While demand for testosterone therapy has soared in the United States, a new study from Northwestern Medicine found several direct-to-consumer companies offering the therapy did not follow medical guidelines nor convey the health risks of therapy.
Dr. Josh Halpern, a Northwestern Medicine urologist, co-authored the study that was published in JAMA Monday.
”Low testosterone is really quite prevalent," Halpern said. "We've seen an increased use in testosterone overall over the last few years. It really does need to be prescribed and monitored carefully, and so, that was the reason that we wanted to explore kind of the quality of care that these platforms were offering."
Dr. Justin Dubin, a fellow urologist, posed as a “secret shopper” in the study, contacting seven companies offering testosterone therapy.
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“I was basically playing myself, a 34-year-old man. I personally interacted with all the platforms. I got the required bloodwork, and I went to the initial telemedicine consultations,” Dubin said, adding he followed a consistent script that included his symptoms and his desire to have a family in the future.
Dubin said his interactions with the companies surprised him.
“Despite my testosterone levels being normal, despite my desire to, you know, have future children, six of the seven companies offered me testosterone,” Dubin said.
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Only half of the companies asked about his desire for a family, even though research shows testosterone therapy can harm fertility.
Only one asked about his heart health, despite increased cardiovascular risks as well.
“None of the companies actually used our urology guideline testosterone levels for diagnosis or treatment,” Dubin said, referring to guidelines established by the American Urological Association and the Endocrine Society.
The study, published online, does not name the companies involved. The authors said they believe there is value in telemedicine improving access to this kind of care.
“There's this huge stigma associated with things like erectile dysfunction and low testosterone. People don't want to go see a doctor in person,” Dubin said.
Both doctors say they hope the study findings motivate the direct-to-consumer companies offering this treatment to improve their counseling and follow medical guidelines.
Their recommendation for anyone considering testosterone treatment?
“Do your research and then talk with a local healthcare provider prior to engaging in any telemedicine platform at this time,” Dubin said.
