1. Is bloodwork required before treatment?
Non-negotiable for TRT, HRT, peptides. The clinic that prescribes hormones from a questionnaire alone is not practicing medicine, that's the easiest red flag. Reputable clinics require comprehensive labs at intake.
2. Are prescriptions written by a U.S.-licensed physician?
Verify the physician's name and license. They should be licensed in your state. Some clinics rely on nurse practitioners or PAs (which can be appropriate depending on state law and supervision). Others rely on offshore prescribers, a red flag.
3. Are the pharmacy partners U.S.-based and FDA-registered?
U.S. 503A or 503B compounding pharmacies. Or major brand-name pharmaceuticals. Either is fine. Overseas pharmacies, generic "research" suppliers, or unnamed pharmacy partners are red flags.
4. What's the lab monitoring schedule?
For TRT: at minimum month 3, month 6, then annually. For HRT: 8-12 weeks post-start, then annually. For GLP-1s: every 6 months. Clinics that don't have a schedule, or only require initial labs, aren't following standard of care.
5. Can you reach a physician between visits?
Things come up: side effect questions, dose adjustments, lab interpretation. Real clinics have communication channels, secure messaging, scheduled video calls, or both. "Submit a ticket" only is a red flag.
6. Are the right tests being run?
- For men's TRT: total + free testosterone, SHBG, sensitive estradiol assay, full thyroid, hematocrit, lipids, metabolic. Standard E2 assay alone is a red flag.
- For women's HRT: estradiol, progesterone, FSH, LH, AMH, full thyroid, testosterone, DHEA-S
- For peptides: comprehensive markers depending on protocol
7. Are protocols individualized?
Generic "everyone gets 200 mg/week" protocols are a red flag. Individualization, based on labs, age, goals, fertility considerations, is the standard.
Bottom line
Reputable telehealth and prescription-mill telehealth aren't the same product. The questions above separate them clearly. A 10-minute review of any clinic's website usually reveals which category they fall into. The legitimate clinics tell you about labs, physicians, pharmacies, and monitoring on their main pages. The mills bury those details, or don't have them.