Can't make a Tuesday call? View the recorded call and slide deck in the Premium MasterMind Vault A lot of you are building practices around patient schedules, kids, and second jobs, and 4 o’clock on a Tuesday doesn’t always work. So I set up a new section in the Classroom called the Mastermind Vault. Every call gets added there after it ends. Each session includes: - The full call recording - The slide deck we walked through - A folder with the handouts, templates, and resources we referenced This week’s session is already up/ video will be added after the call. We covered lean mass on GLP-1s: what the DEXA data actually shows, what “lean” really measures on a scan, and how to build protein, strength, and re-measurement into intake so nobody has to remember it at a 15-minute follow-up. GLP-1s offer better patient outcomes and better revenue opportunities for practices. If you watch a replay and have a question or a de-identified case, drop it in the comments or bring it to the next live call. The live calls are still the best place to work through your own cases.

Can you actually see estrogen clearance on labs? Partly. And the part you can’t see is where a lot of cases get stuck. The liver’s phase 1 pathway (2-OH vs 4-OH vs 16-OH) shows up on a urine panel like the DUTCH. Serum labs won’t show it. Gut beta-glucuronidase shows up on a stool panel like the GI-MAP or GI Effects. The step in between, where the liver tags estrogen and sends it out in bile, has no direct test. You piece it together from indirect bilirubin, bile flow markers, and the pattern on the urine panel. We’re on the group call today at 4 PM Arizona (3 PM PT / 6 PM ET). What’s your go-to workup when estrogen symptoms don’t match the serum numbers? Drop it below or bring a de-identified case to the call.

The DPC Launch group discussion is tomorrow, Tuesday, November 3, at 4:00 PM Arizona time (3:00 PM Pacific, 6:00 PM Eastern). Daylight saving ended Sunday, so if you're outside Arizona, the call is an hour earlier on your clock than it was last week. This week we're talking lean mass on GLP-1s: what the DXA sub studies actually showed, what "lean mass" really measures, and how to build protein and resistance training into weight loss visits from the start. Drop your questions or a de-identified case in the comments so we can work through it together. We'll go over Sunday's poll answer too. Monday Poll : Which "GLP-1" has the most promising evidence for reduction of inflammatory markers?

Most of us track the scale on our GLP-1 patients. The DXA data says we should be paying just as much attention to what the scale can't see. In the STEP 1 body composition substudy (140 participants on semaglutide 2.4 mg for 68 weeks), mean weight loss was about 15%. When you work through the DXA numbers, roughly 39% of the weight lost was classified as lean mass. That number gets quoted a lot, usually without context. A few things worth sitting with: • DXA "lean mass" includes water, glycogen, and organ tissue, so it likely overstates true skeletal muscle loss. • Fat mass still fell far more than lean mass, and visceral fat dropped by about 27%. • Lean mass as a share of total body mass actually went up. Some lean loss is expected. The clinical questions are how much, in whom, and what you're doing about it from the first visit: protein targets, resistance training, and when you re-measure. Then the SURMOUNT-1 DXA data on tirzepatide came out, and the comparison to placebo surprised a lot of providers. Poll: In the SURMOUNT-1 DXA substudy, how did the share of weight lost as lean mass on tirzepatide compare with placebo? Comment your guess below. The answer and the full protocol (protein targets, training prescription, and a re-measurement schedule) are in the GLP-1 and weight loss module in the Classroom tab Tuesday . We'll dig into this on Tuesday's call at 4 PM Arizona time (3 PM PT, 6 PM ET). Adding A Dexa or body Comp to your Practice?? A cash-pay DEXA scan typically costs between $75 and $390, with a national median price of around $149. Cost Breakdown by Facility Type - University / Research Labs: $40 – $80 (often used for public or promo exercise-science studies) - Independent DEXA & Wellness Clinics: $99 – $195 (standard self-pay pricing, frequently includes basic body-composition reports and consultations) - Longevity / Med-Spa / Concierge Clinics: $175 – $250+ (often bundled with resting metabolic rate [RMR] or VO2 max testing) - Hospital Imaging Departments: $200 – $600+ (generally the most expensive option and usually focused on clinical bone-density orders rather than fitness/body-composition tracking)

Welcome to everyone who just joined. Since a lot of you are in the middle of building right now, let's start with the question I get most: How do I price a membership? Nobody asks their gym to justify $50 a month by counting visits. You pay it whether you go twice or twenty times, and the gym plans its whole business around that predictable base. Direct Primary Care is the same model. We just haven't been trained to think about it that way. The typical ranges look like this: - Gyms: roughly $10 to $60 a month, with premium clubs at $200 or more - DPC adults: roughly $50 to $150 a month (Depending on Services offered, Offering after hours coverage ... rates are MUCH higher. In a prestigious community? Rates are much higher, Offering Telemedicine only? Rates are likely lower) - DPC children: $20 to $49 a month (think sick visits and annual physicals) - DPC families: $350 or more: All inclusive : children typically do not have routine labs etc So a DPC membership usually lands right around what people already pay to work out it's health care, in a preventative scope. The difference is what's behind it: same-week/day access, a provider who answers their texts, wholesale labs and meds, and someone who actually knows their history. Where new practices get stuck is pricing per visit in their heads. If you think "she only came in twice this year," $80 a month feels too high. If you think in panel math, it looks different. **500 members at $80 a month is $40,000 a month in recurring revenue** before a single add-on. The membership pays for access. Utilization is what you manage. A few things that matter more than the exact number: - Price by age tier so families can afford to bring everyone in - Decide what's included before you launch, then protect it - Know your break-even panel size before you set the price What are you charging, or planning to charge, for an adult membership? Drop your number and your town size in the comments. We'll dig into pricing on Tuesday's call at 4 PM Arizona time.