madman
Super Moderator
* They discuss how these clinics often bypass proper lab testing, ignore fertility risks, and prioritize quick prescriptions over patient safety—all under the buzzword of “optimization.”
Testosterone therapy is trending—but are clinics doing it right? Dr. Geo and Dr. Justin Dubin break down the real risks behind today’s low-T industry.
In this revealing episode, Dr. Geo is joined by Dr. Justin Dubin, a fellowship-trained urologist and host of The Man Up Podcast, to break down the growing concerns around direct-to-consumer testosterone clinics. They discuss how these clinics often bypass proper lab testing, ignore fertility risks, and prioritize quick prescriptions over patient safety—all under the buzzword of “optimization.”
Together, they explore:
* Dr. Dubin’s shocking undercover study on online TRT clinics
* Why 6 out of 7 clinics prescribed testosterone to men who didn’t qualify
* The risks of infertility, priapism, and cardiac issues from poorly managed TRT
* What’s wrong with the “one-size-fits-all” approach to men’s health
* How to ask the right questions before starting hormone therapy
* The role of Clomid, SARMs, and hCG in fertility and testosterone treatment
* When to see a board-certified urologist vs. an online clinic
If you're considering TRT or want to protect your long-term health, this episode is a must-listen. Packed with science, honesty, and practical guidance.
Methods
Using internet searches with 18 search terms, we identified US-based companies providing testosterone therapy online and operating in all 50 states between April and August 2022. Of 10 companies identified, 3 were excluded from evaluation: 1 did not accept new patients, and 2 did not accept the secret shopper’s laboratory test results because tests were not performed within the company’s specified timeframe. Seven companies underwent secret shopper assessment, wherein the secret shopper (J.M.D.) used a script to inquire about and initiate the process of testosterone therapy. The script described a hypothetical 34-year-old man with low energy and low libido who was interested in future fertility (eAppendix in the Supplement). In addition to completing the intake evaluation, the secret shopper completed all required testing at an independent laboratory (LabCorp) and the initial telemedicine consultation for each platform (eTables 1 and 2 in the Supplement). The evaluation and management of the secret shopper through each platform were assessed according to guideline statements from the Endocrine Society<a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799297#ild220036r5" data-tab-toggle=".tab-nav-references">5</a> and the American Urological Association<a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799297#ild220036r6" data-tab-toggle=".tab-nav-references">6</a> to examine guideline concordance. Descriptive statistics were performed using Microscoft Excel, version 16.20 (Microsoft Corp). The study did not meet Northwestern University criteria for human participants research because it was conducted without identification of any individuals, and the unit of observation was at the platform level.
Testosterone therapy is trending—but are clinics doing it right? Dr. Geo and Dr. Justin Dubin break down the real risks behind today’s low-T industry.
In this revealing episode, Dr. Geo is joined by Dr. Justin Dubin, a fellowship-trained urologist and host of The Man Up Podcast, to break down the growing concerns around direct-to-consumer testosterone clinics. They discuss how these clinics often bypass proper lab testing, ignore fertility risks, and prioritize quick prescriptions over patient safety—all under the buzzword of “optimization.”
Together, they explore:
* Dr. Dubin’s shocking undercover study on online TRT clinics
* Why 6 out of 7 clinics prescribed testosterone to men who didn’t qualify
* The risks of infertility, priapism, and cardiac issues from poorly managed TRT
* What’s wrong with the “one-size-fits-all” approach to men’s health
* How to ask the right questions before starting hormone therapy
* The role of Clomid, SARMs, and hCG in fertility and testosterone treatment
* When to see a board-certified urologist vs. an online clinic
If you're considering TRT or want to protect your long-term health, this episode is a must-listen. Packed with science, honesty, and practical guidance.
Guideline-Discordant Care Among Direct-to-Consumer Testosterone Therapy Platforms
Justin M. Dubin, MD1; Erin Jesse, MD2; Richard J. Fantus, MD3; et alMethods
Using internet searches with 18 search terms, we identified US-based companies providing testosterone therapy online and operating in all 50 states between April and August 2022. Of 10 companies identified, 3 were excluded from evaluation: 1 did not accept new patients, and 2 did not accept the secret shopper’s laboratory test results because tests were not performed within the company’s specified timeframe. Seven companies underwent secret shopper assessment, wherein the secret shopper (J.M.D.) used a script to inquire about and initiate the process of testosterone therapy. The script described a hypothetical 34-year-old man with low energy and low libido who was interested in future fertility (eAppendix in the Supplement). In addition to completing the intake evaluation, the secret shopper completed all required testing at an independent laboratory (LabCorp) and the initial telemedicine consultation for each platform (eTables 1 and 2 in the Supplement). The evaluation and management of the secret shopper through each platform were assessed according to guideline statements from the Endocrine Society<a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799297#ild220036r5" data-tab-toggle=".tab-nav-references">5</a> and the American Urological Association<a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2799297#ild220036r6" data-tab-toggle=".tab-nav-references">6</a> to examine guideline concordance. Descriptive statistics were performed using Microscoft Excel, version 16.20 (Microsoft Corp). The study did not meet Northwestern University criteria for human participants research because it was conducted without identification of any individuals, and the unit of observation was at the platform level.
