions occupied a gap during the shortage years, and the closing of the shortage lists changed the rules around them. Retatrutide, which patients now ask about constantly, is investigational — it is in trials, it is not an approved medicine you can obtain at a clinic, and any clinic implying otherwise is telling you something untrue.
Physician evaluation with labs first. Evaluation does not guarantee a prescription, and a medicine is one component of a plan that includes nutrition, training, and follow-up.
"Regenerative medicine" is a broad label covering very different things with very different evidence behind them. At one end sit procedures using your own blood or tissue, such as platelet-rich plasma, where there are real randomized trials — with mixed results that vary a great deal by condition, by preparation method, and by how the outcome was measured. At the other end sit commercial stem-cell and exosome products marketed for joints, aging, and almost anything else, where the FDA has issued repeated consumer warnings about unapproved products and documented harm.
The honest summary is that this field is evolving and genuinely contested. The AAOS and other orthopedic groups describe orthobiologics as promising but not yet standard care for most indications, and professional societies have advised against using them in place of established treatments. That is a reasonable position, not a pessimistic one.
Florida law changed here in 2025. CS/CS/SB 1768, now Chapter 2025-185, sets out which stem-cell treatments a Florida physician may offer, the informed consent and advertising disclosures required, and penalties for operating outside it. It is worth knowing that the state law does not displace federal law — the FDA's framework for human cells and tissues still applies on top of it.
What that means for a patient: before considering any regenerative procedure, ask what the specific product is, whether it is FDA-approved for your indication, what the evidence is for your condition rather than the field in general, and what the standard alternative would be. A clinic that cannot answer those four questions plainly is not the place to start.
Discussed cautiously and case by case. NovaGenix does not promise joint regeneration or reversal of degenerative disease.
"Peptides" is a chemical category, not a treatment. It covers FDA-approved prescription drugs, compounds available only through compounding pharmacies, and substances sold online with no medical oversight at all. Lumping them together is how patients end up injecting something with no safety data because a podcast made it sound like a supplement.
The distinction that matters is regulatory. Tesamorelin, for example, is an approved drug — approved specifically for excess abdominal fat in HIV-associated lipodystrophy. It is not a general weight-loss medication and it is not growth hormone, whatever the marketing around it says. Others, including BPC-157 and TB-500, are not FDA-approved for any indication; the FDA has raised concerns about impurities, immune reactions, and gaps in safety data for a number of compounded injectable peptides, and the agency's compounding advisory process has been actively reviewing this category through 2026.
NovaGenix discusses peptides when they are clinically appropriate, after an evaluation, and with the approved-versus-compounded distinction stated out loud. Evaluation does not guarantee a prescription. And NAD+, which appears on nearly every peptide menu in the country including conversations here, is not a peptide at all — it is listed because patients ask about it.
Considered case by case. No peptide here is presented as an anti-aging treatment or a substitute for a diagnosis.
The single most useful thing to understand about erectile dysfunction is that it is often a vascular symptom before it is a sexual one. Erections depend on healthy blood vessels and endothelial function, and the arteries involved are small — which means they tend to show trouble earlier than the coronary arteries do. New ED in a man in his forties or fifties is a reason to check blood pressure, lipids, and glucose, not just to write a prescription. The AUA guideline treats that evaluation as part of ED care, not as an optional extra.
The second thing worth separating is desire from function. Low libido and difficulty with erections are different complaints with different causes, and they frequently travel together in ways that confuse the picture. Low testosterone can drive the first and contribute to the second, but testosterone is not a first-line treatment for erectile dysfunction in a man whose levels are normal — and a great many men with ED have perfectly normal levels. Antidepressants, blood-pressure medications, alcohol, sleep apnea, prostate surgery, and anxiety all belong in the same conversation.
On treatment: PDE5 inhibitors such as sildenafil and tadalafil are well studied and effective for most men, but they are genuinely contraindicated with nitrates and need care alongside some blood-pressure drugs — which is exactly why they are prescription medicines. That is also why the "male enhancement" supplement aisle is a real hazard rather than a harmless one. The FDA has issued a long and continuing series of notifications about these products containing undeclared sildenafil or tadalafil, in unknown doses, sold to men who may be taking nitrates and have no idea what they just swallowed.
Physician evaluation first, including the cardiovascular and medication review. Evaluation does not guarantee a prescription.
The same references as above, cut a different way — by what kind of source it is. Society guidelines first, then landmark trials, then regulators, then the institutes worth bookmarking. All open in a new tab.
You should compare. When you do, the questions that separate practices are whether a physician is actually involved in your care, which labs are drawn and how often they are repeated, whether fertility is discussed before testosterone is prescribed, and what ongoing monitoring is included rather than billed later. A second opinion from a local urologist or endocrinologist is also a reasonable step.
The interactive editions carry the full citation lists. The PDF is provided for printing and for patients who prefer to read offline.
Testosterone replacement therapy, 13 chapters, with a searchable table of contents and print-to-PDF.
OpenWomen's hormone replacement therapy, 13 chapters, with the same searchable contents and print-to-PDF.
OpenRegenerative medicine in Florida, 11 chapters, including the 2025 state statute and the federal framework.
OpenPeptide therapy, 12 chapters, one peptide at a time with its regulatory status attached.
OpenErectile dysfunction, 12 chapters, including the nitrate rule and what gets referred to urology.
OpenThe original Patient Education Series Volume 1, formatted for printing.
Download PDFThe HIPAA intake form, and the practice's patient forms page.
Intake form Patient formsWho reviews this material and how care is structured.
Dr. Timothy Mackey, D.O. About NovaGenixShort answers, with a link to the longer one.
The AUA uses 300 ng/dL total testosterone as a reference point for discussion, confirmed on two separate morning blood draws. But the number alone does not make the diagnosis — symptoms have to fit, and free testosterone, SHBG, LH, and FSH often matter as much as the total. A man at 320 with clear symptoms and a man at 280 with none are different conversations.
Yes. Exogenous testosterone suppresses the signals that drive your own testosterone and sperm production, and for many men sperm counts fall substantially. In most cases this reverses after stopping, but not always and not quickly. If you may want children, say so before your first prescription — there are approaches using hCG or SERMs such as enclomiphene that are designed around that goal.
The TRAVERSE trial found testosterone noninferior to placebo for major adverse cardiac events in men with hypogonadism and elevated cardiovascular risk. That is meaningful reassurance on the central question. It is not a clean bill of health: the trial and the 2025 FDA labeling changes flagged atrial fibrillation, pulmonary embolism, and increases in blood pressure. This is why blood pressure and bloodwork are followed on treatment.
Testosterone is not a weight-loss drug and should not be prescribed as one. In men who are genuinely hypogonadal, treatment tends to shift body composition — more lean mass, somewhat less fat mass — often with little change on the scale. If weight is the primary concern, that is a separate evaluation with different tools.
Generally, no — not in the way the packaging implies. Supplement blends are not equivalent to prescription testosterone therapy, they are not held to the same manufacturing standards, and the evidence for meaningful changes in testosterone levels is thin. Correcting a real vitamin D or zinc deficiency is a different matter, and that requires testing.
Usually by the pattern, not the lab. Perimenopause is marked by changing cycle length, new sleep disruption, hot flashes or night sweats, and mood or cognitive changes while periods are still happening. Hormone levels fluctuate so widely during this phase that a single draw is often uninformative — which is why history carries most of the weight in the diagnosis.
"Bioidentical" describes molecules structurally identical to the ones the body makes. It is a description of chemistry, not a safety claim — and many FDA-approved hormone products are themselves bioidentical. Compounded bioidentical preparations are not held to the same approval standards, and ACOG has advised against assuming they are safer or more effective.
The Menopause Society's 2022 position is that hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause, and that for women under 60 or within ten years of menopause onset without contraindications, the benefit-risk profile is favorable. Outside that window, or with certain histories, the calculation changes — which is what the evaluation is for.
Obesity behaves like a chronic condition, and for most people stopping the medication is followed by regain. Some patients taper successfully with substantial changes to nutrition, training, and sleep in place; many do not. The useful framing is to ask at the outset what the plan is for year two, not to treat the question as something to deal with later.
Some lean mass loss accompanies almost any significant weight loss. How much depends heavily on protein intake, resistance training, and the rate of loss — which is why those are part of the program rather than optional extras. This matters most for older patients, where lean mass is already declining.
No. Retatrutide is investigational — it is still in clinical trials and is not an approved medication available by prescription. Trial results so far have drawn a lot of attention, and that attention has produced a market of unregulated online sellers. A clinic that offers it as a treatment is not describing an approved product.
Some are, most of the ones patients ask about are not. Tesamorelin is an approved drug with a specific indication — excess abdominal fat in HIV-associated lipodystrophy — and is not a general weight-loss or anti-aging treatment. Compounds such as BPC-157 and TB-500 are not FDA-approved for any indication, and the FDA has raised concerns about impurities, immune reactions, and missing safety data in this category.
The evidence is evolving and contested, and it varies a great deal by condition and by what is actually being injected. The FDA has issued repeated warnings about unapproved stem-cell and exosome products marketed direct to consumers, including reports of serious harm. Before considering any such procedure, ask what the product is, whether it is approved for your indication, and what the standard treatment would be.
It can be, and that is the reason ED deserves an evaluation rather than just a prescription. Erections depend on healthy blood vessels, and the arteries involved are small enough to show trouble before the coronary arteries do — so new ED, particularly in a man in his forties or fifties, is a reasonable prompt to check blood pressure, lipids, and blood sugar. Diabetes, sleep apnea, several common medications, and anxiety are also frequent contributors.
Sometimes, but it is not a general treatment for ED. Testosterone is most relevant when levels are genuinely low and the dominant complaint is low desire; many men with erectile difficulty have normal testosterone, and treating them with it will not address the vascular or medication-related cause. Desire and function are separate problems that often occur together — sorting out which one you actually have is most of the evaluation.
Frequently not. The FDA maintains a running list of these products found to contain undeclared sildenafil or tadalafil — the same active ingredients as prescription ED medications, in unknown amounts, sold without the warnings that come with them. The danger is specific: those drugs are contraindicated with nitrates, and a man taking nitroglycerin for chest pain has no way of knowing a supplement contains them.
NovaGenix is self-pay and does not bill insurance; payment options are discussed during the consultation. The sequence is a free phone consultation, then physician evaluation with labs through Labcorp, then — if treatment is appropriate — medication with scheduled follow-up. Telehealth is available for eligible Florida patients. Evaluation does not guarantee a prescription.
Reading is where good care starts, not where it ends. A consultation costs nothing and does not commit you to treatment — and an evaluation does not guarantee a prescription.
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Medical disclaimer This library is educational and is not medical advice, a diagnosis, or a treatment recommendation for any individual. It does not create a physician–patient relationship. Nothing here should be used to start, stop, or adjust a medication on your own. Treatment decisions at NovaGenix are made by Timothy Mackey, D.O. after evaluation, and evaluation does not guarantee a prescription. Read the full medical disclaimer.