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Telehealth websites promise cure for “male menopause” despite FDA ban on off-label ads

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Online stores sprang up during the COVID-19 pandemic‘s telehealth boom touting testosterone as a cure-all for men’s age-related illnesses — despite FDA rules issued years ago restricting such “low testosterone” advertising. 

In ads on Google, Facebook and elsewhere, testosterone telemedicine websites may promise a quick fix for sluggishness and low libido in men. But evidence for that is lacking, physicians said, and the midlife malaise for which testosterone is being touted as a solution is more likely caused by chronic medical conditions, poor diet or a sedentary lifestyle. In fact, doctors urge caution — and the FDA recommends that all testosterone supplements carry a warning that they may increase the risk of heart attack and stroke.

Valid medical reasons do exist for treating some men with testosterone. The hormone as a medication has existed for decades, and today’s patients include men with hypogonadism, some transgender men who use it to help transition physically, and, sometimes, women dealing with menopausal symptoms. It has also been used for decades by bodybuilders and athletes to enhance strength.

However, online dispensaries can overplay the idea of what is sometimes called “male menopause,” or even “manopause,” to drive sales of highly profitable testosterone-boosting injectables, often ignoring safety guidelines that should prevent healthy men from using the hormone. Some of the websites target military veterans.

“I have seen ads online that do cross the line,” said Steven Nissen, a physician and the chief academic officer for the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic. “For mood and low energy, prescribing testosterone provides little to no benefit. They are promoting testosterone for indications that are not on the label.”

Testosterone telehealth websites almost all cite one study published in 2002 by New England Research Institutes scientists who found testosterone levels drop 1% a year in men over 40. Stefan Schlatt, director of the Center for Reproductive Medicine and Andrology at the University of Muenster in Germany, said the data behind the statistic included older men in deteriorating health whose levels declined because of illnesses.

“Healthy men do not show a drop,” he said.

That 2002 study led to a flood of “low-T” ads on U.S. television — ads that were later banned by the FDA in a 2015 ruling that accused the pharmaceutical industry of exaggerating the low-T phenomenon to scare men into buying drugs. According to another study, the market for testosterone supplements stood at $1.85 billion in 2023.

The deluge of ads “has fueled demand for a largely uninsured product, allowing for high markups,” said Geoffrey Joyce, director of health policy at the USC Schaeffer Center for Health Policy & Economics and a research associate at the National Bureau of Economic Research. “The primary driver is manufactured demand.”

Barbara Mintzes, a professor of evidence-based pharmaceutical policy at the University of Sydney’s Charles Perkins Centre in Australia, said low testosterone should really be seen as a sign of a condition that needs to be treated. She said diabetes, heart disease, high blood pressure, obesity, exposure to toxic chemicals like PFAS and stress can all reduce testosterone levels.

Several websites reviewed by KFF Health News brand themselves as news and fitness magazines, with advertisements embedded in articles steering readers toward order forms for testosterone replacement therapy, shorthanded as TRT. The sites’ prices for TRT range from $120 to $135 a month, not including initial mail-back blood tests for around $60. Some sites promise increased libido and reduced stomach fat.

Male Excel’s ads on Google, for example, say TRT “improves mood” and “restores vitality.” And its site says testosterone treatment will provide “muscular definition,” “weight loss,” “explosive drive,” “deeper sleep” and “restored energy” above a link to a free assessment on its online telehealth platform. Craig Larsen, the company’s CEO, did not reply to several attempts to contact him by phone and email.

Both Male Excel and Hone Health are among the sites that pitch to military veterans. Hone Health included a video of a veteran who said he was refused testosterone treatment by a Department of Veterans Affairs hospital.

Saad Alam, CEO and co-founder of Hone, said that his company is what he called a “conservative” player in the market. He said that Hone prescribes only to men who are hypogonadal and tests men every 90 days, unlike other companies that operate telehealth websites as what he called a “cash grab.”

“I agree that patients should be treated by their doctors. But the U.S. medical system isn’t at a point where it can service men who have this problem, and some endocrinologists would rather treat patients who are higher-profit,” Hone said. “That’s why people are coming to us.”

One popular form of TRT is injectable testosterone cypionate. According to the Medicare average sales price database, it costs $0.027 per milligram. Online purveyors who sell the drug directly to consumers in 200 mg/mL vials for an average price of $129 per month are charging the equivalent of $1.55 per mg — a markup of more than 50 times the average Medicare price.

According to a 2022 study, the TRT telehealth websites create a way to circumvent doctors who refuse to prescribe the hormone. In that study, Justin Dubin, a urologist at the Memorial Healthcare System in Florida, posed as an online mystery shopper. He reported an above-normal testosterone level, and stated his desire to start a family, even though such therapy can curb sperm production. But six of the seven unnamed online TRT clinics prescribed him testosterone via a medical professional.

“And that’s concerning,” Dubin said. “Telemedicine helps men with hypogonadism who might be too embarrassed to discuss erectile dysfunction. But we need to do a better job of understanding the appropriateness of care.”

Still, while the FDA doesn’t allow off-label marketing, it does allow such off-label prescriptions.

Off-label use of testosterone replacement has become especially commonplace among veterans. And among male service members who received TRT in 2017, fewer than half met the clinical practice guidelines, according to a report by the U.S. military.

Phil Palmer, a 41-year-old Marine Corps veteran who lives outside Charleston, South Carolina, said he pays out-of-pocket for bloodwork and prescriptions for a pellet skin-implant form of testosterone and for clomiphene, a drug that can help counter the male infertility that is a side effect of testosterone treatment. He said the treatment appeals to him and other veterans dealing with the aftermath of military service.

“The environment we served in and stress levels have a lot to do with it,” Palmer said. “We were exposed to burn pits. The military doesn’t teach you to eat well — we ate a lot of processed food.”

In medical settings, TRT can speed recovery of soldiers who have bone density issues or spinal cord injuries, said Mark Peterson, a professor of physical medicine and rehabilitation at the University of Michigan Medical School. But, he said, “for men in the normal-T range, using an online prescription to buy testosterone to reduce stomach fat can be counterproductive.”

Those who use it also risk having to take testosterone medication indefinitely, because TRT can cause the body to cease its own production of the hormone.

Palmer, who founded a nonprofit that helps veterans heal through exercise, nutrition, and mentorship, said the medication has been helpful for him but urges fellow veterans to seek care from their doctors rather than what he called “bro science” websites touting testosterone.

“It’s not a magic pill,” he said.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.



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Barbie announces first “Diwali doll” ahead of festival of lights

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A new Barbie has joined Mattel’s lineup of inclusive dolls. The first “Diwali doll” was announced by the toymaker on Friday, a few weeks shy of the Hindu holiday of Diwali, also known as the festival of lights. 

The festival, which lasts for five days, is marked on Western calendars to begin on Nov. 1, but some celebrations start on Oct. 31.

The doll, created in collaboration with fashion designer Anita Dongre, features traditional elements including the lehenga skirt, floral print and golden shoes, according to Mattel’s website. The doll is available at major retailers for $40.

“The look is infused with beauty and symbolism to rejoice in victory of light over darkness with contemporary silhouettes,” the description reads for the Diwali doll.

Lalit Agarwal, country manager for Mattel India, said in a news release that through the Diwali doll, the brand is hoping to showcase “India’s vibrant cultural heritage on a global stage while continuing to celebrate the power and beauty of diversity.” 

Earlier this year, Mattel announced the first-ever blind Barbie doll and a Black Barbie with Down syndrome. 

In addition, to celebrate International Women’s Day on March 8 and Barbie’s 65th birthday on March 9, the doll brand announced it was adding new dolls to its Role Models collection, based on real-life singers and actresses from around the world. They’re not for sale – a one-of-a-kind doll was made for each of the honored women.

The dolls are meant to introduce “girls to remarkable women’s stories to show them you can be anything,” according to Mattel



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Keanu Reeves debuts as pro auto racer at Indianapolis Motor Speedway, spins out

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Keanu Reeves doesn’t think he’s John Wick until he puts on the suit


Keanu Reeves doesn’t think he’s John Wick until he puts on the suit

02:07

Hollywood actor Keanu Reeves made his professional auto racing debut on Saturday at the famed Indianapolis Motor Speedway.

“The Matrix” star, who qualified 31st out of 35 cars, ran as high as 21st before a single-car crash a little more than halfway through the 45-minute race briefly stopped him in his tracks.

GR Cup Series Reeves Auto Racing
Keanu Reeves drives during the GR Cup Series auto race at Indianapolis Motor Speedway, Saturday, Oct. 5, 2024, in Indianapolis.

Darron Cummings / AP


The 60-year-old spun into the grass without a collision on the exit of Turn 9 when he had about 21 minutes of racing left. He re-entered the course and continued driving, signaling he was uninjured.

Reeves finished 25th.

The actor is competing at Indianapolis in the Toyota GR Cup, a Toyota spec-racing series and a support series for this weekend’s Indy 8 Hour sports car event. He has a second race on Sunday.

GR Cup Series Reeves Auto Racing
Keanu Reeves drives during the GR Cup Series auto race at Indianapolis Motor Speedway, Saturday, Oct. 5, 2024, in Indianapolis.

Darron Cummings / AP


He is driving the No. 92 BRZRKR car, which is promoting his graphic novel “The Book of Elsewhere.” He is teammates with Cody Jones from “Dude Perfect.”

Reeves has previous racing experience as a former participant in the Toyota Grand Prix of Long Beach in the celebrity race. Reeves won the event in 2009.





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Passenger lands small plane after pilot experiences medical emergency

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Heat may be factor in several plane crashes


Heat may be factor in multiple small plane crashes over weekend

05:13

A passenger successfully landed a small plane on Friday after the pilot had a medical emergency, the Federal Aviation Administration said. 

The twin-engine Beechcraft King Air 90 was traveling from Henderson Executive Airport in Las Vegas, Nevada to Monterey Regional Airport in California, with a pilot and one other person on board, the FAA said. 

The pilot suffered an unspecified medical emergency while flying, the FAA said, forcing the passenger to take the controls and make an emergency landing at Meadows Field Airport in Bakersfield, California. 

The Kern Fire Department told CBS News affiliate KBAX that firefighters were called to a report of a medical emergency on the plane. The pilot was reported to be “incapacitated,” the fire department said. Firefighters saw the plane approach and land safely, then “chased” the plane down the runway in emergency vehicles to meet it. 

The FAA did not release the passenger or pilot’s identities nor give an update on the pilot’s condition. The pilot was taken to an area hospital by ambulance. The passenger did not report any injuries. 

The FAA and the National Transportation Security Board will investigate the incident, the FAA said.



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