With more American men turning to testosterone therapy to increase energy, build muscle, and treat erectile dysfunction, it’s no surprise that web-based merchants are vying for market share at the expense of doctors and pharmacies.
But are online sales of testosterone safe? No, cautions a new investigation. As per US News, following anonymous testing of seven U.S.-based online retailers of testosterone therapy to consumers across the country, this result has been reached.
In conclusion, the vast majority of internet pharmacies are happy to sell testosterone to people who are not testosterone deficient. In addition, the majority fail to enquire about potentially troublesome underlying diseases and fail to warn patients about the potential hazards, including infertility.
“We discovered that the majority of these platforms provide treatment to males who, according to existing medical criteria, are not good candidates and that many of these platforms do not provide enough counseling regarding the risks of treatment,” stated research author Dr. Joshua Halpern. He specializes in andrology and infertility and is an assistant professor at the Feinberg School of Medicine at Northwestern University in Chicago.
The study team noted that between 2017 and 2019, there was a 1500% increase in the number of visitors to internet portals claiming to treat erectile dysfunction. This is a potentially significant and developing worry.
Halpern noted, however, that testosterone therapy is a well-established medical treatment for males with testosterone insufficiency. Testosterone deficiency is the combination of low testosterone levels in the blood and the usual symptoms of low testosterone, such as low energy and desire, he explained.
“Most men with these symptoms who seek testosterone treatment are attempting to enhance their quality of life,” Halpern remarked. “However, other men may seek testosterone therapy for other reasons, such as gaining muscle mass.” When prescribed to individuals who require it, administered as directed, and monitored carefully, it is “considered generally safe,” he said.
Nonetheless, Halpern and his colleagues emphasized that, according to the U.S. Drug Enforcement Administration, testosterone is a prohibited substance. This implies that similar to anabolic steroids and the anesthetic party drug ketamine, there is a low-to-moderate risk of addiction.
Halpern explained that a primary care physician, urologist, or endocrinologist often prescribes testosterone through a neighborhood drugstore.
Even when administered correctly and under ideal medical conditions, testosterone therapy is not without risks. According to Halpern, these include blood thickening and infertility. It can also cause a rare but serious rise in red blood cell counts, which can cause blood clots and bleeding and/or increase the risk of heart attacks or stroke.
Given these issues, Halpern and his colleagues questioned whether approved prescribing guidelines and risk disclosures are a standard component of the online purchase process.
Evidently not, as the team discovered after creating a “secret shopper” internet profile to research online testosterone therapy possibilities. The “dummy” profile, depicting a 34-year-old guy battling with low energy and reduced libido – symptoms of low testosterone levels — made it plain that the patient was interested in trying testosterone while remaining fertile in the future.
The profile was uploaded to seven U.S.-based online portals that offer testosterone. Various intake methods included submitting lab testing results and engaging in telemedicine consults with nurse practitioners, physician assistants, or unlicensed individuals.
Nearly 86% of the sites offered to sell testosterone despite the fact that the dummy’s testosterone levels were within the normal range. Six of the seven portals had no minimum testosterone level requirement for therapy.
The investigators discovered that only one of the portals inquired about the patient’s specific heart health history or personal interest in future fertility and that only half of the portals raised potential fertility concerns. More than 83 percent of the time, blood thickness concerns were never mentioned.
“Testosterone therapy has many benefits, but it also has risks and is not appropriate for everyone,” Halpern emphasized. “While online direct-to-consumer platforms offer great promise in expanding access to care for men with low testosterone, there are some drawbacks. Men should first discuss testosterone treatment with their local health care provider.”
The findings were published in the December issue of JAMA Internal Medicine as a research letter. Dr. Pieter Cohen is an internist at Cambridge Health Alliance and an adjunct professor at Harvard Medical School in Boston.
Despite not being a member of the study team, he concludes that the current research “eloquently emphasizes many of the risks associated with acquiring testosterone from an online provider, even after undergoing blood testing.”
Cohen highlighted that “the patients were not appropriately screened, the testosterone prescription was not suitable, and patients were urged to utilize a variety of other questionable and potentially deadly medicines in addition to testosterone.”
In many cases, he continued, the symptoms people are quick to assign to low testosterone are actually the result of normal aging or other ailments. “But that hasn’t prevented testosterone marketers from trying to get as many people as possible on the medicine,” Cohen said.