The Nico Misleh Podcast

Are your HRT protocols failing even when lab results look normal? What if a patient's high testosterone was actually a sign of deficiency? In episode 45 of The Nico Misleh Podcast, host Nico Misleh reveals the critical lab insights that most clinicians miss. Discover why relying on total testosterone alone can lead to poor patient outcomes and learn how understanding markers like free testosterone, SHBG, and ferritin can solve the most complex cases, from mysterious fatigue and low libido to hormone induced psychosis. Nico shares powerful patient stories that show why mastering lab interpretation is essential for clinical confidence and exceptional results.Ready to stop guessing and start mastering hormone optimization? Gain the confidence to handle any patient case by enrolling in The HRT Master Course. This is your path to becoming the go to expert your patients deserve. Sign up now: https://hrtuniversity.com/hrtcourse/⁠For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠⁠ (yes, it's daily... and yes, people stay subscribed)- Join HRT University: ⁠https://hrtuniversity.com/⁠- Join the HRT University Facebook Group: ⁠⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr⁠Chapters:0:00 - The Hidden Lab Marker Your Patients Aren't Getting 1:15 - Why Most Doctors Get HRT Labs Wrong 3:37 - Stop Wasting Money on These Useless Tests 7:08 - The GOLD Standard For Hormone Lab Testing 8:04 - Is "No-Lab" HRT A Dangerous Guessing Game? 10:31 - How Objective Labs Create Unbelievable Patient Trust 12:03 - The Single Most Important Testosterone Lab to Check 12:56 - Patient Case: His Testosterone Was 900, But He Felt Terrible 16:12 - SHOCKING Diagnosis: The Real Reason He Had Low T Symptoms 19:13 - The Counterintuitive Fix: Why He Needed MORE Testosterone 24:39 - Patient Case: A Young Woman's Sudden, Terrifying Psychosis 30:47 - The Surprising Lab Result That Solved The Mystery 35:52 - A Miracle Cure? Her Psychosis Vanished in ONE Week 39:34 - The #1 Red Flag You MUST Check In Your Female Patients 42:16 - How to Become the "Go-To" HRT Expert in Your Area 46:36 - Get My Personal Help With Your Toughest Cases

Is your medical license a trap? The healthcare system is forcing dedicated clinicians like you into burnout, making you work for insurance companies instead of your patients. In episode 44 of The Nico Misleh Podcast, host Nico Misleh exposes the broken insurance model and reveals how a cash-based practice is the key to regaining your autonomy. Discover how to escape the golden handcuffs, realign with your values, and practice medicine on your own terms. This episode provides the blueprint for building a profitable clinic that delivers incredible patient outcomes and restores your passion for healing.Ready to build a practice that gives you freedom and financial control? Mastering a specialty like hormone replacement therapy is your first step toward true autonomy. Learn the clinical and business strategies to create a thriving cash-based service that your patients will value. Begin your journey and explore The HRT Master Course at https://hrtuniversity.com/hrtcourse/⁠For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below:- Nico's Daily Newsletter: ⁠⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠⁠ (yes, it's daily... and yes, people stay subscribed)- Join HRT University: ⁠https://hrtuniversity.com/⁠- Join the HRT University Facebook Group: ⁠⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr⁠Chapters:0:00 - Insurance Is A Business, NOT Healthcare 1:09 - Insurance vs. Cash-Pay: The REAL Battle 2:00 - The #1 Myth About Medical Insurance 3:33 - Does Insurance Approval Mean It's Safe? 4:41 - The Shocking Truth About Birth Control 6:07 - How Insurance Companies Deny Your Care 7:58 - Who Do You REALLY Work For? (It's Not Your Patients) 8:41 - The Golden Handcuffs Trapping Doctors 10:33 - The True Cause of Clinician Burnout 11:34 - Why You Became a Healer in the First Place 13:08 - What a "Cash-Based" Clinic Actually Is 14:04 - How Car Insurance Proves Healthcare is Broken 15:55 - The Secret to Loving Your Job Again 16:55 - Proof: Doctors are Happier in Cash-Pay 17:37 - Make Less Money, Have a Better Life? 19:34 - The Hidden Pain of Working for Insurance 20:23 - When Your Colleagues Attack You 22:50 - Don't Fix a Broken System, Do This Instead 25:31 - How Patients Win in a Cash-Based Model 26:35 - Reclaim the Provider You Were Meant to Be 27:49 - How Insurance KILLED the Art of Medicine 30:30 - Patient Story: Doctor Dismisses Low Testosterone 33:51 - Patient's Life Transformed by TRT 34:34 - Doctor's SHOCKING Offer After Seeing Patient Thrive 37:23 - The Secret to Never Stop Learning 38:16 - This Makes It All Worth It 38:54 - Why Your Job is Like a Bad Relationship 41:06 - The Hidden Dangers in Your Medicine Cabinet 44:13 - Why I LOVE My Cash-Based Clinic 45:01 - A Guide to Mastering HRT 46:03 - Join Our Community of Clinic Owners 47:00 - My FREE Daily Email for Clinicians 47:51 - Exciting News for HRT University

Jillian Martin wears a lot of hats: hospitalist, psych NP, regulatory consultant, emergency psych provider, and now, HRT clinic owner. In this episode, she sits down with Nico to talk about her journey from operational nursing to launching her own hormone clinic, Valen Medical, on Cape Cod.They dive into how Jillian and her husband are building the clinic behind the scenes, when to start paying yourself (and your spouse), and what to do when you’re juggling multiple jobs but want your clinic to take off. The two also explore treating adolescents, the intersection of hormones and mental health, and how TBI history could be affecting your patient’s hormone cascade.This one’s for the multi-passionate provider wondering how to make their HRT clinic sustainable, profitable, and personally fulfilling, without burnout or a social media presence.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In episode 3 of her marketing series, Emily Beal tackles one of the biggest mindset blocks for clinic owners: what to write in your emails, especially when your list is tiny (or nonexistent). She shares a real message from a provider who felt stuck before even getting started, and gives step-by-step advice to help you build writing confidence without using AI or generic templates.You’ll learn why your personal story matters, how to break past perfectionism, and how to make your writing actually feel like you. Whether you’ve written nothing yet or have drafts sitting in Google Docs, this episode is the push you need to finally start hitting “send.”Click here to join Emily's weekly marketing newsletter: https://nicomislenp.kit.com/5bc0d4dd96 NICO LIVE, our ⁠⁠⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! ⁠Get your tickets for NICO LIVE here⁠⁠ 🎟️

In this episode, Nico sits down with Brad Cunningham, founder of Orange Financial and Nico’s go-to guide for all things money. Brad’s not your typical finance guy. He doesn’t wear a three-piece suit, he doesn’t believe in one-size-fits-all advice, and he’s way more interested in transformation than spreadsheets.They talk about debt, building wealth, how your childhood shapes your money mindset, and what most high earners are still getting wrong. Brad also shares the business principles that helped him build a thriving, referral-only firm with zero ads and 1,000+ raving clients, and why that same model applies perfectly to HRT clinic owners who want freedom and sustainability.📧 Email Brad: brad_cunningham@lfgco.com🍊 Orange Financial: https://goorangefinancial.com/🎟️ Brad will also be speaking at our NICO LIVE Conference in September! ⁠⁠Grab your tickets here⁠⁠.

In this episode, Nico sits down with Mike Belkin, a nurse practitioner and founder of Men's HealthSpan, a telehealth-only HRT clinic. Mike shares how he went from procrastination and urgent care shifts to finally launching his own clinic, and landing 45 patients in under a year while still working full-time.They dive into Mike’s unconventional path (including chiropractic school, a syndicated cartoon, and some “California years”), what’s working in his patient acquisition strategy, and the mindset shifts every new clinic owner needs to scale sustainably. Plus, Nico gives a masterclass on boots-on-the-ground marketing, pricing strategy, and how to grow to 100+ patients, without relying on ads or social media.Tickets for ⁠NICO LIVE⁠ are on sale UNTIL AUGUST 8TH. ⏰ ⁠Get your tickets here!For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In episode #2 of her marketing series, Emily Beal shares the next step in building a sustainable marketing strategy for your HRT clinic, without relying on Instagram or TikTok. She breaks down why in-person networking and email marketing are the foundation of long-term growth, and how you can start both this week without getting overwhelmed.From how to reach out to local gyms, spas, and providers to exactly what to include in your first email campaign, Emily walks you through the practical steps to build real community and consistent patient flow. Plus: how to set up your email list (legally), why segmentation matters, and how to write emails people actually want to read.Click here to join Emily's weekly marketing newsletter: ⁠https://nicomislenp.kit.com/5bc0d4dd96⁠NICO LIVE, our ⁠⁠⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! ⁠Get your tickets for NICO LIVE here⁠⁠ 🎟️

In this episode, Nico sits down with Danielle Hayden, founder of Kickstart Accounting and the podcast Business by the Books. They talk about why traditional accounting often fails business owners, how Danielle built a bookkeeping company designed for real humans, and what every clinic owner needs to know about their numbers, especially if you’re in growth mode.Danielle shares the biggest money mistakes providers make, why your P&L should feel empowering (not terrifying), and how to stop letting tax season run your life. Whether you're just getting started or scaling your team, this conversation will help you stop avoiding your numbers and start using them as a tool for confidence, clarity, and smart growth.👉 Kickstart Accounting: https://kickstartaccountinginc.com/🎉 Choose your Gift: https://kickstartaccountinginc.com/gift/💲Mention Nico’s name on the referral spot (or Nico Misleh- HRTU) when you book a Discovery Call and they will waive the $299 set-up fee. 🎟️ Kickstart Accounting will also be at our NICO LIVE Conference in September! ⁠Grab your tickets here⁠.

NICO LIVE, our ⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! Get your tickets for NICO LIVE here⁠ 🎟️ In this episode, Nico sits down with Mason Collins, a family nurse practitioner and founder of Live Oak Testosterone & Weight Loss. From giving out his personal cell number to now leading a growing multi-provider team, Mason shares the hard lessons and smart moves that helped him scale a thriving hormone and weight loss clinic in just a few years. They talk about pricing strategy, patient retention, when to hire, and how to avoid getting lost in shiny object syndrome. If you’re a practitioner looking to grow without burning out, this one’s for you.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In this kickoff episode of her new marketing series, Emily Beal breaks down the real reason most HRT clinic owners struggle with marketing, and it’s not what you think. If you’ve ever felt overwhelmed by strategy, confused by social media, or stuck paying for marketing that doesn’t feel like you, this episode is your reset button.Emily shares her “marketing order of operations” and challenges providers to think differently about how they show up. From defining your mission and messaging to rediscovering your creative spark, this episode is all about building a marketing foundation rooted in purpose, authenticity, and simplicity. Click here to join Emily's weekly marketing newsletter: https://nicomislenp.kit.com/5bc0d4dd96NICO LIVE, our ⁠⁠⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! ⁠Get your tickets for NICO LIVE here⁠⁠ 🎟️

In this raw and honest episode, Nico sits down with UK-based physician ⁠Dr. Max Draper⁠ to unpack the journey from conventional GP to hormone optimization expert. Max shares his personal battle with testicular cancer, the years of missed low T symptoms, and how TRT completely transformed his health, and career.They talk about the differences between UK and US healthcare, the broken state of modern medicine, and why more clinicians are trading 10-minute factory-style visits for meaningful, transformative care. This episode is packed with perspective, hope, and inspiration for anyone looking to practice medicine on their own terms.NICO LIVE, our ⁠⁠⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! ⁠Get your tickets for NICO LIVE here⁠⁠ 🎟️ For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠⁠https://nicomislenp.kit.com/8050eeea5f⁠⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr⁠

Nico sits down with Courtney Walker, a Tennessee-based attorney, business owner, and legal pioneer in the med spa and wellness clinic space. They talk about why most providers don’t need a high-priced law firm on retainer, how proactive legal education can save you thousands, and what every clinic owner should know before launching or scaling their cash-based practice.Courtney shares her wild journey from corporate banking law to building a multi-state med spa and launching a legal membership for healthcare entrepreneurs. If you’ve ever been overwhelmed by legal gray areas, confused by consent forms, or unsure how to structure your practice, this episode is packed with insight, clarity, and encouragement.⚖️ Use code HRTU10 and get 10% off of her Senior Associate Program. When you're ready, you can sign up using this link here. 🎟️ Courtney will also be speaking at our NICO LIVE Conference in September! Grab your tickets here.

NICO LIVE, our ⁠⁠⁠three-day business conference designed for nurse practitioners who want to grow cash-based, concierge, and wellness-focused practices is coming up! ⁠Get your tickets for NICO LIVE here⁠⁠ 🎟️ In this episode, Nico sits down with Andrew Hewitt—psychiatric nurse practitioner, clinic owner, and relentless hustler—to talk about the long, messy, and inspiring path to building a life and business with purpose. Andrew shares how he went from working construction in Brooklyn to living in his car at 36… to now running a thriving mental health clinic and coaching other NPs to do the same.They talk about imposter syndrome, pricing with integrity, manifesting success, and what it actually takes to build something meaningful in a chaotic world. If you’ve ever questioned your path, this one’s for you.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdr

In this special episode, Emily and Cherrelle take over the podcast to share everything going into planning the first-ever Nico Live Conference happening September 5–7 in Cincinnati. From venue walkthroughs and swag bag surprises to booking AV teams and picking the perfect brisket, they pull back the curtain on what it really takes to build a business event from scratch.You’ll hear about the speaker lineup, VIP social night, thoughtful touches for attendees—and why this won’t be your typical medical conference. If you're thinking of coming or already grabbed your ticket, this episode will get you excited for what’s ahead!🎟️ You can purchase your tickets here!

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠https://hrtuniversity.com/ to learn more. Thank you to everyone who made this possible! 🙏In this episode, Nico chats with Emily, an emergency medicine NP turned integrative hormone expert, about building a hormone clinic in an ultra-affluent mountain town—and the unique challenges that come with it.They dive into pricing strategies for high-income clients, why traditional monthly memberships don’t always work, and how to shift into retainer-style care without sounding salesy. Plus, they unpack what it really means to “niche down,” how to avoid overcomplicating your offers, and why focusing on hormone optimization can be your simplest (and smartest) business move.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend. Early bird tickets on sale this week!!!

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠⁠⁠⁠https://hrtuniversity.com/⁠ to learn more. Thank you to everyone who made this possible! 🙏In this raw and inspiring conversation, Nico chats with Matt, an Ohio-based nurse practitioner who’s officially going all in on building his hormone clinic—despite having no patients, no space (yet), and just 60 days before he leaves his current job.They talk through mindset blocks, navigating non-compete contracts, choosing a brick-and-mortar location, treating men vs. women, and how to market with authenticity. If you’ve been hesitating to take the leap or want a behind-the-scenes look at what it really takes to start a practice, this episode is for you.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠⁠⁠⁠https://hrtuniversity.com/⁠ to learn more. Thank you to everyone who made this possible! 🙏In this episode, Nico is joined by Adam Costilo, founder of The Payment Doctor and a trusted preferred vendor for HRT University. They break down the hidden risks of using Stripe, Square, and PayPal for your hormone or weight loss clinic—and how these platforms can freeze your funds or even shut you down without warning.Adam shares real horror stories, explains how telehealth and payment processing collide, and gives practical advice on how to set up your clinic for long-term financial stability. If you’re a provider taking payments (aka all of us), this episode is a must-listen.🗣️ Mention “HRTU” when you schedule your free consultation and he'll make sure you’re taken care of.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠⁠⁠⁠https://hrtuniversity.com/⁠ to learn more. Thank you to everyone who made this possible! 🙏In this solo episode, Nico explores a powerful idea: hormone replacement therapy isn’t just about labs and protocols—it’s about helping people self-actualize. Using Maslow’s Hierarchy of Needs as a framework, Nico walks through how optimal hormones support every layer of the human experience—from basic physiological survival to emotional safety, confidence, connection, and ultimately, purpose.Whether you're a provider or just curious about how HRT impacts more than just symptoms, this episode will reshape how you view your role in patient care.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠⁠⁠⁠https://hrtuniversity.com/⁠ to learn more. Thank you to everyone who made this possible! 🙏This one might surprise you. In this solo episode, Nico gets real about who shouldn’t take the HRT University Master Course. If you’re looking for a cookie-cutter protocol, a quick certification, or a shortcut to confidence, this course isn’t for you. But if you’re ready to master hormone therapy, build a standout practice, and serve patients with depth and nuance—you just might be the exact person this course was built for.Nico breaks down what makes HRT University different (and honestly, harder), why principles > protocols, and what kind of provider will thrive inside the program.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend

The HRTU Master Course is now LIVE and available for purchase! Head to ⁠⁠⁠⁠⁠⁠⁠https://hrtuniversity.com/⁠ to learn more. Thank you to everyone who made this possible! 🙏In this powerful episode, Nico sits down with husband-and-wife duo Todd and Tori, two Florida-based nurse practitioners who launched Evolve Health & Wellness just two and a half years ago—and are already on track to hit seven figures in revenue. They share how they balanced launching their practice while still working part-time in hospitals, what sparked their explosive growth, and the systems they’re putting in place to scale.From community-rooted marketing and personalized patient care to the importance of mentorship and mindset, this episode is full of actionable insights for anyone running or dreaming of launching their own clinic. Bonus: Tori gives us a glimpse into the cutting-edge survivorship clinic where hormones and research meet cancer recovery.For practitioners who want to confidently grow their practice with guidance in TRT, HRT, and business strategy, find us below: 👇📝 Nico's Daily Newsletter: ⁠https://nicomislenp.kit.com/8050eeea5f⁠ (yes, it's daily... and yes, people stay subscribed)🗣️ Join the HRT University Facebook Group: ⁠https://www.facebook.com/groups/1179376819949373/?ref=share&_rdrUpcoming Reminders:📅 2025 Live Event in Cincinnati – September 5th Weekend