Buying testosterone online is a growing concern, says study


A recent investigative study says men buying testosterone on the internet has potential health pitfalls. A Northwestern Medicine study published in the December issue of JAMA Internal Medicine found a concerning trend between 2017 and 2019, the number of visits to direct-to-consumer online portals claiming to treat erectile dysfunction jumped 1500 percent. 

Men should always talk to their healthcare provider before considering purchasing testosterone treatments sold online.

Why men seek testosterone treatment

Testosterone is a male hormone produced by the testicles in men. This powerful hormone is known for boosting energy levels, building muscle mass, and preventing erectile dysfunction. Men experiencing decreased fatigue, low muscle mass, and trouble getting or maintaining an erection often seek testosterone treatment to remedy these issues. The definition of testosterone deficiency is having together low levels of the hormone along with symptoms such as low energy and low libido. 

Unfortunately, many online platforms do not consistently follow the American Urological Association (AUA) and Endocrine Society (ES) guidelines. These guidelines state specifically safe and effective management for men using testosterone therapy. The online platforms are taking advantage of men by selling testosterone directly to men, bypassing the need for a doctor necessary for evaluating if a man is testosterone-deficient and determining the pros and cons of testosterone therapy. 

Study design

The research team used a “secret shopper” to evaluate seven US-based online companies selling testosterone therapy in all 50 states. The secret shopper claimed he was 34 years of age and had symptoms such as low energy and low sexual desire. Each online platform had the secret shopped complete an intake evaluation, which required diagnostic testing and a telehealth visit conducted by a physician assistant, nurse practitioner, or non-medically licensed person. 

Researchers found many gaps in counseling, such as covering the risks and benefits of therapy and offering testosterone therapy to men who do not meet the guidelines for testosterone deficiency. 

Some of the key findings included:

  • Only one of seven online platforms asked the secret shopper about any recent cardiovascular events or about their future fertility aspirations.
  • Fifty percent of the online companies had a treatment goal of more than 1,000 ng/dl testosterone levels without mentioning fertility risks.
  • Eighty-three percent failed to discuss the risks of polycythemia or increased blood thickness.
  • Six of the seven online platforms had no threshold for treatment initiation and were not following the AUA and ES guidelines.

Why online purchases of testosterone can be dangerous

The problem with online portals selling testosterone directly to men, without being evaluated by their healthcare provider for testosterone deficiency, is the potential for health risks, including fertility. 

Many platforms selling the hormone do not offer appropriate medical counseling to review the potential dangers of using testosterone treatment if a man is not deficient in the hormone. The problem is that men purchasing testosterone online are seeking ways to improve their quality of life, but without having to see a doctor first. In addition, some men like the convenience of buying online and not having to discuss with a doctor embarrassing issues such as erectile dysfunction. 

The U.S. Drug Enforcement Administration regards testosterone as a controlled substance. This hormone is similar to anabolic steroids and ketamine, with a low-to-moderate risk of becoming addicted. 

This is why testosterone should only be prescribed by a medical doctor who has evaluated a man of their need for testosterone. If the evaluation does show a man to have low testosterone levels, then the doctor will prescribe the medication through a man’s pharmacy. 

A healthcare provider must regularly monitor men using prescribed testosterone as it is not without risks. These risks include blood clots raising the risk of heart attacks or stroke, infertility, increased red blood cell counts, an enlarged prostate, and an increase in sleep apnea symptoms. 

Bottom line

Men should be extremely cautious before considering purchasing testosterone through any online portal. Numerous pitfalls can seriously affect their long-term health when using these platforms that do not follow AUA and ES guidelines. These guidelines set the standard for diagnosing men with low testosterone and then how to administer an appropriate and regularly monitored treatment while taking this medication. 

Buying testosterone online is a growing concern, says study
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Dr. David B. Samadi

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Dr. David B. Samadi