Direct-to-Consumer Testosterone Not Offered in Accordance With Guidelines

Direct-to-consumer (DTC) platforms offer testosterone therapy to men not meeting guideline-based criteria, according to a research letter published in JAMA Internal Medicine. Justin M. Dubin, MD, 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 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 platform asked about recent cardiovascular events or 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.