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The American Urological Association and Endocrine Society published guidelines for the management of testosterone deficiency in 2018. Testosterone prescription patterns have varied widely recently, owing to increased public interest and emerging data on the safety of testosterone therapy. The effect of guideline publication on testosterone prescribing is unknown. Thus, we aimed to assess testosterone prescription trends using Medicare prescriber data. Specialties with over 100 testosterone prescribers from 2016-2019 were analyzed. Nine specialties were included (in order of descending prescription frequency): family practice, internal medicine, urology, endocrinology, nurse practitioners, physician assistants, general practice, infectious disease, and emergency medicine. The number of prescribers grew by a mean of 8.8% annually. There was a significant increase in average claims per provider from 2016 to 2019 (26.4 to 28.7, p < 0.0001), with the steepest increase occurring between 2017 and 2018 when the guidelines were released (27.2 to 28.1, p = 0.015). The largest increase in claims per provider was among urologists. Advanced practice providers comprised 7.5% of Medicare testosterone claims in 2016 and 11.6% in 2019. While no causation can be established, these results suggest that professional society guidelines are associated with increasing numbers of testosterone claims per provider, especially among urologists. The changing demographics of prescribers justifies targeted education and further research., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Direct-to-consumer telemedicine platforms have expanded their reach to include services for the evaluation and treatment of testosterone deficiency., Aim: We aim to (i) evaluate the treatment practices and costs associated with receiving testosterone therapy through direct-to-consumer telemedicine platforms; (ii) compare these practices to the American Urological Association guidelines; and (iii) compare the cost of receiving similar care at a tertiary center., Methods: Google was queried to identify telemedicine platforms offing testosterone therapy. Websites were analyzed for information regarding the initial consultation, initial laboratory evaluation, follow up, treatment monitoring regimen, and associated costs of receiving testosterone therapy. The costs for similar services at a tertiary care center were estimated using a single institution's online cost estimator for a patient with no insurance, private insurance, or Medicare., Outcomes: Evaluation and treatment practices of each platform were compared to the American Urological Association guidelines, and a cost analysis was completed for the cost of (i) undergoing an initial evaluation, and (ii) receiving 12 months of treatment through each platform and at a tertiary center., Results: Three online platforms met inclusion criteria: Hone, Regenex Health, and TRT Nation. The initial evaluation and follow up of patients on TTh were similar between the online platforms and practice guidelines. The costs of the initial consultation were lowest for the patient with Medicare at a tertiary center and via the telemedicine platforms. Conversely, the cost of 12 months of intramuscular testosterone treatment was highest via the telemedicine platforms, ranging from $1,586 to $4,200, as compared to the tertiary center, which ranged from $134.01 to $1,333.04 with varying insurance models. Costs of ongoing treatment with transdermal testosterone are similarly higher via DTC platforms., Clinical Implications: Patients with private insurance or Medicare should be counseled that ongoing treatment through telemedicine platforms will likely incur a greater cost than receiving such care at a tertiary center that can utilize insurance coverage., Strengths & Limitations: Practice and cost comparisons include accurate, up-to-date information based on each platform's website. Limitations include the analysis of only three telemedicine platforms, and the ability to describe only the information provided on each website. In addition, cost estimates for the tertiary center only include a single type of private and public insurance, limiting generalizability., Conclusion: This observational study indicates that direct-to-consumer telemedicine platforms are largely following practice guidelines in the evaluation and treatment of testosterone, however, there is a high cost associated with ongoing treatment. Jesse E, Sellke N, Rivero M-J, et al. Practice Comparison and Cost Analysis of Direct-to-Consumer Telemedicine Platforms Offering Testosterone Therapy. J Sex Med 2022;19:1608-1615., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Online telehealth platforms are becoming increasingly common across several areas of medicine, including those related to men's health conditions. These ventures now offer virtual services for the evaluation of testosterone deficiency and treatment via the online sale of testosterone therapy (TTh). We sought to compare the cost of undergoing virtual evaluation and treatment with TTh via online telehealth platforms, as compared to what may be offered by a board-certified urologist following the American Urologic Association (AUA) guidelines at a tertiary care center. Google was queried to identify platforms that offer an online consultation and prescription service for TTh. Platforms that did not provide transparency of services including details of the initial consultation, laboratory work, type of medication offered, and associated fees on the company website were excluded. Information regarding the type of providers used, services and laboratory work included in the initial consultation, and price for the evaluation and three months of treatment with TTh were gathered. These were compared to the services and prices that a board-certified urologist at a tertiary care center may offer while following the AUA guidelines for the evaluation and management of testosterone deficiency. Costs for services at the tertiary care center were estimated using a single institution's online cost estimator1 for a patient with no insurance, a patient with basic employee insurance, and a patient with Medicare. A total of three online platforms met inclusion criteria: Hone, Regenex Health, and TRT Nation. The services provided for the initial evaluation and for follow up of patients on TTh were similar between the online platforms and those suggested by AUA guidelines (Table 1). The cost of the initial consultation including laboratory services were lowest for the patient with Medicare at a tertiary center ($0) and via the online platform, Hone ($45.00) (Table 2). The estimated cost for three months of treatment with TRT including follow up was lowest among the patient with Medicare ($32.79) and the patient with basic employee insurance ($192.58) at the tertiary center (Table 3). The cost of three months of treatment and follow up was highest via the online platform Regenex Health ($1,059.00). While online telehealth platforms may offer a cost benefit in the initial consultation and evaluation for TRT for some patients, the cost of ongoing treatment greatly exceeds that which may be obtained at a tertiary care center for patients with basic insurance plans or Medicare. Patients without insurance may encounter a high cost of initial evaluation at a tertiary center, however, ongoing follow up and medication costs for these patients is likely similar between select online platforms and a tertiary center. No [ABSTRACT FROM AUTHOR]