Why we published this
Most direct-to-consumer telehealth companies don't publish outcomes. They have reasons — internal data is messy, denominators are awkward, regulatory scrutiny is real. But the absence of data is itself a signal: if a company hasn't told you what works, the most likely explanation is that they don't measure it, or what they measure doesn't look good.
We measure. Every patient gets bloodwork at week 0, week 8, week 16, week 24, and quarterly thereafter. That's the dataset.
Cohort
1,247 men who started a Dominant testosterone protocol between October 2024 and April 2026. Median age 41. Median baseline Total T 312 ng/dL. Median baseline Free T 8.4 ng/dL. Symptom load (validated ADAM/AMS questionnaires): moderate to severe in 89%.
| Protocol | n | % of cohort |
|---|---|---|
| FORGE (injection) | 512 | 41% |
| EMBER (cream) | 289 | 23% |
| SPARK (enclomiphene) | 261 | 21% |
| HYBRID (enclo + cream) | 185 | 15% |
Bloodwork outcomes at week 16
| Protocol | Median ΔTotal T | Median ΔFree T | % in optimal range |
|---|---|---|---|
| FORGE | +672 ng/dL | +14.2 ng/dL | 91% |
| EMBER | +412 ng/dL | +9.6 ng/dL | 78% |
| SPARK | +218 ng/dL | +4.8 ng/dL | 64% |
| HYBRID | +498 ng/dL | +11.1 ng/dL | 87% |
Read these honestly. FORGE produces the highest absolute lift; SPARK produces the smallest. That doesn't make SPARK worse — it makes it different. SPARK patients self-select for lower-baseline-T, fertility-preserving goals; their lift is smaller because their starting point is closer to normal and their goal is to get into range, not to maximize.
Symptom resolution
Validated ADAM questionnaire scores at week 16 vs week 0:
- Energy: 87% reported meaningful improvement
- Libido: 79% reported meaningful improvement
- Mood / mental clarity: 84%
- Sleep quality: 71%
- Strength / training capacity: 88%
- Body composition (self-reported): 76%
Adverse events
Out of 1,247 patients across 18 months:
| Event | n | Rate |
|---|---|---|
| Hematocrit >52% requiring intervention | 74 | 5.9% |
| E2 elevation requiring management | 112 | 9.0% |
| BP elevation requiring intervention | 43 | 3.4% |
| PSA velocity warranting urology referral | 11 | 0.9% |
| Acne/skin events (mild–moderate) | 67 | 5.4% |
| Injection site reactions | 38 | 7.4% of FORGE |
| Skin transfer events (cream) | 4 | 1.4% of EMBER |
| Major adverse cardiac event | 0 | 0% |
| Treatment discontinuation due to AE | 29 | 2.3% |
Retention
Of patients reaching week 24, 91% remained on protocol at month 12. Of those, 88% remained at month 18. Discontinuation reasons: 31% completed family planning and stopped intentionally, 24% cost, 18% switched protocols, 14% adverse events, 13% other.
91% week-24 retention is high for any chronic therapy. It's almost double the published retention for compounded TRT in retail-pharmacy contexts.— Dominant clinical team analysis, internal
Fertility outcomes
Among SPARK and HYBRID patients (n=446) with paired sperm analyses:
- Median sperm concentration at week 0: 38 M/mL
- Median sperm concentration at week 24: 51 M/mL (+34%)
- LH and FSH preserved or elevated in 96% of patients
Methodological notes and limits
This is internal data, not a randomized trial. Selection effects exist: patients self-selected protocols, and those who stayed long enough to be measured at month 18 are by definition the patients for whom the protocol worked. We don't pretend otherwise.
What this data does establish: among men who completed a Dominant protocol with proper monitoring, the safety profile matches published TRT literature, the efficacy matches or exceeds it, and adherence is materially better than retail-pharmacy benchmarks.
What we'll publish next
- 24-month outcomes (early 2027)
- Sub-group analysis by age band
- SPARK long-term fertility tracking
- Combined testosterone + sexual-health protocol outcomes
You can read the full anonymized dataset on request. We are unusually willing.