“Our research shows that these clinics are providing significant misinformation about the treatment of erectile dysfunction and hypogonadism. In addition, they often offer treatments that are not supported by evidence or have no therapeutic benefit, but can have a high out-of-pocket cost,” Kansal said.
“We believe that urologists should be aware of what is happening in the mainstream men’s health landscape because patients we see may have questions related to information they received from these clinics or their websites or even have complications after they have been treated in one of them.”
Kansal conducted the study as a fellow in Men’s Sexual and Reproductive Health at the Medical College of Wisconsin, Milwaukee, in collaboration with Peter Dietrich, MD, Amy Guise and colleagues. Upon completion of the fellowship in June, he will lead the Men’s Health Clinic at DuPage Medical Group, DuPage County, Illinois.
The research analyzed content found on the websites for men’s health clinics that were identified through an Internet search using the terms “men’s health clinic” or “low T center.” After excluding centers affiliated with a hospital or offering only hormone therapy for women, the review included 236 different clinics.
“Many of these companies have multiple clinic locations. Therefore, we expect that the 236 different websites probably represent thousands of centers visited by hundreds of thousands of men,” said Kansal.
Highlighting some of the study’s key findings, he reported that there was significant heterogeneity in practitioners, including 17 different medical and alternative medicine specialties. Interestingly, urologists were listed as the primary care provider in only 7.6% of clinics, and of all 236 clinics, 91.1% did not list a urologist or endocrinologist on staff. 26% of the clinics did not list the main provider and 7% listed an alternative provider, such as a naturopath or chiropractor, as the main provider.
Most clinics advertised the treatment of erectile dysfunction. Intracavernosal injections were offered by about 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% offered platelet-rich plasma (PRP) injections (Figure). No clinic listed pricing information for either of the latter two modalities.
“It is disturbing to see so many clinics offering shock wave therapy and platelet-rich plasma injections, as they are investigational treatments recommended by the American Urological Association and the Sexual Medicine Society of North America should only be performed in the context of clinical trials. Kansal said.
“It is important to note that the term shock wave is loosely defined in the mainstream media. It is critical to understand that there is a difference in shock waves, which are characterized by a rapid increase in pressure compared to radial waves, which have a much lower pressure amplitude. While there is some evidence that true low-intensity shockwave therapy has clinical utility in selected patients, all the clinics studied actually promote radial wave therapy, which has no proven clinical utility in ED treatments.
Information on the cost of testosterone treatment was also sparse. Of the clinic websites that mentioned reimbursements, many simply stated the availability of a financial plan that may or may not be covered by insurance. Some clinics listed a monthly fee ranging from $80 to $800.
Of great concern, many clinics offering testosterone therapy promoted unrealistic expectations and suggested that higher-than-normal testosterone levels are needed to see a benefit, Kansal said.
“Our findings showed that few commercialized clinics offered evidence-based standard treatments, which is concerning. We recommend that patients research these clinics before seeking help,” he said.