Direct-to-Consumer Healthcare Websites Need Better Patient Education

Direct-to-consumer healthcare websites that offer a medication after online screening might be improving patient access to care, but they often fail to provide the patient education industry groups say is necessary to ensure informed treatment decisions, according to research in JAMA Internal Medicine.

The researchers zeroed in on DTC websites offering testosterone therapy to cisgender men. In an analysis of these websites, the team found that services don’t follow American Urological Association (AUA) or Endocrine Society (ES) guidelines for patient education.

This comes as direct-to-consumer online services become commonplace in healthcare. These companies are prevalent in the mental and reproductive healthcare space and provide patients access to prescription medications after a telehealth consultation with an online provider.

They are also advantageous in the men’s healthcare space, the authors argued in a research letter. Low testosterone levels, known as hypogonadism, can cause some highly stigmatized issues, like erectile dysfunction, decreased libido, fatigue, and depression. An online DTC platform may help connect men to testosterone treatments that can help these ailments.

But assuring good outcomes requires a thorough assessment and understanding of testosterone treatments, the researchers cautioned. Getting testosterone treatments via a DTC healthcare website may be beneficial so long as there is enough information to help consumers assess whether they truly qualify for the treatment.

“Testing and treatment for low testosterone is more accessible than ever before thanks to these online platforms. Men can be evaluated and even start testosterone therapy without leaving home,” Joshua A. Halpern, MD, senior author on the paper and urologist at Northwestern Medicine, said in a public statement. “While there’s benefit in improving access, there’s also potential for harm when providers fail to follow evidence-based guidelines, or when the benefits and risks of treatment are not appropriately communicated.”

Through a secret shopper study, the researchers found that patient education is insufficient.

The team looked at seven US-based online companies that provide testosterone treatments in all 50 states, posing as a 34-year-old man displaying some hypogonadal symptoms like low energy and low libido.

The secret shopper completed patient intake, laboratory diagnostic testing, and telemedicine assessments with nurse practitioners, physician assistants, or non-medically licensed personnel. The process was efficient, the researchers reported, but left some information gaps for the consumer.

“While my interactions with the telemedicine platforms were pleasant and efficient, I was surprised by some of the gaps in their counseling and their recommendations that I pursue testosterone therapy,” Justin Dubin, MD, first author and secret shopper of the study, said in a press release.

Specifically, Dubin and team found that online direct-to-consumer healthcare websites are offering testosterone therapies to individuals who do not qualify. In total, 85.7 percent of the platforms included in the study offered testosterone therapy to the secret shopper, even though he had normal total testosterone (TT) and said he prioritized future fertility.

Moreover, the criteria for offering testosterone therapy was out of step with recommendations from the AUA and ES. One website offered treatment to men with TT below 450 ng/dL, which is within the normal TT range (264 to 916 ng/dL), the researchers said. The remaining six platforms had no threshold for offering testosterone treatment.

This is particularly troublesome because these websites aren’t always communicating the risks of taking testosterone therapy, especially for those who don’t qualify.

For example, 83.3 percent of the websites did not discuss the risks of an increase in blood thickness, and half did not discuss the fertility risks of testosterone therapy.

Meanwhile, patient intake and assessment were found lacking. Only one in seven platforms asked patients about high-risk medical history, like recent cardiovascular events. The same proportion asked about the consumer’s desire for future fertility.

These findings are alarming considering the insurgence of direct-to-consumer online healthcare platforms. As these platforms become more commonplace, it will be critical to first compel them to prioritize patient education but to also supplement that education in the more traditional medical space.

“Online platforms have great potential for expanding access to men’s healthcare screenings and treatments, especially for issues like erectile dysfunction and infertility,” Halpern concluded. “However, until these services are providing therapies based on established guidelines, it’s important than patients and providers are educated on the potential pitfalls of seeking this type of treatment online.”