MONDAY, Dec. 19, 2022 (HealthDay News) — Direct-to-consumer (DTC) platforms offer testosterone therapy to men not meeting guideline-based criteria, according to a research letter published in the December issue of JAMA Internal Medicine.

Justin M. Dubin, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined whether DTC platforms provide appropriate, guideline-concordant care for testosterone therapy. Ten companies were identified that provide testosterone therapy online; seven were included in the evaluation and underwent a secret shopper assessment, wherein the secret shopper used a script describing a 34-year-old man with low energy and low libido interested in future fertility, to inquire about and initiate testosterone therapy.

The researchers found that the secret shopper was offered testosterone therapy by six of the seven platforms, despite the shopper reporting normal testosterone levels and normal free testosterone and desiring fertility. Only one of the platforms asked about recent cardiovascular events or future fertility intentions. The criteria for offering testosterone therapy were not in accordance with the Endocrine Society or the American Urological Association; six platforms had no total testosterone threshold for initiating treatment. Three of the six platforms offering testosterone therapy stated a treatment goal of 1,000 mg/dL or more for total testosterone levels and did not discuss the associated fertility risks; five of six did not discuss polycythemia risks. In addition to testosterone therapy, the secret shopper was offered a broad range of off-label medications.

“As DTC testosterone therapy increases in popularity, patients and clinicians should be educated about the potential pitfalls of these platforms,” the authors write.

Several authors disclosed financial ties to Endo International; one disclosed ties to Coloplast.

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