Tier1 OptimalQuestions? Call Ava our 24/7 AI concierge · (289) 434-0509
Sexual Health · Ontario, Canada
You don't have to tell anyone. Not your partner, not your pharmacist, not even your family doctor. Ava handles the conversation. Crystal handles the prescription. The medication arrives in unmarked packaging.
Your dedicated clinician: Crystal Troup, NP
15+ years · Licensed in Ontario, Canada · Same clinician, every visit
Lead Clinician
Crystal Troup, NP
15+ years · Ontario, Canada
Your Clinician
Crystal has seen it all before. She treats sexual health exactly like every other medical concern — clinically, carefully, and confidentially. No awkwardness. No judgment. Just structured assessment, evidence-based treatment, and ongoing monitoring.
“Every patient deserves more than a prescription. They deserve a clinician who listens, a protocol built on real data, and support that doesn't stop.”
The Difference
A clinician-led, coordinated white glove premium clinical experience with 24/7 AI concierge support so you never have a disruption in treatment, never miss an appointment, and always feel supported.
From the moment you enroll, Brett personally walks you through onboarding, intake forms, scheduling, and everything you need to get started. You don't have to figure anything out.
Crystal sees you personally at every appointment. Same clinician, every visit. No handoffs. No rotating providers. Your protocol is built for YOUR body, reviewed at every visit, and adjusted based on how you actually feel.
Appointments scheduled in advance. Prescription refills coordinated before you run out. Bloodwork requisitions sent to your email. Lab locations looked up for you. The administrative work is handled so you can focus on feeling your best.
After every appointment: check-ins. After every bloodwork: a clear protocol update. After every change: someone confirming it's working. This is how optimization is supposed to work.
Privacy & Discretion
Crystal via secure telehealth. No waiting rooms.
Medical records protected under Ontario health privacy law.
Medication mailed in unmarked packaging. No indication of contents.
You never explain your situation to a new provider.
The reality
49%
of Canadian men between ages 40 and 88 experience erectile dysfunction. It's the most frequently underreported health condition in men — most never bring it up with a doctor.
30%
of men experience premature ejaculation at some point — the most common sexual dysfunction in men under 40.
These are medical conditions with effective treatments. They are not character flaws. They are not inevitable. And with Tier1 Optimal, the entire process is confidential, discreet, and handled by a licensed clinician who has seen it all before.
The TRT Connection
Many men treating ED with sildenafil or tadalafil are addressing the symptom without investigating the cause. Low testosterone is one of the most common underlying drivers of erectile dysfunction — and it is frequently missed.
Crystal runs a comprehensive panel that includes testosterone, free testosterone, SHBG, estradiol, and metabolic markers alongside your sexual health assessment. If a hormonal component exists, she addresses both simultaneously.
Why this matters
The patients who get the best results are the ones who address both the medical and the relational side. Crystal treats the biology. The closeness comes back on its own.
Treatment Options
Crystal selects the right medication for your specific situation — no templates.
Option 01
ED · PDE5 Inhibitor
Taken 30–60 minutes before activity. Effects last 4–6 hours. Available in multiple dose strengths. Crystal prescribes the appropriate dose based on your health profile. Well-established safety record with decades of clinical data.
Option 02
ED · Long-acting
PDE5 inhibitor with a longer duration of action — up to 36 hours. Can be taken as-needed or as a daily low-dose for continuous effect. Many patients prefer tadalafil for its flexibility.
Option 03
PE · Ejaculatory control
Low-dose SSRI medication prescribed off-label for PE. Works by modulating serotonin levels. Can be taken daily or on-demand depending on Crystal's recommendation. Clinically proven to increase time to ejaculation.
Option 04
PE · Local application
Lidocaine/prilocaine cream applied before activity to reduce sensitivity and delay ejaculation. Works locally without systemic side effects. Crystal advises on proper application technique.
What to Expect
Week 1–2
Crystal prescribes your initial medication and dosing. You test it and report back on effectiveness and any side effects.
Week 2–6
Crystal adjusts dosing based on your feedback. Many patients find their optimal dose within the first month. If bloodwork reveals a hormonal component, Crystal may recommend adding TRT.
Week 6–12
Confidence returning. If on combination therapy (TRT + ED medication), the synergy becomes clear — hormone optimization often means less reliance on medication over time.
90-Day Mark
Crystal reviews, assesses, adjusts. Ongoing prescriptions issued. Supply ships.
This assessment is 100% confidential.
Self-Assessment
Take the 2-minute assessment.
★ The White Glove Difference
Sexual Health protocols require coordination — lab timing, dosing adjustments, pharmacy follow-through, insurance navigation. We handle all of it. You just focus on your results.
How It Works
Select the membership that fits your goals. Your first month is collected when you book — that's not a sign-up fee, it's your membership starting immediately. Includes your initial consultation and assessment.
Your first clinical appointment with Crystal Troup, NP. She reviews your medical intake, discusses your goals and symptoms, and orders your comprehensive bloodwork panel.
Crystal prescribes in 90-day cycles, so you see her quarterly for bloodwork review, protocol adjustments, and progress check-ins. Same clinician, every visit.
Pharmaceutical-grade medication mailed directly to your door in discreet packaging.
Insurance Note: Many workplace insurance plans include coverage for ED medications (Sildenafil, Tadalafil), though coverage limits and prior authorization requirements vary. A good portion of patients find at least partial coverage. Brett can help you verify your plan.
I got my life back. That is not an exaggeration.
— Tier1 Optimal Patient
Sexual Health FAQ
49% of Canadian men between ages 40 and 88 experience erectile dysfunction. It is the most frequently underreported health condition in men — most never bring it up with a healthcare provider.
Confidential · Discreet · Fast
Mailed in unmarked packaging. No one sees. No one knows. From $125/mo.
Not ready for an annual commitment? We also offer a flexible month-to-month plan — no contract, cancel anytime. See all plans →
Book Your Free Consultation
Pick a slot that works for you. No credit card required for the free consultation with Brett.
Questions? Call Ava · 905-802-9603