Online retail establishments fueled the telehealth boom brought on by the COVID-19 pandemic, touting testosterone as a panacea for age-related male diseases, despite FDA regulations issued years ago that restricted such advertising to “low testosterone levels. “
In classified ads on Google, Facebook, and elsewhere, testosterone-laced telemedicine may promise a quick fix for laziness and low libido in men. But evidence is lacking, doctors say, and the midlife malaise for which testosterone is touted as a solution is more apparent. Likely caused by chronic diseases, a poor diet, or a sedentary lifestyle. In fact, doctors urge caution and the FDA recommends that all testosterone supplements warn that they could increase the threat of central attack and stroke.
There are valid medical reasons to treat some men with testosterone. The hormone-as-drug has been around for decades, and patients today include men with hypogonadism, transgender men who use it to ease physical transition, and sometimes menopausal women. symptoms. It has also been used for decades by bodybuilders and athletes for their strength.
However, online dispensaries would arguably exaggerate the concept of what is rarely referred to as “male menopause,” or even “manopause,” to spur sales of blockbuster testosterone-boosting injectables, ignoring the rules of protection that deserve to save healthy men. to use the hormone. Some Internet sites target veterans.
“I’ve noticed online classifieds crossing the line,” said Steven Nissen, M. D. and educational director of the Cleveland Clinic’s Heart, Vascular and Thoracic Institute. “For temperament and lack of energy, prescribing testosterone provides little to no benefit. They advertise testosterone according to the directions on the label.
Testosterone telefitness websites almost all cite a study published in 2002 by scientists at the New England Research Institutes that found that testosterone levels drop by as much as 1% per year in men over the age of 40. Stefan Schlatt, director of the Center for Reproductive Medicine and Andrology at the University of Münster in Germany. He said the data for this statistic included older men whose physical condition was deteriorating and whose levels were declining due to illness.
“Healthy men do not show any deterioration,” he said.
That 2002 study sparked a flood of “low T” classifieds on U. S. television. In the U. S. , classified ads were later banned by the FDA in a 2015 ruling that accused the pharmaceutical industry of exaggerating the low-T phenomenon to trap men into buying. According to another study, the testosterone supplement market will be valued at $1. 85 billion by 2023.
The flood of classified ads “fueled demand for a product that is largely uninsured, allowing for higher margins,” said Geoffrey Joyce, director of fitness policy at USC’s Schaeffer Center for Health Policy.
Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the Charles Perkins Centre at the University of Sydney in Australia, said low testosterone levels deserve to be noticed as a sign of a disease that wants to be treated. He said diabetes, central disease, high blood pressure, obesity, exposure to toxic chemicals like PFAS and stress can all lower testosterone levels.
Several internet sites reviewed through KFF Health News tout it as news and fitness magazines, with classified ads embedded in articles directing readers to request bureaucracy for testosterone replacement therapy, abbreviated as TRT. TRT costs on the sites range from $120 to $135 per month. , not to add the initial blood tests mailed in for about $60. Some sites promise increased libido and relief from belly fat.
Male Excel classified ads on Google, for example, say that TRT “improves mood” and “restores vitality. “And its site says the testosterone remedy will bring “muscle definition,” “weight loss,” “explosive motivation,” “deeper sleep,” and “restored energy” via a link to an informal assessment on its online telehealth platform. Craig Larsen, the company’s chief executive, did not respond to several attempts to reach him by phone and email.
Male Excel and Hone Health are among the sites that cater to veterans. Hone Health included a video of a veteran who said he was denied testosterone treatment through a Department of Veterans Affairs hospital.
Saad Alam, CEO and co-founder of Hone, said his company is what he calls a “conservative” player in the market. He said Hone only prescribes to men with hypogonadism and tests men every 90 days, unlike other companies that operate on telehealth. Internet sites as part of what he called a “financial hoarding. “
“I agree that patients want to be treated through their doctors. But the U. S. medical formula gets to a point where it can treat men who have this problem, and some endocrinologists prefer to treat patients who bring more,” Hone said. “That’s why other people come to us. “
A popular form of TRT is injectable testosterone cypionate. According to Medicare’s average selling price database, it costs $0. 027 per milligram. Online providers who sell the drug directly to consumers in 200 mg/mL vials worth an average of $129 per month. Rate of $1. 55 per mg, a profit margin of more than 50 times the average value of Medicare.
According to a 2022 study, TRT telehealth sites create a way to circumvent doctors who refuse to prescribe the hormone. In this study, Justin Dubin, a urologist at Memorial Healthcare System in Florida, posed as an online mystery shopper. He reported more than normal testosterone levels and stated a preference for starting a family, even though such treatment can curb sperm production. But six of the seven anonymous online TRT clinics prescribed testosterone to him through a medical professional.
“And that’s concerning,” he said Dubin. La telemedicine is helping men with hypogonadism who might feel too embarrassed to talk about erectile dysfunction, but we want to better understand the appropriateness of care.
However, while the FDA does not allow unauthorized marketing, it does allow such unauthorized prescriptions.
Off-label use of testosterone replacement products is not unusual among veterans. And of the male military members who won the TRT in 2017, less than a portion met clinical practice guidelines, according to a U. S. Army report. U. S.
Phil Palmer, a 41-year-old Marine Corps veteran who lives outdoors in Charleston, South Carolina, said he will pay out of pocket for blood tests and prescriptions for a form of testosterone in the form of a skin implant and clomiphene. A drug that can help counteract male infertility, which is a side effect of testosterone remedy. He said the remedy appealed to him and other veterans dealing with the consequences of military service.
“The environment in which we serve and the degrees of tension had a lot to do with it,” Palmer said. “We were exposed to burns. The military doesn’t teach you how to eat right – we eat a lot of processed foods.
In medical settings, TRT can speed the healing of infantrymen with bone density disorders or spinal cord injuries, said Mark Peterson, a professor of physical medicine and rehabilitation at the University of Michigan Medical School. But, he said, “for men in the normal T range, an online prescription to buy testosterone to reduce belly fat can backfire. “
Those who use it will likely also have to take testosterone-based medications indefinitely, as TRT can cause the body to stop making the hormone on its own.
Palmer, who founded a nonprofit that helps veterans heal through exercise, nutrition and mentorship, said the drugs have served him well, but he urges other veterans to seek care from their doctors instead of what he calls “fraternal science” websites that promote testosterone.
“It’s a magic pill,” he said.
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