Marketing used by men’s health clinics is cause for concern

Findings from a study characterizing the providers and services offered by stand-alone commercialized men’s health clinics should be eye-opening and alarming for urologists, said Jagan K. Kansal, MD, MBA, at the American Urological Association 2020 Virtual Experience.

“Our review shows that these clinics are providing significant misinformation about treatment of erectile dysfunction and hypogonadism. Furthermore, they are often offering treatments that are not supported by evidence or have no therapeutic benefit but that may carry large out-of-pocket costs,” Kansal said.

“We believe that urologists should be aware of what is happening in the men’s health mainstream landscape because patients we see may have questions related to information they have gotten from these clinics or their websites or even have complications after being treated at one of them.”

Kansal conducted the study as a fellow in Men’s Sexual and Reproductive Health at the Medical College of Wisconsin, Milwaukee, working with Peter Dietrich, MD, Amy Guise, and colleagues. After completing the fellowship in June, he will be leading the Men’s Health Clinic at the DuPage Medical Group, DuPage County, Illinois.

The research analyzed content found on the websites for men’s health clinics identified through an internet search using the terms “men’s health clinic” or “low T center.” After excluding centers that were affiliated with a hospital or offering only female hormone therapy, the review included 236 distinct clinics.

“Many of these corporations have multiple clinic locations. Therefore, we expect the 236 distinct websites probably represent thousands of centers that are being patronized by hundreds of thousands of men,” Kansal said.

Highlighting some of the key findings of the study, he reported there was significant heterogeneity in treatment providers, including 17 different medical and alternative medicine specialties. Interestingly, urologists were listed as the main provider in only 7.6% of clinics, and out of all 236 clinics, 91.1% did not list a urologist or endocrinologist on staff. The main provider was not listed for 26% of the clinics, and 7% listed an alternative provider, such as a naturopath or chiropractor, as the main provider.

Most clinics were advertising treatment for erectile dysfunction. Intracavernosal injections were offered by approximately one-half of the clinics and were the only treatment identified for erectile dysfunction by 24% of the clinics. For regenerative therapies, two-thirds of clinics advertised penile shockwave therapy for erectile dysfunction, and 60% were offering platelet-rich plasma (PRP) injections (figure). No clinics listed pricing information for either of the latter two modalities.

“It is disturbing to see so many clinics offering shockwave therapy and platelet-rich plasma injections considering they are investigational treatments that according to recommendations from the American Urological Association and Sexual Medicine Society of North America should only be performed in the context of clinical trials,” said Kansal.

“It is important to note that the term shockwave is loosely defined in mainstream media. It is critical to understand there is a difference in shockwaves, which is characterized by a rapid increase in pressure compared to radial waves, which have a much lower pressure amplitude. While there is evidence that true low-intensity shockwave therapy has clinical utility in select patients, all the clinics reviewed are actually advertising radial wave therapy, which has no proven clinical utility in ED treatments.”

Information on costs for testosterone treatment was also scarce. Among the clinic websites that mentioned fees, many simply indicated the availability of a financial plan that may or may not be covered by insurance. Some clinics listed a monthly fee that ranged from $80 to $800.

Of great concern, many clinics offering testosterone therapy were promoting unrealistic expectations and suggesting higher than normal testosterone levels are needed to see a benefit, Kansal said.

“Our findings demonstrated that few commercialized clinics were offering evidence-based, standard-of-care treatments, which is concerning. We recommend that patients research these clinics before seeking care,” he said.