A review of 253 testosterone clinic websites found a quarter breaking guidelines

A content analysis of 253 websites selling testosterone treatment found that a quarter routinely used drugs other than testosterone to treat symptomatic low testosterone, one in five claimed the treatment reduces cardiovascular risk, and one in ten said it would prescribe to men whose testosterone was already normal. The study's authors describe these as serious and frequent breaches of advertising law. The more useful finding for a reader is narrower: the standard by which a clinic decides whether you qualify is not standard at all.

What was measured

The analysis, published in the Journal of Clinical Endocrinology and Metabolism, used content analysis methodology with a coding frame built from international guidelines [s1]. Researchers identified publicly accessible websites offering testosterone prescriptions using predefined search terms in English, Arabic, Hindi and Spanish, across three search engines, running the searches through virtual private networks in multiple geographical regions to reduce location bias [s1].

From 1,138 sites found, 253 met inclusion criteria: 144 in the United States and Canada, 48 in Europe, 17 in Australia, 12 in Asia, 11 in South America and 10 in the Middle East [s1]. The context the paper gives for why this matters is a market number: testosterone prescriptions have increased up to 12-fold globally over the past two decades [s1].

What the sites said

Five non-guideline-based practices were counted. Sixty-one clinics (24.4%) routinely used non-testosterone androgens or testosterone secretagogues, such as gonadotrophins, to treat symptomatic low testosterone [s1]. Fifty-two (20.6%) asserted that testosterone treatment reduces cardiovascular risk [s1]. Thirty (11.9%) claimed that microdosing improves treatment effects [s1]. Twenty-five (9.9%) prescribed testosterone to men with normal serum testosterone, defined in the analysis as above 12 nmol/L [s1]. And 25 (9.9%) claimed antiaging effects [s1].

The geographical pattern is stated plainly by the authors: US-based clinics more frequently made non-guideline-based claims than clinics in other locations [s1]. The paper's framing is regulatory rather than clinical — it notes that EU and UK law tightly regulates the advertising of medical products, and its recommendation is enforcement of existing laws by national regulators [s1].

The standard those claims are being measured against

The American Urological Association's guideline sets out what a diagnosis requires. A total testosterone below 300 ng/dL is the recommended cut-off in support of a diagnosis of low testosterone [s2]. The diagnosis should be made only after two total testosterone measurements taken on separate occasions, both in the early morning [s2]. And the clinical diagnosis of testosterone deficiency is made only when low levels are combined with symptoms or signs [s2]. The guideline also specifically does not recommend validated questionnaires for deciding who is a candidate for treatment or for monitoring response [s2] — which is notable given how many online intake forms are built around exactly that.

Three requirements, then: two morning blood draws, a threshold, and symptoms. A single afternoon draw, or a questionnaire alone, does not meet the standard the guideline sets.

This is not only an online problem

The AUA's own executive summary is unusually direct about the offline picture. It states that testosterone testing and prescriptions have nearly tripled in recent years, and that some studies estimate up to 25% of men who receive testosterone therapy do not have their testosterone tested before treatment begins [s2]. Of men treated with testosterone, nearly half do not have levels checked after therapy commences [s2]. And up to a third of men placed on testosterone therapy do not meet the criteria to be diagnosed as testosterone deficient [s2].

The same summary makes the symmetrical point: a large share of men who do need treatment fail to receive it, because of clinician concerns about prostate cancer and cardiovascular events that the guideline says current evidence fails to definitively support [s2]. Both failures are real, and they are not the same failure.

What is actually known about the platforms themselves

Less than the market's size would suggest. A 2023 systematic review in the World Journal of Men's Health searched six databases and found only ten studies out of 3,003 identified that met inclusion criteria on direct-to-consumer men's health platforms [s3]. Four of them examined why men use the platforms, finding convenience, embarrassment and health motivation as the predominant factors [s3]. Six examined quality of care, and found varying levels of adherence to established clinical guidelines, alongside satisfactory patient outcomes with low levels of patient-reported side effects and adverse events [s3].

The review's own summary of the field is that research is lacking given the infancy of the space, and that major limitations in the quantitative studies affected the accuracy of findings [s3]. So the honest state of knowledge is: we know what many of these clinics advertise, because someone counted; we know less about what happens to the people who use them, because nobody has followed them for long.

The question worth asking

The content analysis does not establish that any individual clinic harmed anyone, and it does not measure prescribing — it measures what websites say. But the specific claims it found are the ones that determine whether a man is a candidate. A clinic that states testosterone reduces cardiovascular risk, or that prescribes above the normal threshold, has already answered the eligibility question before the blood test.

The verifiable thing a reader can check against a guideline is procedural: how many morning blood draws were taken, on how many separate days, and whether symptoms were required alongside the number [s2].

This article is informational and is not medical advice. Decisions about testing or treatment belong with a reader and their clinician.

Sources

• Discordance Between Online Information and Male Hypogonadism Clinical Guidelines: A Global Multilingual Content Analysis — Journal of Clinical Endocrinology and Metabolism, 2025-12-27
• Evaluation and Management of Testosterone Deficiency: AUA Guideline — American Urological Association, 2018
• Direct-to-Consumer Telemedicine Practices in the Health and Fertility of Men: A Systematic Review of the Literature — The World Journal of Men's Health, 2023-08-25