Washington (US): America has witnessed an increase in demand Testosterone therapy. Motivations range from virility enhancement to increased strength and energy. It has become a full-fledged business in recent years with numerous direct-to-customer platforms offering therapy.
That being said, the therapy can have numerous risks that patients need to be aware of before undertaking it. And according to a new study published in the journal “Jama Internal Medicine“, many of these platforms are not providing proper guidelines for its safe and effective use on men.
“Testing and treatment for Low testosterone Thanks to this it is more accessible than ever Online platform. “Men can be evaluated and started on testosterone therapy without leaving home,” said Joshua A. Halpern, MD, senior author of the paper and a urologist at Northwestern Medicine. Follow evidence-based guidelines, or when the benefits and risks of treatment are appropriate. When not otherwise stated.”
Men with low testosterone levels, or Hypogonadism, can experience symptoms like erectile dysfunction, loss of libido, fatigue and depression among other problems. While hormone augmentation therapy may improve these symptoms for some people, it may be ineffective or even harmful when prescribed to men who do not meet the criteria for hypogonadism, including infertility and risk of cardiovascular events and other side effects.
Using a mystery shopper, the study authors evaluated seven US-based online companies that offer testosterone therapy in all 50 states. Using the script to inquire about and initiate testosterone therapy, the mystery shopper identified himself as a 34-year-old man with hypogonadal symptoms, including low energy and low libido, who was interested in future fertility. For each platform, he completed an intake assessment, required laboratory diagnostic testing, and an initial telemedicine consultation, which was conducted by either a nurse practitioner, physician assistant, or nonmedical licensed individual.
“While my interactions with the telemedicine platforms were pleasant and efficient, I was surprised by some of the gaps in their counseling and their recommendations for pursuing testosterone therapy,” said Justin Dubin, MD, first author and the study’s secret shopper.
The authors found that online platforms offered therapy to men who did not meet guidelines for testosterone deficiency, while failing to communicate the risks and benefits of therapy. The study is the first to identify guideline-discrepancy practices by direct-to-consumer testosterone therapy platforms, with the following key findings:
Despite having normal total testosterone (TT) and free testosterone levels and desiring future fertility, 85.7 percent of the platforms offered testosterone therapy. Only 1 of the 7 platforms asked the mystery shopper about recent cardiovascular events or her wishes about future fertility. Criteria for offering testosterone therapy were inconsistent with AUA and ES guidelines, with one platform only offering treatment to men with TT below 450 ng/dL (normal range = 264 – 916 ng/dL), while six others had treatment initiation There is no threshold for Half of the platforms cited a treatment target of TT levels greater than 1,000 ng/dL and did not discuss the reproductive risks of testosterone therapy. 83.3 percent did not discuss the risks of polycythemia, which is an increase in the thickness of the blood. In addition to testosterone therapy, the secret shopper was also offered a wide range of off-label medications. As direct-to-consumer testosterone therapy continues to grow in popularity, the authors hope that future policy initiatives will facilitate more consistent and guideline-based care through these organizations.
Dr. “Online platforms have great potential to expand men’s access to healthcare screening and treatment, especially for issues like erectile dysfunction and infertility,” says Dr. Halpern. says Halpern. “However, unless these services provide therapies based on established guidelines, it is more important than ever that patients and providers are educated about the potential pitfalls of receiving these types of treatments online.”
For men concerned about their testosterone levels, Dr. Halpern recommends seeing a provider with expertise in hypogonadism, such as a urologist, endocrinologist, or even starting with their primary care physician. For some men, lifestyle changes can improve their physical symptoms and improve mood.
“Testosterone is not a magic bullet, but it can be a very effective therapy when prescribed appropriately and within guidelines,” Dr. says Halpern. “For others, making lifestyle choices that emphasize exercise, healthy eating and adequate sleep may be the right answer. Working with an experienced provider is the first step to finding the right, personalized care plan that fits your individual needs.”
Northwestern Medicine’s urology program ranks among the nation’s most experienced and respected, providing comprehensive inpatient and outpatient care, including state-of-the-art diagnostic and treatment capabilities, for men, women and adolescents.
