Online shops emerged over the course of the year Covid-19 pandemicThe telehealth boom of 1999 promoted testosterone as a panacea for age-related diseases in men – despite FDA rules was enacted years ago and restricts such “low testosterone levels” Advertising.

Testosterone telemedicine websites may appear in ads on Google, Facebook, and elsewhere promise a quick solution against sluggishness 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 likely to be caused by chronic illness, poor diet or a sedentary lifestyle. In fact, doctors advise caution – and the FDA recommends it for everyone Testosterone supplements carry a warning label that they can increase the risk of heart attack and stroke.

There are valid medical reasons for treating some men with testosterone. The hormone has been around as a medication for decades, and today’s patients are also affected by it Men with hypogonadismsome transgender men who use it to ease physical transition, and sometimes Women struggling with menopausal symptoms. It has also been used by bodybuilders and athletes for decades Increase strength.

However, online pharmacies can overstate and often ignore the idea of ​​what is sometimes called “male menopause” or even “manopause” to boost sales of highly profitable testosterone-boosting injectables Security guidelines this should prevent healthy men from using the hormone. Some of the websites are aimed at military veterans.

“I’ve seen ads online that push the envelope,” said Steven Nissen, a physician and chief academic officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic. “For mood swings and low energy levels, prescribing testosterone offers little to no benefit. They promote testosterone for indications that are not on the label.”

Testosterone telehealth websites cite almost all of them a study A study published in 2002 by scientists at the New England Research Institute found that testosterone levels decline by 1% per year in men over 40. Stefan Schlatt, director of the Center for Reproductive Medicine and Andrology at the University of Münster in Germany, said the data behind the statistics included older men with deteriorating health whose levels have dropped due to illness.

“Healthy men don’t show waste,” he said.

That 2002 study led to a flood of “low-T advertising” on U.S. television—advertising that was later banned by the FDA in a 2015 ruling that accused the pharmaceutical industry of promoting low-T. Exaggerating the T phenomenon to entice men to buy medication. According to another study, the testosterone supplement market was worth $1.85 billion in 2023.

The flood of advertising” has fueled demand for a largely uninsured product, allowing for high markups,” said Geoffrey Joyce, director of health policy at the USC Schaeffer Center for Health Policy & Economics and research fellow at the National Bureau of Economic Research. “The main driver is demand for industrial goods.”

Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the Charles Perkins Center at the University of Sydney in Australia, said low testosterone levels should actually be viewed as a sign of a medical condition that needs treatment. She said diabetes, heart disease, high blood pressure, obesity, exposure to toxic chemicals like PFAS and stress can all lower testosterone levels.

Several websites reviewed by KFF Health News describe themselves as news and fitness magazines, with ads embedded in articles directing readers to order forms for testosterone replacement therapy, or TRT. Websites’ prices for TRT range from $120 to $135 per month, plus initial blood tests by mail for about $60. Some websites promise increased libido and reduction in belly fat.

For example, Male Excel’s ads on Google state that TRT “improves mood” and “restores vitality.” And the website states that testosterone treatment will result in “muscle definition,” “weight loss,” “explosive drive,” “deeper sleep,” and “restored energy,” via a link to a free assessment on the online telehealth platform . Craig Larsen, the company’s CEO, did not respond to multiple attempts to contact him by phone and email.

Both Male Excel And Honest Health are among the websites aimed at military veterans. Hone Health included a video of a veteran claiming this refused testosterone Treatment at a Department of Veterans Affairs hospital.

Saad Alam, CEO and co-founder of Hone, said his company is a “conservative” player in the market. He said Hone only prescribes to men who are hypogonadal and tests men every 90 days, unlike other companies that operate telehealth websites, which he called a “money grab.”

“I agree that patients should be treated by their doctors. But the U.S. health care system is not yet at a point where it can help men with this problem, and some endocrinologists prefer to treat higher-profit patients, Hone said. “That’s why people come to us.”

A popular form of TRT is injectable testosterone cypionate. According to the Medicare average selling price database, it costs $0.027 per milligram. Online retailers that sell the drug directly to consumers in 200 mg/ml vials at an average price of $129 per month charge the equivalent of $1.55 per mg – a markup of more than 50 times that average Medicare price.

According to a Study 2022, the TRT telehealth websites create a way to bypass 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 above-average testosterone levels and expressed a desire to start a family despite such therapy can inhibit sperm production. But six of the seven unnamed online TRT clinics prescribed testosterone to him through a doctor.

“And that’s concerning,” Dubin said. “Telemedicine helps men with hypogonadism who may be too embarrassed to talk about erectile dysfunction. But we need to better understand the appropriateness of treatment.”

Although the FDA does not allow off-label marketing, it does allow such off-label prescriptions.

The off-label use of testosterone replacements has become particularly common among veterans. And among male service members who received TRT in 2017, fewer than half met clinical practice guidelines, according to a study US military report.

Phil Palmer, a 41-year-old Marine Corps veteran who lives outside of Charleston, South Carolina, said he pays out of pocket for blood tests and prescriptions for a testosterone pellet skin implant form and for Clomiphene, a drug that can help counteract male infertility, which is a side effect of testosterone treatment. He said the treatment is attractive to him and other veterans struggling with the effects of military service.

“The environment we served in and the stress levels had a lot to do with it,” Palmer said. “We were exposed Burn pits. The military doesn’t teach you to eat well – we ate a lot of processed foods.”

In the medical field, TRT can speed recovery for soldiers with bone density problems or spinal cord injuries, they say Mark Peterson, professor of physical medicine and rehabilitation at the University of Michigan Medical School. But, he said, “for men in the normal T range, using an online prescription to purchase testosterone to reduce belly fat can be counterproductive.”

Anyone who uses it also risks having to do it Take testosterone medication indefinitelybecause TRT can cause the body to stop its own production of the hormone.

Palmer, the founded a non-profit organization The drug helps veterans heal through exercise, nutrition and mentoring, said the drug has been helpful for him, but urges his veterans to seek care from their doctors instead of turning to websites that advertise testosterone as ” “bro science”.

“It’s not a magic pill,” he said.

KFF Health Newsformerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – the independent source for health policy research, surveys and journalism.

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