Paul got his first bottle of pills from Hims in May. He said he didn’t really need generic Viagra, but after a friend bragged that he’d been using it for years to “have sex over and over again,” Paul decided to give it a try. So he signed up for Hims and found the process for getting it from the direct-to-consumer telehealth company to be a breeze. Paul, who is in his early 40s, answered a few multiple-choice questions online, a doctor was supposed to review his responses, and then a bottle of pills showed up in the mail a few days later.
He had taken the drug twice, though it didn’t work as well as he thought it would. No one explained what to expect, which probably wouldn’t happen in a typical health care setting. When I asked Paul (a pseudonym) why he didn’t just go to his doctor to address the issue, his response was succinct: “Speed, convenience, sure my doctor would say no.” His primary care provider had mentioned some time ago that he believed Viagra was being overprescribed.
The direct-to-consumer healthcare industry has been booming in recent years. The pandemic accelerated the rise of telehealth, which these DTC companies have become both culturally and legally attached to. Grand View Research estimates that the global telehealth market will be worth $101.2 billion by 2023 and growing rapidly. Many startups have emerged to capitalize on this growth, with venture capital and investor money pouring in. Hims & Hers Health has a market cap of over $4 billion. Ro, another major player in the industry, 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. However, most of their business propositions are aimed specifically at young men and, more specifically, their insecurities. Are you worried about your hairline? Your fertility? What about your erections? Are you afraid to talk to a doctor in person about any of this? Well, Hims promises you can “avoid the awkward doctor’s visit” and offers “an erectile dysfunction cure from the comfort of your couch.” A “healthy, handsome you” is just a click away.
“These platforms are essentially designed to minimize the distance between advertising and trying to get consumers to get prescriptions in their hands,” said Matthew McCoy, an assistant professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania. “The upside is efficiency — people, of course, don’t have a lot of time to spend on these things all the time. The downside is the risk that you’re not making a fully informed decision or that the kind of advice you’re getting is influenced by the company’s financial incentives rather than your doctor’s honest opinion about what’s in your best medical interest.”
Those at the forefront of the DTC wellness revolution have American men right where they want to be: insecure, anxious, and ready to open their wallets.
There is a number of There are variations in how these services work, but the gist is this: you visit a website (perhaps because you saw an advert for it), fill out a questionnaire about your condition, maybe chat with a doctor (although often not), and voilà, a prescription is on its way to you in discreet packaging.
“Typically this bypasses traditional health care settings, and often involves little or no involvement from health care providers,” says Ashwini Nagappan, a doctoral candidate at UCLA’s Fielding School of Public Health who has studied DTC medicine and ethics.
There are some altruistic appeals: DTC treatment services can help access people who live in remote areas or can’t easily get to a doctor. But for many clients, and especially young men, the benefit is that the service is more convenient than a traditional appointment.
“In general, men are less likely to use health care than women,” says Joshua Halpern, chief scientific officer at Posterity Health, a male fertility clinic, and 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 physician, so the process of getting care can be difficult, especially if it takes months to get an appointment.”
Even if they have a relationship with a healthcare provider, it may not be one that makes them feel comfortable bringing up sensitive or stigmatized issues. Research shows that when seeking care for sexual health issues, privacy is a top concern for young men. A review of the literature on DTC telemedicine and men noted that men who use DTC platforms cite convenience as an important motivator, along with embarrassment and confidentiality. Interestingly, financial factors did not play a significant role. A survey conducted in late 2019 and early 2020 found that men under the age of 40 and in the middle income range were more likely to use DTC telehealth services than older, wealthier men.
While DTC services can help provide timely access and destigmatize certain issues, there are some significant drawbacks. Men who use these services may not get the thorough evaluation they need to uncover underlying conditions and address their overall health, Halpern said, and they may not see the health care provider who is best suited to manage their condition.
“They may also have to pay more for care that is more affordable elsewhere or even covered by their health insurance,” he said.
Her research suggests that some platforms may also be providing what’s known as off-guideline care, meaning patients are getting unnecessary tests and inappropriate treatments, such as testosterone replacement for men trying to conceive, which can be harmful in some cases. Many doctors have sounded the alarm about DTC telehealth companies, and some firms have also been in trouble with the law. The Justice Department has charged the leaders of ADHD-focused telehealth company Done with fraud over its Adderall prescribing and advertising practices.
Despite all the problems with DTC companies, it’s fair to note that traditional healthcare settings are far from perfect. Patients can lie to their doctors in person. Healthcare providers don’t always have a full view of their patients’ health or everything they’re taking. Finding insurance and booking appointments is a hassle. But dispensing drugs anonymously on the internet is a far cry from what’s happened in healthcare historically, and it poses different risks.
These companies are in the business of selling pharmaceuticals.
“When you come in person or do telehealth through a more established health care entity, there is a lot more collection of your medical history,” Nagappan said.
While DTC platforms state that they have an important goal in encouraging young men to address medical needs they may have overlooked, the financial factors involved are different than those involved at a traditional doctor’s office.
“These companies are in the business of selling drugs,” McCoy said. “Medical providers are ideally in the business of providing the best medical care, which sometimes involves prescribing drugs, but sometimes involves alternative methods or nothing at all.”
One man who got generic Viagra through Hims told me that he used the platform to avoid the “8 million” questions his doctor would ask — and he knew he’d probably get approved. “I mean, any time you’re dealing with a drug company that’s trying to provide a direct-to-consumer service, you have to know that their doctors are just checking boxes,” he said. “They’re not going to give you a lot of crap. If you have a pulse, they’re going to give you a prescription.” (He also had concerns about privacy, but he said the packaging wasn’t as discreet as he’d hoped — “Hims” was on the shipping label, and he knew his mailman.)
These companies make money if you buy something, and even better if you set up a recurring subscription, so ads that focus on young men’s fears can be very profitable.
“You might say that makes them a target for high-pressure, potentially manipulative marketing, which we should be concerned about,” McCoy said.
The dynamic is similar to pharmaceutical TV commercials for drugs like Ozempic or Cialis. Instead of getting advice from an uninterested party, like their doctor, people receive messages from a fairly interested party — the pharmaceutical company — in the hopes that they’ll show up at their next medical visit and ask questions.
A Hims spokesperson said in an email that the company’s “core tenet” is “helping people address issues that can be difficult to talk about, but are essential to feeling good and healthy” and that its platform and customer experience are “designed to help customers navigate the many hurdles that come with getting care and accessing the care they need.” When asked how doctors are compensated, they said it’s a time-based model that takes into account time spent and “certain efficiency metrics,” but not prescriptions written. The spokesperson emphasized that “the health and well-being of our customers will always be our top priority” and confirmed that fees are only charged if someone receives care. A Ro spokesperson said it was “misleading” that its patient base skews younger, with 87% over the age of 30. They said providers’ decisions about prescribing drugs do not impact their compensation and provided a link to their operating system.
DTC telehealth can play a role in helping people get treatment they might not otherwise seek, whether for alcoholism, depression, or hair loss, and it can at least help people realize they’re not alone in whatever is troubling them. As I was reporting this story, a friend told me he got a prescription for hair loss medication from Hims after his barber mentioned his bald spot — which, I thought, was a no-brainer.
But it’s hard not to recognize the financial incentives of these companies and the way they distort care. They prescribe all sorts of drugs over and over again and don’t ask too many questions in the process. The young man who hears an ad about hair loss on his favorite podcast isn’t just a patient — he’s a customer.
Emily Stewart is a senior correspondent at Business Insider, writing about business and economics.
