Baseline screening
Hormones, IGF-1, insulin, immune phenotyping and epigenetic clocks, delivered encrypted to your wallet.
HelixCare Clinics · Rx Protocols
Three protocols. One biology.
Thymic renewal, male hormone optimization and female hormone optimization. Each runs on its own, and each is built to combine safely with the others (by sex) and with the Mitochondrial Renewal peptide protocol.
How the protocols fit together
Standalone by design, stackable by sex.
The thymic protocol is for everyone. Hormone optimization is prescribed by sex, so a stack uses one hormone protocol at most. When protocols are combined, a HelixCare clinician staggers the start dates and merges the lab schedule, and the interactions below are checked before anything is prescribed.
| Protocol | Thymic Renewal | Male HOT | Female HOT | Mitochondrial (peptides) |
|---|---|---|---|---|
| Thymic & Immune Renewal | — | Combine | Combine | Combine |
| Male Hormone Optimization | Combine | — | Not applicable | Combine |
| Female Hormone Optimization | Combine | Not applicable | — | Combine |
HOT = hormone optimization therapy. The Mitochondrial Renewal Protocol (MOTS-c × SS-31) is described on the peptides page
Stack builder
See a combined week before your consult.
Choose a sex and the protocols you're interested in. The builder merges the weekly schedule and the lab panel, and lists every interaction your clinician will review. It's a planning tool: your prescriber sets the actual doses.
Example week
Starting sequence
Combined lab panel
Interactions your clinician will check
Protocol 01 · Men and women
Thymic & Immune Renewal
A 12-month protocol that aims to regrow thymus tissue and restore younger immune profiles. It's modeled on the TRIIM pilot trial1, with one deliberate change: a GLP-1 medication replaces metformin. SGLT2 inhibitors are deliberately left out.
Evidence status
Early human data. The original TRIIM regimen was a 9-person, uncontrolled 12-month pilot in men aged 51–65. Our GLP-1 modification hasn't been tested in a trial. HelixCare offers it only as a monitored protocol, with results tracked in MyHelix.
Growth hormone for this purpose is off-label and requires physician supervision and cancer-risk screening.
What TRIIM found
After 12 months, 7 of 9 men showed more functional thymus tissue on MRI. Immune markers moved in a younger direction, and four epigenetic clocks read an average of about 2.5 years younger than expected, with GrimAge's gain persisting 6 months after treatment stopped1.
The "IM" in TRIIM stands for insulin mitigation. Growth hormone raises insulin resistance, and metformin and DHEA were there to limit that. They weren't the anti-aging agents.
Why we changed it
- GLP-1 medication instead of metformin. It lowers insulin more strongly. In a randomized trial, semaglutide also slowed several epigenetic clocks, though only in people with HIV-associated fat redistribution4. Metformin also blunts muscle growth and mitochondrial gains from exercise in older adults2,3, which works against growth hormone's anabolic aim.
- No SGLT2 inhibitor. Growth hormone directly promotes ketone production in people taking empagliflozin5. Combined with GLP-1 appetite loss, that raises the risk of ketoacidosis at normal blood sugar, which normal glucose readings can hide.
Components
| Component | Clinician framework | Role |
|---|---|---|
| rhGH (somatropin) | TRIIM start: 0.015 mg/kg SC, 3–4 nights a week at bedtime. Adjusted from week 4.Titrated to raise IGF-1 toward the upper end of the age range while keeping fasting insulin low. | Thymus regeneration signal |
| DHEA | Men: 50 mg daily from week 2 (TRIIM).Women: often lower, around 25 mg, with androgen monitoring. Reduced or omitted if on testosterone. | Insulin mitigation, adrenal androgen support |
| GLP-1 medication | Semaglutide from 0.25 mg weekly, or tirzepatide from 2.5 mg weekly, started around week 3 and escalated per label.The goal is controlling fasting insulin, not maximum weight loss, so the lowest effective dose is kept. | Replaces metformin |
| Vitamin D3 | 3,000 IU daily (TRIIM) | Immune support |
| Zinc + copper | 50 mg elemental zinc daily (TRIIM), plus 1–2 mg copperCopper is our addition: long-term high-dose zinc can cause copper deficiency. | Thymic function co-factor |
| Metformin | Removed | Replaced by the GLP-1 medication |
| SGLT2 inhibitor | Not used | Ketoacidosis risk with growth hormone |
12-month schedule
rhGH3–4 nights / week
DHEA · D3 · zincDaily
GLP-1 medicationWeekly
Labs & reviewMonths 2, 3, 4, 6, 9
Full panel (baseline, month 12)Dose-adjustment labsFollow-up clocks 6 months after stopping
What we measure
- IGF-1, fasting insulin and glucose, HbA1c, HOMA-IR
- Recent thymic emigrants (CD31+ naive CD4 T cells), naive/memory ratios, TREC, lymphocyte-to-monocyte ratio
- Epigenetic clocks: GrimAge, PhenoAge, DunedinPACE
- DXA lean mass and grip strength
- CMP, eGFR, lipids and ApoB, CBC; PSA in men
Watch for
- Swelling, joint pain or carpal tunnel symptoms (growth hormone)
- Nausea, reduced appetite, gallbladder pain (GLP-1)
- Lean mass loss on DXA: protein intake and resistance training are part of the protocol
- Thymus MRI fat fraction alone can mislead, because GLP-1 fat loss changes it too. Immune markers confirm real regrowth.
Not for you if
- Active cancer, or a high personal or family cancer risk
- Personal or family history of medullary thyroid cancer or MEN2
- History of pancreatitis
- Proliferative diabetic retinopathy
- Pregnancy, or trying to conceive
Protocol 02 · Men
Male Hormone Optimization
Traditional testosterone replacement by injection, with hCG to keep the testes working and anastrozole available only when estradiol runs high. Everything is dosed to lab results and symptoms, not to a fixed number.
Who qualifies. Testosterone is prescribed when symptoms match and a morning fasting total testosterone is clearly low on two separate tests6. It isn't prescribed for aging alone. If you plan to have children soon, tell your clinician first: testosterone suppresses sperm production.
Components
| Component | Clinician framework | Role |
|---|---|---|
| Testosterone cypionate or enanthate | Typically 100–200 mg a week in total, split into two IM or SC injections (for example, Monday and Thursday).Dosed to a mid-normal level measured midway between injections6. Splitting doses smooths peaks and troughs. | Restores testosterone |
| hCG | 250–500 IU SC, 2–3 times a week.In one study, 500 IU every other day alongside testosterone preserved sperm production8. Since 2020 hCG is a biologic in the US and can't be compounded, so branded products are dispensed9. | Maintains testicular function and fertility |
| Anastrozole | Only if needed: 0.25–0.5 mg once or twice a week, when sensitive estradiol is high and symptoms such as breast tenderness or fluid retention appear.Not given routinely. Estradiol protects bone and helps control body fat and libido in men10, so over-suppressing it causes harm. Off-label in men. | Controls excess estradiol |
First-year schedule
Testosterone2 injections / week
hCG2–3 times / week
AnastrozoleOnly if needed
Labs & reviewThen every 6–12 months
Full panelFollow-up labs (weeks 6–8 shown at month 2)
What we measure
Stop and review if
- Hematocrit rises above 54%: pause until it falls6
- PSA rises more than 1.4 ng/mL within 12 months: urology referral6
- New breathing pauses in sleep, leg swelling, or an irregular heartbeat. TRAVERSE saw more atrial fibrillation, kidney injury and pulmonary embolism with testosterone7.
- Estradiol falling low on anastrozole: joint pain, low libido, low mood
Not for you if
- Prostate or breast cancer
- A prostate nodule or raised PSA not yet assessed by urology
- Hematocrit already above 50%, or untreated severe sleep apnea
- Heart attack or stroke in the past 6 months, or uncontrolled heart failure
- A clotting disorder
Protocol 03 · Women
Female Hormone Optimization
Built on the best-supported approach to menopause hormone therapy: estradiol through the skin, micronized progesterone to protect the uterus, local vaginal estrogen for genitourinary symptoms, and testosterone only for low sexual desire, dosed to premenopausal levels.
What it treats, and what it doesn't. Hot flashes, night sweats, sleep disruption, vaginal dryness and bone loss respond well. Hormone therapy isn't recommended solely to prevent chronic disease. The large WHI trial found higher risks with the older oral regimen of conjugated estrogens plus medroxyprogesterone12, which is why this protocol uses transdermal estradiol and micronized progesterone.
Components
| Component | Clinician framework | Role |
|---|---|---|
| Estradiol, transdermal | Patch 0.025–0.1 mg/day, changed once or twice weekly, or an estradiol gel or spray. Start low and adjust to symptoms.Transdermal is preferred: it avoids the liver's first-pass effect and is associated with lower clot risk than oral estrogen11. | Relieves symptoms, protects bone |
| Micronized progesterone | If you have a uterus: 100 mg nightly (continuous), or 200 mg nightly for 12 days a month (cyclic, often used in perimenopause).Protects the uterine lining from estrogen. Taken at bedtime, since it can be sedating. | Endometrial protection, sleep |
| Vaginal estradiol or prasterone | Low-dose estradiol insert or cream twice weekly, or vaginal prasterone (DHEA) nightly.Can be used alone or alongside systemic therapy. | Genitourinary syndrome of menopause |
| Testosterone, transdermal | Only for low sexual desire causing distress (HSDD), after assessment. Dosed to the premenopausal range.Check levels at baseline and 3–6 weeks. Stop if there's no benefit by 6 months14. No female-specific product is approved in the US, so use is off-label. | Libido |
First-year schedule
Estradiol patch/gelContinuous
ProgesteroneIf uterus present
Vaginal estrogenIf needed
TestosteroneOnly for HSDD
ReviewsThen yearly
Full reviewSymptom review · testosterone level at 3–6 weeks (month 1) if prescribed · 6-month testosterone decision
What we measure
- Symptom scores: that's how estradiol is dosed, not blood levels
- Blood pressure, lipids and ApoB, fasting glucose
- Mammography on schedule; DXA bone density
- Total testosterone and SHBG if testosterone is used
- Estradiol level only if symptoms persist, to check absorption
Contact your clinician if
- Any unexpected vaginal bleeding: it needs endometrial evaluation
- Leg pain or swelling, chest pain, or sudden shortness of breath
- A new breast lump
- Acne, scalp hair loss or a deeper voice on testosterone
Not for you if
- Breast cancer, or another estrogen-dependent cancer
- Unexplained vaginal bleeding
- A past blood clot, stroke or heart attack
- Active liver disease
- Starting more than 10 years after menopause or over 60 needs an individual risk review
Next steps
Every protocol starts with a blood draw.
Your baseline panel, genome and medications live in MyHelix, and you share them with a HelixCare clinician for your consult. Nothing is prescribed without them.
HelixCare consult
A licensed clinician reviews your stack, checks the interactions and decides whether each protocol is right for you.
Add mitochondrial renewal
MOTS-c and SS-31 pair with any protocol here, especially alongside resistance and zone 2 training.
Evidence
References
- Fahy GM, Brooke RT, Watson JP, et al. Reversal of epigenetic aging and immunosenescent trends in humans. Aging Cell. 2019;18(6):e13028.
- Walton RG, Dungan CM, Long DE, et al. Metformin blunts muscle hypertrophy in response to progressive resistance exercise training in older adults: a randomized, double-blind, placebo-controlled, multicenter trial (MASTERS). Aging Cell. 2019;18(6):e13039.
- Konopka AR, Laurin JL, Schoenberg HM, et al. Metformin inhibits mitochondrial adaptations to aerobic exercise training in older adults. Aging Cell. 2019;18(1):e12880.
- Semaglutide slows epigenetic aging in a randomized trial of HIV-associated lipohypertrophy. Nat Commun. 2026. Trial NCT04019197; epigenetic outcomes were not pre-specified.
- Growth hormone directly favors hepatic ketogenesis in persons with prediabetes or type 2 diabetes mellitus treated with empagliflozin. Endocrine. 2021;73(2):325–330.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.
- Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389(2):107–117.
- Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189(2):647–650.
- U.S. Food and Drug Administration. Transition of human chorionic gonadotropin and other biological products to licensure as biologics, effective March 23, 2020.
- Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. N Engl J Med. 2013;369(11):1011–1022.
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.
- Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–333.
- Hodis HN, Mack WJ, Henderson VW, et al. Vascular effects of early versus late postmenopausal treatment with estradiol (ELITE). N Engl J Med. 2016;374(13):1221–1231.
- Davis SR, Baber R, Panay N, et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.
- Wolthers T, Hoffman DM, Nugent AG, et al. Oral estrogen antagonizes the metabolic actions of growth hormone in growth hormone-deficient women. Am J Physiol Endocrinol Metab. 2001;281(6):E1191–E1196.
- Eli Lilly and Company. ZEPBOUND (tirzepatide) prescribing information: use with oral hormonal contraceptives.
These protocols are clinician frameworks for education and consult preparation, not medical advice or instructions to self-treat. Doses shown are illustrative; a licensed HelixCare Clinics prescriber sets eligibility, doses and monitoring for each person, and may decline any protocol. Growth hormone for immune or anti-aging purposes, DHEA in these regimens, anastrozole in men and testosterone in women are off-label uses. Prescription medications are dispensed only where legally permitted. These medications are prohibited in sanctioned sport. If you have chest pain, sudden shortness of breath, one-sided leg swelling or signs of stroke, call emergency services.