Dec. 8, 2022 (HealthDay News) — As more American men turn to testosterone therapy to boost energy levels, build muscle and combat erectile dysfunction, it’s no surprise that web-based marketers are stepping into the breach. trying to keep market share away from doctors and pharmacies.
But are online testosterone purchases safe? No, warns a new study.
The finding follows anonymous testing of seven US-based online businesses that sell testosterone therapy to consumers across the country.
Conclusion: The vast majority of online portals are willing to sell the hormone to patients who do not actually have a testosterone deficiency. Most also fail to ask about potentially problematic underlying conditions and do not neglect to warn patients about possible risks, including infertility.
“We found that most of these platforms offer treatment to men who are not considered suitable candidates according to current medical guidelines, and many platforms do not provide appropriate advice about the risks of treatment,” said study author Dr. Joshua Halpern. He is a specialist and associate professor of andrology and infertility at Northwestern University Feinberg School of Medicine in Chicago.
This is a potentially huge and growing concern, given the 1,500% increase in visits to direct-to-consumer online portals claiming to treat erectile dysfunction between 2017 and 2019, the research team found.
Halpern acknowledged that “testosterone therapy is a well-established medical treatment for men with testosterone deficiency.”
Testosterone deficiency is “the presence of low testosterone levels in the blood and a combination of symptoms classically associated with low testosterone, [such as] low energy and low libido,” she said.
“Men with these symptoms who seek testosterone treatment are often trying to improve their quality of life,” Halpern noted, “although some men may continue testosterone therapy for other reasons. [including] build muscle.”
When prescribed to those in need, taken as directed and properly monitored, it is “generally considered safe,” he said.
Still, Halpern and his colleagues emphasized that testosterone is considered a controlled substance according to the US Drug Enforcement Administration. This means that, along with similar drugs such as anabolic steroids and the sedative ketamine, the risk of addiction is low to moderate.
For this reason, Halpern said, “testosterone is usually prescribed through a local pharmacy by a primary care provider, such as a urologist or endocrinologist.”
Even when administered correctly and under ideal medical conditions, testosterone therapy is not without risk. These include blood clotting and infertility, Halpern said. It can also cause a rare but serious increase in the number of red blood cells, which can cause blood clotting and bleeding and/or increase the risk of heart attack or stroke.
With such concerns in mind, Halpern and his colleagues wondered whether approved prescribing guidelines and risk disclosures should be a routine part of the online purchasing process.
Apparently, the team found out after a “mystery shopper” set up an online profile to explore web-based testosterone therapy options.
Crafted as a 34-year-old man struggling with low energy and low libido — both characterized by low testosterone levels — the “dummy” profile revealed that the patient in question was interested in trying testosterone while remaining fertile along the way. .
The profile was submitted to seven US online portals that sell testosterone. Admission procedures include submitting various types of laboratory test results and participating in telemedicine consultations conducted by nurses, physician assistants, or individuals without any medical license.
Conclusion: About 86% of the sites offered to sell testosterone, even though the dummy profile clearly listed testosterone levels that fell within the normal range. Six of the seven portals did not have a testosterone level threshold to warrant treatment.
Only one of the portals asked about the patient’s specific heart health history or personal interest in future fertility, but half raised potential fertility issues. In more than 83% of cases, concerns about blood thickness were never mentioned, the investigators found.
“Testosterone therapy has many benefits, but it also has risks and is not suitable for everyone,” Halpern said. “While direct-to-consumer online platforms hold great promise in expanding care options for men with low testosterone, there are some drawbacks. Men should start talking to their local healthcare providers before considering testosterone therapy.
The findings were published as a research letter in the December issueJAMA Internal Medicine.
Dr. Pieter Cohen is a general internist at Cambridge Health Alliance and an associate professor at Harvard Medical School in Boston.
Although not part of the research team, he suggests that the new study “elegantly highlights the many pitfalls of obtaining testosterone from an online provider, even after completing blood tests.”
Cohen noted that “patients were not screened properly, testosterone was not prescribed appropriately, and patients were encouraged to use a number of other questionable and potentially dangerous drugs in addition to testosterone.”
In addition, he added, in many cases, the symptoms people often attribute to low testosterone are actually a function of normal aging or other diseases. “But that didn’t stop testosterone marketers from starting to do whatever they could with the drug,” Cohen said.
The Mayo Clinic has more information on the pros and cons of testosterone therapy.
SOURCES: Joshua Halpern, MD, MS, specialist and assistant professor of andrology and infertility, Feinberg School of Medicine, Northwestern University, Chicago; Pieter Cohen, MD, general internist, Cambridge Health Alliance and associate professor, Harvard Medical School, Boston; JAMA Internal Medicine, December 2022