Online prescription providers are more interested in your hairline than your health

Paul got his first bottle of pills from Hims in May. He said he didn't really need the generic Viagra, but after a friend bragged that he'd been using it for years to "go multiple rounds," Paul figured he'd give it a shot. So he signed in to Hims and found that the process of getting it from the direct-to-consumer telehealth company was almost disturbingly easy. Paul, who's in his early 40s, answered some multiple-choice questions online, a doctor supposedly reviewed his responses, and then a bottle of pills showed up in the mail a couple of days later.

He's used the drug twice, though it doesn't really work how he thought it would. Nobody had explained what to expect, which probably wouldn't be the case in a regular healthcare setting. When I asked Paul (a pseudonym) why he didn't just go to his regular doctor for the issue, his answer was succinct: "Speed, convenience, positive my doctor would say no." His primary-care provider had mentioned a while back that he thought Viagra was overprescribed.

The direct-to-consumer health industry has exploded in recent years. The pandemic accelerated the rise of telehealth, which these DTC companies are a part of both culturally and legally. Grand View Research estimates that the global telehealth market was worth $101.2 billion in 2023 and that it's growing rapidly. Multiple startups have popped up to capitalize on this growth, with venture capital and investor dollars flowing in. Hims & Hers Health has a market cap of over $4 billion. Ro, one of the other main players in the industry, has raised over $1 billion and has a valuation of $6.6 billion, according to PitchBook.

These companies sell a wide array of products to help with everything from weight loss to mental health. Much of their business proposition, however, is targeted specifically at young men and, more specifically, at their insecurities. Are you worried about your hairline? Your fertility? What about getting an erection? Are you scared to talk to a doctor face-to-face about any of this? Well, Hims promises you can "skip the awkward doctor visits" and offers "ED meds from your couch." A "healthy, handsome you" is only a click away.

"These platforms are basically set up to minimize the distance from advertising and hooking the consumer to getting a prescription in their hand," said Matthew McCoy, an assistant professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania. "The advantage of that is efficiency — people, understandably, don't have a lot of time always to spend on these sorts of things. The downside of that is risks that you're not making fully informed decisions or that the kind of advice that you're getting is being colored by the company's financial incentives rather than a doctor's honest opinion of what's in your medical best interest."

Those at the forefront of the DTC health revolution have American guys right where they want them: insecure, on edge, and ready to open their wallets.

There are some variations in how these services work, but the gist is this: You go to a website (probably because you saw some ad for it), fill out a questionnaire about your condition, maybe chat with a doctor (though often you don't), and then voilà, a prescription is on its way to you in what's promised to be discreet packaging.

"It typically bypasses traditional healthcare settings, and often there's little to no involvement of a healthcare provider," said Ashwini Nagappan, a doctoral candidate at UCLA's Fielding School of Public Health who has studied DTC medicine and ethics.

There is some altruistic appeal: DTC medication services can help with access for people who live in remote areas or can't easily get to a doctor. But for many clients, and especially young men, the upside is that it's simply more convenient than a traditional appointment.

"In general, men are less likely to utilize healthcare when compared to women," said Joshua Halpern, the chief scientific officer at Posterity Health, a male-fertility clinic, and an adjunct assistant professor of urology at Northwestern University's Feinberg School of Medicine. "And we know that many young men don't even have a primary-care physician to begin with, so the process of establishing care can be daunting, especially when it can take months to get an appointment."

Even if they do have a relationship with a medical provider, it may not be the type where they feel comfortable bringing up sensitive or stigmatized issues. Research indicates that when it comes to seeking care for sexual-health concerns, privacy is a primary consideration for young men. A review of literature on DTC telemedicine and men notes that men who use DTC platforms cite convenience as an important motivation, as well as embarrassment and discretion. Financial factors, interestingly, aren't very much in play. A survey conducted in late 2019 and early 2020 found that men under 40 and in the middle-income range were likelier to use DTC telehealth services than older, wealthier men.

While DTC services may help with timely access and do some work on destigmatizing certain issues, there are substantial drawbacks. Men using these services might not get the comprehensive evaluation they need to uncover underlying conditions and address their overall health, Halpern said, and they may not be seeing a healthcare provider who is most appropriate for managing their condition.

"They can also end up paying more for care that would be more affordable elsewhere or even covered by their medical insurance," he said.

His research suggests that some platforms may also be providing what's known as guideline-discordant care, meaning patients are getting unnecessary tests and inappropriate treatments, such as testosterone replacement for men who are trying to conceive, which can be detrimental in some cases. Plenty of doctors have sounded the alarm about DTC telehealth companies, and some firms have gotten into legal trouble, too. The Department of Justice has charged the leaders of the ADHD-focused telehealth company Done with fraud over its Adderall prescription practices and advertising.

For all the issues with DTC companies, it's fair to note that traditional healthcare settings are far from perfect. Patients can lie to their doctors in person. Providers don't always have a full view of their patients' health or everything they're taking. Navigating insurance and appointments is a hassle. But handing out drugs in a faceless manner across the internet is markedly different from what has happened in healthcare historically, and it presents different risks.

"When you're in person or you're doing telehealth through a more established healthcare entity, there is a little bit more collection of your medical history," Nagappan said.

While DTC platforms say they serve a valuable purpose in getting young men to address medical needs they would otherwise ignore, the monetary factors involved are different from those at a regular physician's office.

"These companies are in the business of selling drugs," McCoy said. "A medical provider ideally is in the business of providing the best medical care, which sometimes involves writing prescriptions for drugs, but sometimes involves alternative modalities or nothing at all."

One man who got generic Viagra through Hims told me he went through the platform to avoid the "8 million" questions his doctor would ask — and he knew he'd probably be approved. "I mean, whenever you deal with these drug companies that are trying to do direct-to-consumer, you've got to know that their doctors are just checking a box," he said. "They're not going to give you too much crap. If you have a pulse, they're going to give you a prescription." (He was also concerned about privacy, but he said the packaging wasn't as discreet as he'd hoped — "Hims" was on the shipping label, and he knows his mail guy.)

These companies make money if you buy something, and it's even better if you set up a recurring subscription, so advertising that leans into young men's fears can be especially fruitful.

"You might say that makes them a target for high-pressure, potentially even manipulative marketing in a way that we should worry about," McCoy said.

The dynamic is similar to pharmaceutical ads on TV for drugs like Ozempic or Cialis. Instead of getting advice from disinterested parties, like their doctors, people are getting messages from quite interested parties — pharmaceutical companies — hoping they show up at their next medical visit and make an ask.

A spokesperson for Hims said in an email that a "core tenet" of the company is "to help people address issues that may be hard to talk about, but are important for feeling good and being healthy" and that its platform and customer experience is "is designed to help customers bypass the various hurdles that come with getting the care and accessing necessary treatments." When asked how doctors are compensated, they said it's a time-based model that takes into consideration time spent and "certain efficiency metrics," but it's not about prescriptions written. The spokesperson emphasized that "the health and well-being of our customers will always be our top priority" and confirmed that fees are only charged if someone receives treatment. A spokesperson for Ro said that it's a "misconception" that its patient base skews younger and that 87% are over 30. They said that providers' prescribing decisions do not impact their compensation and provided a link to their operating system.

DTC telehealth can play a role in people getting treatment they may otherwise not seek, whether for alcoholism or depression or hair loss, and at the very least it can help people realize they're not so alone in whatever issue that's ailing them. While I was reporting for this story, a friend told me he got a hair-loss prescription from Hims after his barber mentioned his bald spot — to me, that seems fine.

But it's hard not to recognize these companies' financial incentives and the ways they may distort care. They're prescribing all sorts of drugs constantly and not asking too many questions in the process. That young guy listening to a hair-loss ad on his favorite podcast isn't just a patient — he's a customer.

Emily Stewart is a senior correspondent at Business Insider, writing about business and the economy.

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