The Growing Conversation Around Testosterone Deficiency
In contemporary society, discussions surrounding testosterone deficiency have become increasingly prevalent, with both influencers and politicians fixating on ways to avert a lifestyle characterised by “low testosterone levels.” As cultural awareness of this hormone intensifies, so too does the demand for solutions. In a timely development, the telehealth giant Hims has introduced a testosterone replacement therapy service tailored for cisgender men.
This initiative will provide two types of injectable treatments, alongside an oral pill option that can be dispatched to patients following a home capillary blood test. Peter Stahl, a urologist and Senior Vice President of Men’s Health at Hims, emphasises the goal of maximising outreach and encouraging as many individuals as possible to undergo testing.
Initially launched to offer medications for erectile dysfunction, Hims has expanded into female health and evolved from a startup to a publicly traded company, serving 2.9 million customers since its inception in 2017. The addition of testosterone replacement therapy (TRT) marks a significant milestone for the health platform and represents a committed focus on male healthcare. “When we started, we lacked the capacity to address a complex condition like testosterone deficiency. We have finally matured,” Stahl remarks.
Navigating a Competitive Landscape
Hims now finds itself in competition with a burgeoning array of online clinics that provide testosterone therapy, many of which have emerged in recent years, leveraging telehealth services for rapid establishment. Numerous offerings in this sector market testosterone as a lifestyle enhancer or an anti-ageing remedy.
Stahl observes that testosterone deficiency is a “severely underdiagnosed” and “misunderstood” medical condition. Following the Anabolic Steroid Control Act of 1990, testosterone became a controlled substance, and for decades, its use has been associated with gym enthusiasts fixated on muscle gain. “This has generated considerable stigma,” he notes. Earlier research also suggested that testosterone therapy carried cardiovascular risks, although recent findings indicate these concerns may have been overstated.
The fixation on testosterone levels has permeated the Make America Great Again (MAGA) movement. This autumn, Pentagon chief Pete Hegseth announced mandatory screening for testosterone deficiency among the majority of male soldiers in the US Armed Forces. Furthermore, Texas Republicans have weaponised the term “low T” as an insult, questioning masculinity in a heated Senate race between Ken Paxton and James Talarico.
A recent survey conducted this summer among 2,000 American men reveals an increasing willingness to discuss testosterone treatment; however, the stigma surrounding the use of medication to address low levels still lingers.
Understanding the Regulatory Landscape
As a controlled substance, testosterone cannot be dispensed like many other popular treatments available through digital clinics. Unlike GLP-1 medications or estrogen-based hormone replacement therapy, which are often prescribed following a quick questionnaire, TRT necessitates synchronous care. This means potential users must engage in a video consultation with a physician prior to obtaining a prescription and for ongoing follow-up.
It is crucial to recognise that testosterone therapy can lead to infertility and should not be administered to individuals attempting to conceive, argues urologist Mohit Khera, director of the Andrology Research Laboratory at Baylor College of Medicine’s McNair Medical Institute. Khera views telehealth TRT services as a promising avenue to enhance access to medication, “as long as they are appropriately monitored.”
While laboratory tests can indicate if testosterone levels fall below thresholds established by organisations such as the American Urological Association, diagnoses are not solely reliant on blood tests. Physicians assess test results alongside patient symptoms and medical history. Common signs of hypogonadism (the clinical term for this diagnosis) include sexual dysfunction and muscle mass loss. Stahl describes this condition as a “powerful biomarker” for understanding an individual’s health status.
Innovative Testing Methods
“Frankly, it is underutilised,” he explains, noting that men with low testosterone levels face a 35% increased risk of overall mortality. The “low T” test does not necessitate conventional blood extraction. Instead, Hims will send patients a Tasso blood collection device, a single-use round tool that adheres to the upper arm and punctures the skin with micro-needles to gather a small sample. Subsequently, the patient sends the sample to a laboratory for analysis of a broad range of 21 different biomarkers to evaluate their health, including triglycerides and thyroid hormones, in addition to testosterone.
Depending on the results, patients may be prescribed a compounded injectable testosterone, a commercially available injectable, an oral tablet, or even something entirely different if their testosterone levels are not low. Stahl believes that hormonal testing can serve as an incentive for men who might otherwise be reluctant to consult a doctor. “Getting tested for testosterone deficiency is much more appealing for a young man who feels well than undergoing a cholesterol screening. That is why we are striving to capitalise on that opportunity to the fullest.”
Challenges in Online Testosterone Sales
The expansion of Hims occurs during a challenging period for online testosterone sales. In 2022, urology researchers conducted an undercover investigation into how digital clinics prescribed the medication, revealing that six out of seven analysed platforms offered testosterone replacement therapy despite normal hormone levels being recorded.
While Stahl aims to test a broad population, he maintains a more cautious philosophy regarding who should genuinely receive a testosterone prescription, especially when juxtaposed with digital clinics that market it as an anti-ageing treatment or lifestyle enhancement: “If you do not present symptoms, it does not matter what your testosterone level is; you will not receive treatment on our platform.”