It started with a Google search for prescription medications I might get online.
Almost immediately, ads from telehealth companies began chasing me around the Internet, promising access to drugs to make me prettier, skinnier, happier, and hornier. Several of these companies sell anti-aging creams. While decidedly pro-aging, I don’t love the visible effects of my sun-soaked youth. “Sure,” I thought. “Why not?”
Within the hour I had joined the millions of Americans who get prescription drugs from providers in cyberspace.
Telehealth, an umbrella term for health care delivered by phone, video chat, or messaging, exploded during the pandemic. Since then, it has become a mainstay of many medical practices. Also riding the telehealth wave is a raft of Internet-based companies that facilitate prescribing—and often sell—medications for complaints that because of time, money, or embarrassment people don’t want to discuss with a doctor face-to-face.
My experience represents the sunny side of direct-to-consumer telehealth. It took about 15 minutes to fill out a medical history, upload photos of my face, and enter my credit card information on forhers.com, a website run by the telehealth company Hims & Hers Health, Inc. Twenty minutes later, a nurse practitioner had prescribed a Hers product containing tretinoin, a well-studied Vitamin A derivative that smooths fine wrinkles and fades dark spots. Six days after that, it showed up at my door.
Compared to the conventional health care system, the process of obtaining the prescription felt like scoring a fast pass at Disneyland.
But last year, urologist Justin Dubin discovered a darker side of DTC telehealth. Alarmed at seeing patients who had been prescribed the hormone testosterone without good medical reason or warnings about side effects, Dubin went undercover as a secret shopper at seven platforms targeting men’s health. Following a script, he described himself as a happily married 34-year-old man bothered by low energy, decreased sex drive, and erectile dysfunction. “I read about low testosterone and its symptoms online,” he told potential prescribers, “and I am worried that I might have it.”
Dubin, who like his alter ego was 34, submitted his own lab results showing healthy hormone levels. “It was pretty clear that I did not need testosterone,” said Dubin, who treats patients at Memorial Healthcare System in Florida. Nonetheless, as he detailed in a study published in JAMA Internal Medicine in December 2022, providers working for six of the seven companies defied medical society guidelines to offer to prescribe him injectable testosterone. They also offered to sell him several other testosterone-boosting drugs and supplements that were inappropriate for his hypothetical case.
“This was just egregious, what Dubin found,” said Steven Woloshin, a professor of medicine at Dartmouth. Even though Dubin’s script made it clear that he and his wife wanted to have a child in the near future, half of the telehealth providers offering testosterone failed to warn him that, in addition to other risks, taking the hormone can reduce fertility. “For this simulated patient it could interfere with his goal to have children, and they were treating something he didn’t have,” said Woloshin. “It just seemed like it was just a terrible practice of medicine.”
Woloshin said the paper has big implications about the poor quality of online care: “There’s no reason to think that this is unique to urology.”
In an accompanying editorial, Woloshin, and my former colleague Lisa Gill, an investigative reporter at Consumer Reports, called for better oversight of standalone DTC telehealth services. “Consumers need to be aware of the potential for bad care,” they wrote, “and regulators need to do more to protect them.”