Getting prescription medications online is so easy. Are regulators paying attention?

It all started with a Google search for prescription medications I could get online.

Almost immediately, ads from telehealth companies began pursuing me across the Internet, promising access to drugs to make me prettier, thinner, happier, and hornier. Several of these companies sell anti-aging creams. Although resolutely pro-aging, I don’t like the visible effects of my sun-drenched youth. Of course, I thought. Why not?

In less than an hour, I had joined the millions of Americans who obtained prescription drugs from providers in cyberspace.

Telehealth, an umbrella term for health care delivered over the phone, video chat or messaging, has exploded during the pandemic. Since then, it has become a pillar of many medical practices. Also riding the telehealth wave, many Internet-based companies make it easier to prescribe and often sell medications for complaints that people don’t want to discuss face-to-face with a doctor for reasons of time, money or of embarrassment.

My experience represents the sunny side of direct-to-consumer telehealth. It took me 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 derivative of vitamin A that smoothes fine wrinkles and fades dark spots. Six days later it arrived at my door.

Compared to the conventional healthcare system, the process of getting the prescription was like a fast pass to Disneyland.

But last year, urologist Justin Dubin discovered a darker side to DTC telehealth. Alarmed to see patients being prescribed the hormone testosterone without a valid medical reason or warning about side effects, Dubin infiltrated as a secret marketer on seven platforms targeting men’s health. Following one scenario, he described himself as a happily married 34-year-old man bothered by low energy, decreased libido, and erectile dysfunction. I’ve read about low testosterone and its symptoms online, he told potential prescribers, and I’m afraid I might suffer from it.

Dubin, who like his alter ego was 34, submitted his own lab results showing healthy hormone levels. It was clear I didn’t 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 the medical society’s guidelines by offering to prescribe him injectable testosterone. They also offered to sell him several other testosterone-boosting drugs and supplements that were not suitable for his hypothetical case.

What Dubin found was nothing short of egregious, said Steven Woloshin, a professor of medicine at Dartmouth. Even though Dubin’s scenario 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 this hormone may reduce fertility. For this simulated patient, it could interfere with his goal of having children, and they were treating something he didn’t have, Woloshin said. It just seemed like it was a terrible medical practice.

Woloshin said the paper has big implications for poor quality of care online: There’s no reason to think 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 risk of poor care, they write, and regulators need to do more to protect them.