Paul received his first dose from Hims in May. He didn't really need generic Viagra, but a friend had bragged about using it “on and off” for years, so he thought he'd give it a try. So he signed into Hims and found the process of getting his medication from the direct-to-consumer telemedicine company to be surprisingly easy. Paul, who is in his early 40s, answered a few multiple-choice questions online, a doctor purportedly reviewed his answers, and a bottle of pills arrived in the mail a few days later.
He took the drug twice, but it didn't have the desired effect. No one explained to him what was going to happen, but it probably wouldn't happen in a normal medical setting. When I asked Paul (not his real name) why he didn't go to his family doctor about the issue, his answer was simple: “Quickness, convenience, and the doctor would say no.” His family doctor had said some time ago that he thought Viagra was overprescribed.
The direct-to-consumer healthcare industry has exploded in recent years. The pandemic has accelerated the rise of telehealth, and these DTC companies are culturally and legally part of it. Grand View Research estimates that the global telehealth market will be worth $101.2 billion in 2023 and growing rapidly. Venture capital and investor money has flowed in, and multiple startups have launched to capitalize on this growth. Hims & Hers Health has a market capitalization of over $4 billion. Another major player in the industry, Ro, has raised over $1 billion and is valued at $6.6 billion, according to PitchBook.
These companies sell a wide range of products to help with everything from weight loss to mental health. But many of their business propositions target young men, specifically their insecurities. Worried about your hairline? Your fertility? Your erections? Afraid to talk to your doctor about these things in person? Himes promises you can “skip those awkward doctor's visits” and offers “ED medication right from the comfort of your couch.” A “healthy, handsome you” is just a click away.
“These platforms are essentially built to minimize the distance consumers travel from advertising to getting their prescription filled,” said Matthew McCoy, an assistant professor at the University of Pennsylvania's School of Medical Ethics and Health Policy. “The upside is efficiency — people, of course, don't always have a lot of time for this stuff. The downside is the risk of not making an informed decision, or of receiving advice driven by a company's financial incentives rather than a doctor's honest opinion of their medical best interests.”
Those at the forefront of the DTC health revolution are getting American men exactly where they want them to be: anxious, on edge, and ready to open their wallets.
There is Several How these services work varies, but the gist is this: You visit a website (probably because you saw an ad), fill out a questionnaire about your symptoms, maybe chat with a doctor (though often not), and then your prescription arrives in discreet packaging.
“This typically bypasses traditional medical settings and often involves little to no involvement from health care providers,” says Ashwini Nagappan, a doctoral student studying DTC medicine and ethics at the UCLA Fielding School of Public Health.
DTC medication services also have an altruistic appeal: For people who live in remote areas or can't easily get to a doctor, they provide access. But for many customers, particularly young men, the advantage is that they're simply more convenient than a traditional doctor's appointment.
“Men, in general, are less likely to have access to health care than women,” says Joshua Halpern, chief scientific officer at the male fertility clinic Posterity Health and an adjunct assistant professor of urology at Northwestern University Feinberg School of Medicine. “And we know that many young men don't even have a primary care doctor, so the process of establishing health care can be daunting, especially when it can take months to get an appointment.”
Even if they have a relationship with a health care provider, it may not be one in which they feel comfortable bringing up sensitive or stigmatized issues. Research shows that privacy is a primary consideration for young men when seeking treatment for sexual health issues. A review of the literature on DTC telehealth and men noted that men who use DTC platforms cite convenience as a key motivator, in addition to embarrassment and discretion. Interestingly, financial factors are less relevant. A survey conducted in late 2019 and early 2020 found that men under 40 and with middle-income brackets were more likely to use DTC telehealth services than older, more affluent men.
While DTC services may help with timely access and efforts to destigmatize certain issues, they also have significant drawbacks: Men who use these services may not get the comprehensive evaluation needed to uncover underlying medical conditions and address their overall health, and they may not see the health care provider best suited to manage their condition, Halpern said.
“You may end up paying a lot for treatment that is more affordable elsewhere or that is covered by your health insurance,” he said.
His research also suggests that some platforms may be offering care that goes against the guidelines, meaning patients are receiving unnecessary tests and inappropriate treatments, some of which may be harmful, such as prescribing testosterone replacement therapy for men who want to conceive. Many doctors have sounded the alarm about DTC telemedicine companies, and some have become embroiled in legal trouble. The Department of Justice has charged leaders of Done, an ADHD-focused telemedicine company, with fraud over its prescribing practices and advertising of Adderall.
DTC companies have their problems, but it goes without saying that the traditional healthcare environment is far from perfect: Patients can lie to their doctors in person; healthcare providers don't know all about a patient's health or the medications they're taking; and insurance and appointment procedures are complicated. But distributing medicines anonymously over the internet is very different from how healthcare has traditionally been done, and it comes with different risks.
These companies are in the business of selling pharmaceuticals.
“If you have an in-person visit or a telehealth visit through a more established provider, there's a little more medical history collection going on,” Nagappan said.
DTC platforms claim they serve a valuable purpose by helping young men address medical needs they would normally ignore, but the financial factors involved are different to those in a general doctor's office.
“These companies are in the business of selling drugs,” McCoy says, “and health care providers are in the business of ideally providing the best possible medical care, which may mean writing prescriptions for drugs, but may also mean alternative therapies or doing nothing at all.”
One man who bought generic Viagra from Hims told me he used the platform to avoid the “eight million” questions his doctor would ask, and that he knew would likely get him approved. “I mean, any time you're dealing with a pharmaceutical company that's going to sell directly to consumers, you have to know that their doctor is just checking a box,” he said. “They're not going to give you too much crap. If they've got a pulse, they'll give you a prescription.” (He was also concerned about his privacy, but said the packaging wasn't as discreet as he'd hoped: The shipping label said “Hims,” and he knows his mailman.)
These companies make money when you buy something, and even more so when you sign up for a subscription, so their ads are particularly effective when they appeal to the insecurities of young men.
“You could say they're being targeted by high-pressure, potentially manipulative marketing that we should be concerned about,” McCoy said.
The move is similar to TV ads for drugs like Ozempic and Cialis: Instead of getting advice from a disinterested party like a doctor, people are getting a message from a vested party — the drug company — and hoping that they'll show up at their next appointment to ask questions.
A Hims spokesperson said in an email that the company's “guiding principle” is “to help people address issues that may be difficult to talk about, but are important to feeling good and being healthy,” and that the company's platform and customer experience are “designed to help customers avoid the various hurdles that arise in getting care and receiving the treatment they need.” When asked about doctors' compensation, they said it is a time-based model that takes into account time spent and “certain efficiency metrics,” and not for issuing prescriptions. The spokesperson stressed that “the health and well-being of our customers is always our top priority,” and confirmed that they are only charged when someone receives treatment. A Ro spokesperson said it is a “misconception” that their patient base skews younger, with 87% being over 30. They said doctors' prescribing decisions do not affect compensation and provided a link to the operating system.
DTC telemedicine can play a role in getting people treatment they might not normally get for things like alcoholism, depression, and alopecia. And it can at least help them realize they're not alone in whatever issue they're struggling with. While researching this story, a friend told me he got a prescription for alopecia from Hims after his barber told him he was balding. That seems like a good thing to me.
But it's hard not to recognize the financial incentives of these companies and the ways they can distort health care: They prescribe all kinds of medications constantly and don't ask many questions in the process. That young man hearing an ad for alopecia on his favorite podcast isn't just a patient, he's a customer.
Emily Stewart He's a senior correspondent for Business Insider, writing about business and economics.
