Clinical Policy · 2026
How We Decide
The evidence standard, the testing philosophy and the safety rules behind every Sorrell MD recommendation — including what the practice will not prescribe.
Written and reviewed by Luke Sorrell, MD FACP · Board-certified internist · Updated
TL;DR — The Quick Answer
Longevity medicine has a credibility problem, and the practice does not intend to add to it. Every recommendation at Sorrell MD is sorted into one of three evidence tiers and labelled as such to the patient. Testing is baseline for everyone, risk-directed after that, and repeated on a schedule tied to what is being treated. Hormones, peptides and GLP-1 medications are prescribed only with an indication, baseline labs, defined monitoring and a stop rule, and there is a short list of things the practice declines to prescribe at any price.
Three Tiers of Evidence
Not everything offered in longevity medicine rests on the same footing. Sorrell MD sorts interventions into three tiers, tells patients which tier a recommendation belongs to, and stages them in that order: tier one first, tier two when tier one is in place, tier three only case by case.
| Tier | Standard | Examples at Sorrell MD |
|---|---|---|
| 1 · Guideline-based prevention | Recommended by a major specialty society or supported by randomized outcome trials | ApoB and LDL targets with statins or ezetimibe when indicated; blood pressure control; Lp(a) measured once; menopausal hormone therapy for symptomatic women under 60 or within ten years of menopause; testosterone for confirmed hypogonadism; GLP-1 medications for obesity or type 2 diabetes; age-appropriate cancer screening; resistance training and protein targets |
| 2 · Strong but emerging | Consistent human data, consensus support, outcome evidence still maturing | Coronary CT angiography for plaque characterization; multi-cancer early detection blood tests in adults over 50 or with strong family history; low-dose testosterone for women with low libido; hormone metabolite and gut microbiome testing to answer a specific clinical question; biological-age clocks and VO2 max as tracking metrics |
| 3 · Experimental or off-label | Mechanistic plausibility and small or short human studies; not FDA-approved for the use in question | Most peptides; longevity-directed use of drugs approved for other conditions; supplement regimens beyond correcting a measured deficiency. Never part of a standard protocol. Offered only with a specific indication, written consent that states the evidence gap, monitoring and a stop date. |
Testing Philosophy: Baseline, Risk-Directed, Tracking
The 100 to 200-plus biomarkers quoted on this site are not ordered as one undifferentiated block. They fall into three groups with different rules.
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Baseline: ordered for everyone, once
Lipid panel with ApoB; Lp(a) once in a lifetime; fasting glucose, insulin, HOMA-IR and HbA1c; comprehensive metabolic and blood count panels; full thyroid (TSH, free T3, free T4, antibodies when indicated); sex hormones including SHBG; hs-CRP and homocysteine; vitamin D, B12, folate, ferritin, magnesium, zinc and an omega-3 index. Roughly 60 to 80 markers. These find the risks that end lives early and are invisible without testing.
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Risk-directed: ordered when the history or the baseline points to it
Coronary artery calcium score or CT angiography when age, family history, Lp(a) or ApoB raise cardiovascular concern; NMR lipoprotein particle analysis for discordant lipids; hormone metabolite (DUTCH) testing for unexplained hormonal symptoms; SIBO breath testing and Jona microbiome analysis for persistent gut symptoms; polygenic risk scoring; multi-cancer early detection for adults over 50 or with significant family history. Each is ordered to answer a question, and deferred when there is no question to answer.
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Tracking: repeated on a schedule tied to treatment
Six to twelve weeks after any change in hormone or lipid therapy, then at six and twelve months. DEXA body composition, VO2 max and grip strength annually or when training changes. Biological-age testing annually as a trend line, never as a diagnosis. Lp(a) is not repeated; a normal calcium score is not repeated for three to five years.
What is deliberately deferred: imaging in low-risk adults under 40 with no family history, and any test whose result would not change a decision.
Safety Standards for Hormones, Peptides and GLP-1s
| Therapy | Required before prescribing | Monitoring and stop rules |
|---|---|---|
| Testosterone (men) | Symptoms plus low morning total or free testosterone on two occasions; LH, FSH, estradiol, SHBG, hematocrit, PSA and fertility goals reviewed; enclomiphene considered first when fertility matters | Labs at 6–12 weeks then every 6 months; physiologic targets only; dose reduced or paused for hematocrit above the safe threshold, rising PSA, sleep apnea or cardiovascular red flags |
| Estradiol and progesterone (women) | Clinical diagnosis of perimenopause or menopause; breast, cardiovascular, clotting and bleeding history; transdermal estradiol preferred; progesterone always paired with estrogen when a uterus is present | Symptom-driven dosing with safety labs; any unexplained bleeding, new breast finding or clotting event stops therapy pending evaluation; therapy not started with active hormone-sensitive cancer |
| Low-dose testosterone (women) | Persistent low libido after estradiol is optimized; consent that the use is off-label in the U.S. | Doses one-tenth of male dosing; levels kept in the female physiologic range; stopped for androgenic side effects |
| GLP-1 medications | Indication by BMI, metabolic disease or body-composition data; baseline DEXA or equivalent; protein and resistance-training plan agreed in writing; pancreatitis and thyroid cancer history screened | Body composition tracked so muscle loss is caught early; dose held rather than escalated when lean mass falls; a taper and maintenance strategy defined from the start, not after |
| Peptides | A specific indication after tier-one options are in place; written consent naming the evidence gap and regulatory status; sourced only from licensed compounding pharmacies | Defined course length with a stop date; labs where the agent affects glucose, IGF-1 or other measurable pathways; no stacking of multiple agents for general “optimization” |
Not prescribed at Sorrell MD: growth hormone for anti-aging, anabolic steroids, supraphysiologic testosterone, peptides without an indication, or any therapy the patient requests that fails the risk-benefit assessment. When the answer is no, the reasoning is explained and an alternative is offered.
What This Looks Like in Practice
- A patient asking for testosterone with a single borderline reading gets a repeat morning draw, a sleep and training review, and a conversation about enclomiphene before any prescription is written
- A 38-year-old with normal ApoB, a low Lp(a), no family history, no metabolic disease and optimal body composition is told a calcium score would add nothing yet, and is scheduled to revisit it at 45
- A patient on a GLP-1 who loses lean mass on DEXA has the dose held and the protein target raised before the next step up
- A patient bringing a list of six peptides from social media is walked through the evidence for each; together we determine which are actually needed and helpful for their goals, then thoughtfully organize and sequence them, alongside hormones, nutrition and training, so they work together rather than in isolation — a systems-biology approach with monitoring and a defined course for each
- A microbiome test is deferred for someone without gut symptoms, and ordered for someone with bloating, irregular bowels and a negative celiac screen
Frequently Asked Questions
Is peptide therapy at Sorrell MD evidence-based?
Peptides sit in the experimental tier of Sorrell MD's evidence standard. Most are not FDA-approved for the uses people ask about, and the human data ranges from reasonable to thin. They are prescribed only when there is a specific indication, after the guideline-based options have been addressed, with written informed consent that states the evidence gap, sourcing from licensed compounding pharmacies, defined monitoring, and a stop date. Dr. Sorrell holds the Peptavo Peptide Therapy Certification; the certification informs the caution, not the enthusiasm.
Does Sorrell MD over-test?
Every patient gets a baseline panel because the most consequential risks (ApoB, Lp(a), insulin resistance, thyroid, hormone, micronutrient and inflammatory status) are invisible without it. Beyond that, tests are risk-directed: a coronary calcium score or CT angiography, microbiome analysis, hormone metabolite testing, polygenic risk or multi-cancer early detection are ordered when history, symptoms or the baseline results point to them, and deferred when they don't. Repeat testing follows a schedule tied to what is being treated, not a calendar of everything.
How does Sorrell MD decide which tests to order?
Three questions, in order: Will the result change a decision? Is there a guideline, consensus statement or strong trial supporting the test for this person's risk profile? Is it the right time, or would it be more informative after a first intervention? A test that fails the first question is not ordered regardless of how interesting it is.
What will Sorrell MD not prescribe?
Testosterone without confirmed low levels on repeat morning testing plus symptoms, or at doses above the physiologic range. Growth hormone for anti-aging. Anabolic steroids. Hormone therapy in the presence of active hormone-sensitive cancer, unexplained bleeding or an unmanaged clotting history without specialist input. GLP-1 medications without a muscle-preservation and taper plan. Peptides without an indication, informed consent and monitoring. Anything a patient requests that fails the risk-benefit assessment, with the reasoning explained.
How are hormones and GLP-1s monitored?
Baseline labs before any prescription; repeat labs at six to twelve weeks during dose optimization and then at set intervals; symptom review at every monthly visit. For testosterone that includes hematocrit, estradiol and PSA where relevant. For estradiol and progesterone it includes a bleeding history and breast and cardiovascular risk review. For GLP-1s it includes body composition, protein intake and resistance training, and a defined taper strategy rather than indefinite escalation.
What happens if Dr. Sorrell is unavailable?
Sorrell MD is a single-physician practice by design; the same board-certified internist sees every patient at every visit. Patients own their records and can export them at any time, labs are drawn through national laboratories and remain accessible in the patient's own accounts, and prescriptions are filled through the patient's own pharmacy, so nothing is locked inside the practice. Planned absences are communicated in advance with guidance for time-sensitive needs. Sorrell MD is not an emergency service; urgent symptoms are always directed to local emergency care.
Clinical References
- Grundy SM, et al. "2018 AHA/ACC Guideline on the Management of Blood Cholesterol." J Am Coll Cardiol. 2019;73(24):e285-e350. doi.org/10.1016/j.jacc.2018.11.003
- Kronenberg F, et al. "Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement." Eur Heart J. 2022;43(39):3925-3946. doi.org/10.1093/eurheartj/ehac361
- Bhasin S, et al. "Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi.org/10.1210/jc.2018-00229
- The North American Menopause Society. "The 2022 hormone therapy position statement." Menopause. 2022;29(7):767-794. doi.org/10.1097/GME.0000000000002028
- Davis SR, et al. "Global Consensus Position Statement on the Use of Testosterone Therapy for Women." Climacteric. 2019;22(5):429-434. doi.org/10.1080/13697137.2019.1637079
- Schrag D, et al. "Blood-based tests for multicancer early detection (PATHFINDER): a prospective cohort study." Lancet. 2023;402(10409):1251-1260. doi.org/10.1016/S0140-6736(23)01700-2
- U.S. Food and Drug Administration. "Certain Bulk Drug Substances for Use in Compounding That May Present Significant Safety Risks." 2023. fda.gov
Questions About Your Case?
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