Testosterone clinics - Do they know what they are doing?

* 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.”



TRT clinics do they know what they are doing.webp


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.




The Rise of Direct-to-Consumer Testosterone Clinics: Hope, Hype, and Hidden Hazards

Introduction


The landscape of men’s health and hormone management is undergoing rapid transformation. Spurred by telemedicine, marketing savvy, and men’s increasing willingness to seek help for sexual and hormonal concerns, direct-to-consumer (DTC) testosterone clinics are now difficult to ignore. On a recent episode of the Dr. Geo Prostate Podcast, Dr. Gio welcomed Dr. Justin Dubin—a fellowship-trained urologist and andrologist—to discuss the clinical realities, dangers, and promise of this booming sector.

Below, we distill the essential insights from their conversation, exploring why these clinics proliferate, what they get right (and wrong), and what every man should know before considering testosterone therapy in the modern era.

Why Direct-to-Consumer Testosterone Clinics Are Exploding

Dr. Dubin notes that the DTC model—for testosterone and other men’s health treatments—took off in the early days of the COVID-19 pandemic. Loosened regulations around telemedicine and controlled substances (such as testosterone) led to an explosion in online clinics and remote prescription platforms. DTC clinics were no longer limited to brick-and-mortar spaces in “hot spot” states like Florida; they now offered access to men in all 50 states.

But why are men flocking to these alternative providers? The podcast highlights several powerful drivers:

Privacy: Studies show privacy trumps both cost and convenience. Men want to avoid the stigma and perceived exposure of going to a clinic for erectile or hormonal issues.

Access: Not all men have easy local access to urologists or hormone specialists, especially in rural areas.

Convenience and Speed: Traditional clinic wait times can be months. DTC clinics often promise near-instant appointments and prescriptions.

Marketing & Destigmatization: Aggressive advertising on social media is helping destigmatize men’s health topics, pulling more men into the conversation—sometimes before they're truly educated about the complexity of hormonal health.

The Core Risks: When Convenience Becomes Hazardous

Despite their promise, Dr. Dubin’s research—summed up in his “secret shopper” study—exposes systemic risks within the DTC model. Key findings and concerns include:

1. Overprescribing Without Sufficient Medical Need

Dubin, posing as a healthy 34-year-old wanting children, submitted real bloodwork with total testosterone at 675 ng/dL—well within the normal range—to seven major DTC clinics. Six out of seven offered him testosterone therapy anyway, despite clear contraindications (normal T, desire for future fertility).

Why is this risky?

Fertility Threats:
Exogenous testosterone suppresses testicular function (LH and FSH), often leading to reduced or absent sperm production—even after just four months of therapy.

Lack of Patient Counseling: Only half of clinics disclosed infertility as a major risk, and most failed to set clinical goals for therapy; some stated the only goal was to “keep raising the dose until you feel better.”

2. Overemphasis on “Optimization,” Not Replacement

Social media and DTC clinics increasingly use the language of “optimization” instead of “replacement.” This suggests any man can benefit from supraphysiological testosterone, regardless of medical indications. But Dr. Dubin and Dr. Gio challenge this paradigm:

There is no agreed-upon, evidence-based “optimized” testosterone target above normal ranges.

More is not always better—there’s no solid evidence supporting improved well-being, mood, or function in eugonadal men bumped into higher ranges.

3. Lack of Thorough Evaluation

DTC visits often last just 15 minutes—and the focus is rarely on the total health picture. As both physicians point out:

Symptoms like low libido, erectile dysfunction, and fatigue often have multifactorial causes (sleep, mental health, relationship issues, medications).

Without in-depth evaluation, underlying cardiovascular, psychological, or metabolic problems may be missed.

4. Use of Non-Physician Providers and Unclear Qualifications

Patients often have little idea who is evaluating them at DTC clinics. Unlike traditional settings, the credentials, experience, and oversight of providers may not be transparent or standardized.

Why Patient Motivation and Psychology Matter

The conversation highlights that DTC clinics tap into deep psychological needs—privacy, autonomy, and the hope for a quick fix—which traditional clinics have often failed to address. Dr. Dubin’s research underlines:

Privacy > Cost or Convenience: Men, even at higher price points, prefer discretion over office visits. This stigma remains a huge barrier to seeking traditional care.

Gateway to Care: Paradoxically, DTC models may function as a gateway—getting men to engage with health issues and, ultimately, see qualified physicians when they want more thorough answers.

Redefining “Optimization” and Realistic Alternatives

The podcast challenges the “optimization” buzzword:

Optimization is subjective and ill-defined. What’s optimal for one man may be maladaptive or even harmful for another.

Genuine “optimization” starts with lifestyle—addressing sleep, stress, diet, and exercise—and reserves pharmacological intervention for well-defined clinical hypogonadism.

Non-Testosterone Therapies

For men experiencing symptoms but wanting to maintain fertility, options like clomiphene citrate or hCG can stimulate endogenous testosterone without suppressing sperm production—an approach underutilized by many DTC clinics.

Practical Takeaways: What Every Patient Should Ask

Both Dr. Dubin and Dr. Gio encourage patients to move from passive recipients to active participants in their health journeys. Before starting or continuing testosterone therapy, especially with DTC clinics, patients should ask:

What is my precise diagnosis and do I qualify for TRT by standard guidelines?

What are the risks and benefits of therapy, including impact on fertility, cardiovascular health, and need for lifelong therapy?

Who is prescribing my medication, and what are their qualifications and experience in androgen management?

Am I being fully evaluated for other causes of my symptoms—sleep apnea, stress, metabolic health, relationships, etc.?

Can I take time to review before making a decision, and obtain a second opinion if desired?

The Bottom Line: Buyer Beware, But Collaboration Is Possible


The DTC testosterone boom is here to stay, driven by privacy, access, and the power of marketing. But with great convenience comes the risk of overdiagnosis, overtreatment, and ignored long-term consequences.

Ideally, DTC clinics and traditional providers can coexist—and even complement each other—if patients are equipped to ask critical questions and demand high standards.

As always: If it sounds too good to be true, it probably is.

Final Word

Being your own health advocate means embracing curiosity and skepticism. Whether you engage with a traditional clinic or a DTC provider, the responsibility to ask informed questions and seek credible medical advice ultimately rests with you. As Dr. Dubin puts it, “If someone’s mad at you for asking questions, that’s a red flag.”

About the Experts:

Dr. Justin Dubin
is a fellowship-trained urologist and andrologist at Memorial Health Care System, host of the Man Up podcast, and an active researcher in men’s health behaviors and clinical care paradigms.

Dr. Geo Espinosa is an integrative urologist, founder of the Dr. Geo Prostate Podcast, and a leading advocate for empowered, evidence-based men’s health.


Guideline-Discordant Care Among Direct-to-Consumer Testosterone Therapy Platforms​

Justin M. Dubin, MD1; Erin Jesse, MD2; Richard J. Fantus, MD3; et al


Methods


Between April and August 2022, we conducted systematic internet searches using 18 predefined search terms to identify US-based companies offering testosterone therapy online and operating in all 50 states. Of the 10 identified companies, three were excluded: one that was not accepting new patients, and two that did not accept laboratory test results from the secret shopper because the tests were not performed within the company’s required timeframe. The remaining seven companies underwent a secret shopper evaluation. The secret shopper (J.M.D.) followed a standardized script representing a hypothetical 34-year-old man experiencing low energy and low libido, with an interest in future fertility (Appendix in the Supplement). In each case, the secret shopper completed the full intake evaluation, obtained required laboratory tests at an independent facility (LabCorp), and participated in the initial telemedicine consultation offered by each platform (Tables 1 and 2 in the Supplement). Assessments of evaluation and management were conducted in accordance with clinical practice guidelines from the Endocrine Society and the American Urological Association to determine guideline concordance. Descriptive statistics were generated using Microsoft Excel, version 16.20 (Microsoft Corp). In line with Northwestern University policies, the study was exempt from human participant research requirements as it did not involve identifiable individuals and used the platform as the unit of analysis.




 
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Most that I have had any experience with would not even qualify to be a member of this forum. I had a friend go to one who gave him a mixture of HCG, testosterone and Arimidex in a single dose. No testing, just a shotgun approach that they used for everyone. The worst part is that in most cases you have to go in weekly to be injected as they don't give prescriptions. Major scam...
 
Most that I have had any experience with would not even qualify to be a member of this forum. I had a friend go to one who gave him a mixture of HCG, testosterone and Arimidex in a single dose. No testing, just a shotgun approach that they used for everyone. The worst part is that in most cases you have to go in weekly to be injected as they don't give prescriptions. Major scam...
I guess I’ve been fortunate to have only ever been treated by two clinics and they both seemed reasonably good at treating patients. I would say that one of the reasons for that is that I do a lot of research before making big changes in my life so trt was obviously no exception. This forum is actually how I found Defy medical and I’ve been happy with them for years. Not perfect, but overwhelmingly a positive experience.


I haven’t listened to the podcasts in this thread, but one thing that jumped out to me is the claim:

Why 6 out of 7 clinics prescribed testosterone to men who didn’t qualify


If they are saying a person has to have repeated tests under the normal reference range then I don’t agree with that logic. I may be in the minority here, but that doesn’t make sense at all to me. Sure if someone is living a very unhealthy lifestyle they should focus on some of those variables first, but at the same time trt can even help with getting and staying on a healthier path. Also, if a guy is in his 40’s and he’s testing at around 410 for total test levels with free t just a few points above the bottom of the range…. then what’s the point of saying “sorry, just suck it up and deal with subpar physical and mental health for the next few years and maybe you’ll deteriorate to the point of being below range by then and we can start treating you” ? Sure, you don’t want to just put everyone on it, but there is a balancing act with regard to helping people get the benefits safely. And the better a clinic is at treating people I’d say the more people they can help. Clearly point out the risks and be realistic about the benefits so they can have informed consent. Then explain why the treatment plan looks the way it does, and adjust accordingly along the way.

I do think it’s important to call out clinics that are harming patients, but I just worry that if the message is stated too loudly the govt. will step in and shut many good clinics down. It wasn’t that long ago that we narrowly avoided our govt. stopping trt from being eligible for telehealth. I do feel better about things with this current administration, but a lot of the same politicians and lobby groups are still operating and would love more ammo to use for their case being made to restrict access to these therapies. So going around trying to say most of these clinics are being irresponsible only helps fuel their case for the need to implement MORE oversight, which basically means just roadblocks so we’re less healthy and being directed towards Big Pharma for our health needs.
 
I guess I’ve been fortunate to have only ever been treated by two clinics and they both seemed reasonably good at treating patients. I would say that one of the reasons for that is that I do a lot of research before making big changes in my life so trt was obviously no exception. This forum is actually how I found Defy medical and I’ve been happy with them for years. Not perfect, but overwhelmingly a positive experience.


I haven’t listened to the podcasts in this thread, but one thing that jumped out to me is the claim:

Why 6 out of 7 clinics prescribed testosterone to men who didn’t qualify


If they are saying a person has to have repeated tests under the normal reference range then I don’t agree with that logic. I may be in the minority here, but that doesn’t make sense at all to me. Sure if someone is living a very unhealthy lifestyle they should focus on some of those variables first, but at the same time trt can even help with getting and staying on a healthier path. Also, if a guy is in his 40’s and he’s testing at around 410 for total test levels with free t just a few points above the bottom of the range…. then what’s the point of saying “sorry, just suck it up and deal with subpar physical and mental health for the next few years and maybe you’ll deteriorate to the point of being below range by then and we can start treating you” ? Sure, you don’t want to just put everyone on it, but there is a balancing act with regard to helping people get the benefits safely. And the better a clinic is at treating people I’d say the more people they can help. Clearly point out the risks and be realistic about the benefits so they can have informed consent. Then explain why the treatment plan looks the way it does, and adjust accordingly along the way.

I do think it’s important to call out clinics that are harming patients, but I just worry that if the message is stated too loudly the govt. will step in and shut many good clinics down. It wasn’t that long ago that we narrowly avoided our govt. stopping trt from being eligible for telehealth. I do feel better about things with this current administration, but a lot of the same politicians and lobby groups are still operating and would love more ammo to use for their case being made to restrict access to these therapies. So going around trying to say most of these clinics are being irresponsible only helps fuel their case for the need to implement MORE oversight, which basically means just roadblocks so we’re less healthy and being directed towards Big Pharma for our health needs.
If the reports we've seen here are an accurate sample, "board certified urologists" are no better than clinics. Different perhaps but not better.
 
If the reports we've seen here are an accurate sample, "board certified urologists" are no better than clinics. Different perhaps but not better.
Good point. We’ve all heard countless stories of urologists “treating” their patients with terrible protocols. Like so many other specialized healthcare fields, it seems they want to be the gatekeepers for their niche. They likely feel threatened that so many clinics are offering treatments to people that would otherwise be patients(ie customers) for their practices.
 
I guess I’ve been fortunate to have only ever been treated by two clinics and they both seemed reasonably good at treating patients. I would say that one of the reasons for that is that I do a lot of research before making big changes in my life so trt was obviously no exception. This forum is actually how I found Defy medical and I’ve been happy with them for years. Not perfect, but overwhelmingly a positive experience.


I haven’t listened to the podcasts in this thread, but one thing that jumped out to me is the claim:

Why 6 out of 7 clinics prescribed testosterone to men who didn’t qualify


If they are saying a person has to have repeated tests under the normal reference range then I don’t agree with that logic. I may be in the minority here, but that doesn’t make sense at all to me. Sure if someone is living a very unhealthy lifestyle they should focus on some of those variables first, but at the same time trt can even help with getting and staying on a healthier path. Also, if a guy is in his 40’s and he’s testing at around 410 for total test levels with free t just a few points above the bottom of the range…. then what’s the point of saying “sorry, just suck it up and deal with subpar physical and mental health for the next few years and maybe you’ll deteriorate to the point of being below range by then and we can start treating you” ? Sure, you don’t want to just put everyone on it, but there is a balancing act with regard to helping people get the benefits safely. And the better a clinic is at treating people I’d say the more people they can help. Clearly point out the risks and be realistic about the benefits so they can have informed consent. Then explain why the treatment plan looks the way it does, and adjust accordingly along the way.

I do think it’s important to call out clinics that are harming patients, but I just worry that if the message is stated too loudly the govt. will step in and shut many good clinics down. It wasn’t that long ago that we narrowly avoided our govt. stopping trt from being eligible for telehealth. I do feel better about things with this current administration, but a lot of the same politicians and lobby groups are still operating and would love more ammo to use for their case being made to restrict access to these therapies. So going around trying to say most of these clinics are being irresponsible only helps fuel their case for the need to implement MORE oversight, which basically means just roadblocks so we’re less healthy and being directed towards Big Pharma for our health needs.
I wouldn't consider Defy as one of the offenders. I also use Defy for certain things and have nothing but positive things to say about them.

Testing is everything. Doing the right tests and then having an understanding of what they indicate is how you decide whether someone should or shouldn't be on HRT. You don't treat numbers. I know guys in the 400-500 range that do very well on their own. Different genetics create some wide variables. AR sensitivity and the resulting genetic expression is unfortunately not created equally in all of us. As you mentioned, it is the free T that makes the mojo happen. Just what level is best for an individual is based on that person's chemistry, other factors like overall health and wellbeing being assumed. DHT is so often overlooked, villainized and misunderstood. It is a crucial part of the equation.

Age takes it's toll, the decline usually begins in the 30's, but it's subtle. Most guys don't really feel it until their 40's. There are a LOT of fat, flabby, no muscle toned pasty 30-year-olds that end up tired, exhausted and depressed 40-year-olds. While I do enjoy being poolside with them (they make me look good), I can't help but feel like the male species is in a free fall. Which brings up another of your points... politics.

"Toxic Masculinity" Pardon me while I go barf... This has to be the most ridiculously stupid thing I have ever heard of. Before I go further, I am an independent. I believe in working things out, being tolerant of other people's views, defending the rights of people to live their lives as they see fit and GETTING ALONG WITH EACH OTHER. We are now so politically divided that those basic common-sense ideals are seen by some as a declaration of war.

There is most definitely a war being waged on testosterone use for biological men to maintain their masculinity. But not for a biological female to artificially create theirs. I am all for that if that is something a free minded person of age chooses. As a matter of fact, I will be happy to help anyone in that subset in their pursuit. It's the hypocrisy and the hostility that are ruining things.

To each their own, but I also get to have my own paradigm. I won't tolerate anyone telling me different. If my male mojo makes me toxic to some, then my advice is to avoid me at all costs. ;)
 
I wouldn't consider Defy as one of the offenders. I also use Defy for certain things and have nothing but positive things to say about them.

Testing is everything. Doing the right tests and then having an understanding of what they indicate is how you decide whether someone should or shouldn't be on HRT. You don't treat numbers. I know guys in the 400-500 range that do very well on their own. Different genetics create some wide variables. AR sensitivity and the resulting genetic expression is unfortunately not created equally in all of us. As you mentioned, it is the free T that makes the mojo happen. Just what level is best for an individual is based on that person's chemistry, other factors like overall health and wellbeing being assumed. DHT is so often overlooked, villainized and misunderstood. It is a crucial part of the equation.

Age takes it's toll, the decline usually begins in the 30's, but it's subtle. Most guys don't really feel it until their 40's. There are a LOT of fat, flabby, no muscle toned pasty 30-year-olds that end up tired, exhausted and depressed 40-year-olds. While I do enjoy being poolside with them (they make me look good), I can't help but feel like the male species is in a free fall. Which brings up another of your points... politics.

"Toxic Masculinity" Pardon me while I go barf... This has to be the most ridiculously stupid thing I have ever heard of. Before I go further, I am an independent. I believe in working things out, being tolerant of other people's views, defending the rights of people to live their lives as they see fit and GETTING ALONG WITH EACH OTHER. We are now so politically divided that those basic common-sense ideals are seen by some as a declaration of war.

There is most definitely a war being waged on testosterone use for biological men to maintain their masculinity. But not for a biological female to artificially create theirs. I am all for that if that is something a free minded person of age chooses. As a matter of fact, I will be happy to help anyone in that subset in their pursuit. It's the hypocrisy and the hostility that are ruining things.

To each their own, but I also get to have my own paradigm. I won't tolerate anyone telling me different. If my male mojo makes me toxic to some, then my advice is to avoid me at all costs. ;)
Agreed on every single point. The people who have been in charge or overseeing public health in this country can’t hide anymore… the results speak for themselves. This is what happens when they prioritize profit over their supposed mission of improving public health. As mentioned above, I hope that will improve with our current administration. Either way putting Robert Kennedy, Casey Means, Jay Bhattacharya, and other similar figures are very high level positions is a good sign. I’m not expecting miracles, but even just adjusting course towards a more positive path will be a huge improvement.

Likewise on the cultural front. I hope we have seen the worst of the craziness and are now moving in a better direction. And you’re right there has been a war on manhood for a while, but again hopefully the worst is behind us. Unfortunately it doesn’t look like the division is getting any better, but I’m with you… to each their own and if you don’t like me then don’t come around me and listen to what I have to say.
 
Buyers beware. I checked out many clinics before I decided to go with defy medical. That was over 10 years ago. I believe I made it right choice.
This the key IMO. There is no substitute for self-education, and as I've pointed out many times, the body is a highly interconnected set of systems, and a lot of urologists and clinics are likely jumping straight to hormone-centric treatments when the underlying issue is something else like chronic infections, bad diet, etc.
 
This the key IMO. There is no substitute for self-education, and as I've pointed out many times, the body is a highly interconnected set of systems, and a lot of urologists and clinics are likely jumping straight to hormone-centric treatments when the underlying issue is something else like chronic infections, bad diet, etc.
I was on Excelmale almost a year before I started TRT
 

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