By Alan Mozes Health Day Reporter
THURSDAY, December 8, 2022 (HealthDay News) — As more American men turn to testosterone therapy as a way to boost energy levels, build muscle and fight erectile dysfunction, it’s no wonder that online merchants have stepped into the breach, seeking to take market share from doctors and pharmacies.
But is buying testosterone online safe? No, a new survey warns.
The finding follows an anonymous test of seven US-based online entities that sell testosterone therapy to consumers across the country.
The result: the vast majority of online portals are perfectly willing to sell the hormone to patients who are not, in fact, testosterone deficient. Most also fail to inquire about potentially problematic underlying conditions and failing to warn patients of the possible risks involved, including infertility.
“We found that most of these platforms offer treatment to men who are not considered suitable candidates under existing medical guidelines, and many platforms did not offer appropriate advice regarding the risks of treatment,” said study author Dr. Joshua Halpern. He is an andrology and infertility specialist and assistant professor at the Feinberg School of Medicine at Northwestern University in Chicago.
This is a potentially significant and growing concern, the study team pointed out, given that between 2017 and 2019 there was a 1500% increase in the number of visits to online portals. direct to consumers claiming to treat erectile dysfunction.
That said, “Testosterone therapy is a well-established medical treatment for men with testosterone deficiency,” Halpern acknowledged.
Testosterone deficiency “is the combination of low blood testosterone and symptoms classically associated with low testosterone, [such as] low energy and low libido,” he explained.
“Men with these symptoms who seek testosterone therapy often try to improve their quality of life,” Halpern noted, “although some men may be on testosterone therapy for other reasons, [including] build muscle mass.
When prescribed to those who need it, taken as directed and monitored appropriately, it “is generally considered safe,” he said.
Still, Halpern and his colleagues pointed out that according to the United States Drug Enforcement Administration, testosterone is considered a controlled substance. This means that alongside similar drugs, such as anabolic steroids and the anesthetic ketamine, there is a low to moderate risk of becoming addicted.
For this reason, Halpern said, “Testosterone is usually prescribed at a local pharmacy by a health care provider, such as a primary care provider, urologist, or endocrinologist.”
Even when administered appropriately and under ideal medical conditions, testosterone therapy is not without risks. These, Halpern said, can include thickening of the blood and infertility. It can also trigger a rare but serious increase in the number of red blood cells, which can lead to blood clots and bleeding and/or increase the risk of heart attack or stroke.
Given these concerns, Halpern and his associates questioned whether approved prescribing guidelines and risk disclosure were an integral part of the online shopping process.
Apparently not, as became apparent after the team set up an online “secret shopper” profile to surf the web for testosterone therapy options.
Fashioned as a 34-year-old man struggling with low energy and low libido – both of which characterize low testosterone levels – the “dummy” profile made it clear that the patient in question was interested in trying testosterone while staying fertile on the road.
The profile was submitted to seven US online portals that sell testosterone. Intake procedures variously involved providing lab test results and engaging in telemedicine consultations conducted by nurse practitioners, physician assistants, or individuals without medical licenses of any kind.
Bottom line: nearly 86% of the sites offered to sell testosterone, even though the fake profile clearly showed testosterone levels that were within the normal range. Six of the seven portals did not have a testosterone level threshold to provide treatment.
Only one of the portals asked about the patient’s specific heart health history or personal interest in future fertility, while only half raised potential fertility issues. More than 83% of the time, blood thickness issues were never mentioned, the investigators found.
“Testosterone therapy has many benefits, but it also comes with risks and isn’t suitable for everyone,” Halpern pointed out. “While direct-to-consumer online platforms hold great promise for expanding access to care for men with low testosterone, there are some downsides. Men should start by speaking with their local healthcare provider before considering testosterone therapy.
Dr. Pieter Cohen is a general internist at the Cambridge Health Alliance and an associate professor at Harvard Medical School in Boston.
Although not part of the study team, his conclusion is that the new survey “elegantly highlights many of the pitfalls of obtaining testosterone from an online supplier, even after having done blood tests.
Cohen noted that “patients were not properly screened, testosterone prescribing was inappropriate, and in addition to testosterone, patients were encouraged to use a host of other questionable and potentially dangerous drugs.”
Beyond that, he added that in many cases, the symptoms that people quickly attribute to low testosterone are actually just a function of normal aging or other illnesses. “But that hasn’t stopped the testosterone marketers from trying to get everyone started on the drug,” Cohen said.
There is more on the pros and cons of testosterone therapy at the Mayo Clinic.
SOURCES: Joshua Halpern, MD, MS, andrology and infertility specialist, and assistant professor, 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
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