* 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.
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.
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.
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.
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 alMethods
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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