Increase in Direct-to-Consumer Telemedicine in Urology

Quality of Health Information Presented in Direct-to-Consumer Telepharmacies for the Treatment of Patients With Erectile Dysfunction

OBJECTIVE

To evaluate the quality of information and counseling for patients regarding erectile dysfunction across major direct-to-consumer telehealth platforms.

MATERIALS AND METHODS

We identified the five largest direct-to-consumer men's telehealth platforms by monthly site visits using Semrush, a web traffic analysis tool. We then analyzed the quality, reliability, accessibility, and readability of patient information on erectile dysfunction on each site using a series of validated metrics for evaluating online health information (Journal of the American Medical Association criteria, DISCERN instrument, LIDA instrument, and Flesch Readability Score).

RESULTS

Five platforms (Hims, Roman, Lemonaid, BlueChew, Numan) were included in the study. Each site offered virtual care and counseling for patients with erectile dysfunction. Overall scores for information quality were highest for the two largest platforms (Hims, Roman) and lower on smaller sites (Lemonaid, BlueChew, Numan). LIDA scores for site accessibility also favored the larger platforms, while reliability and supplement performance was universally poor. Flesch readability scores for written content fell in the "fairly difficult" or "difficult" range for all platforms.

CONCLUSION

The quality of patient counseling varies widely between popular direct-to-consumer telehealth platforms. Men seeking online care for erectile dysfunction are at risk of receiving incomplete or inaccurate information, and urologists should be prepared to guide patients toward reliable sources.

Assessing Public Interest in Online Men's Health Services: A Cross-Sectional Google Trends Analysis of "Hims"

OBJECTIVE

To evaluate public interest in "Hims," a men's health platform, to assess its impact on healthcare access, and identify geographic trends reflecting gaps in traditional healthcare availability.

METHODS

Relative search volume (RSV) data for erectile dysfunction and early climax terms in "Hims" were collected via Google Trends from November 2017 to December 2023 across the United States. Data were analyzed in two intervals (2017-2020 and 2020-2023) using paired t tests to compare RSV and Kruskal-Wallis tests to assess differences among terms. Geographic regions were examined to identify underserved regions.

RESULTS

Public interest in "Hims" increased significantly, with median RSV rising from 0 (interquartile range (IQR): 0-33) in 2017-2020 to 62 (IQR: 30-95) in 2020-2023 (P <.05). Searches related to erectile dysfunction rose from a median RSV of 18 (IQR: 0-100) to 46 (IQR: 0-100) (P <.001), with similar growth observed in searches related to early climax. High RSV was noted in states like Colorado, Wyoming, and Maine, highlighting increased interest in regions with limited healthcare resources. A marked rise in telehealth engagement during the COVID-19 pandemic further emphasized the role of digital platforms in healthcare delivery during periods of restricted access.

CONCLUSION

The rise in search interest for "Hims" underscores the increasing demand for telehealth services to for men's health, particularly in underserved regions. These findings highlight the potential of digital platforms to bridge gaps in healthcare access.

Testicular Cancer Survivorship and Fertility Preservation

Testicular cancer disproportionally affects men of reproductive age making fertility an important aspect of testicular cancer survivorship. Men with testicular cancer have more semen parameter abnormalities and a higher incidence of infertility compared to the general population. All treatment options for testicular cancer negatively affect fertility with recovery rates varying by treatment. For these reasons, clinicians should offer sperm cryopreservation, ideally before orchiectomy to maximize the possibility of biologic paternity, if desired. Several innovations have positively impacted this space including direct-to-consumer cryopreservation and bench research demonstrating the feasibility of reintroducing testicular cells post-therapy.

Beyond the prescription: trends and challenges in erectile dysfunction medications among young adult men

We sought to assess erectile dysfunction (ED) medication use among males aged 18-40. Between June and July 2023, a cross-sectional survey on Qualtrics (Provo, UT) was disseminated via Research Match. Among 210 respondents, ED prevalence was 57.1% with 39.0% reporting prior ED medication use. Black or African American race (OR = 3.54, p < 0.001), Hispanic or Latino ethnicity (OR = 3.32, p = 0.01), and Medicare or Medicaid insurance status (OR = 6.07, p < 0.001) were associated with increased medication utilization. Income >$200,000 was associated with decreased medication usage (OR 0.23, p = 0.04). ED severity significantly correlated with higher medication usage. Primary care providers were the most common source of acquisition (47.6%), followed by online direct to consumer (DTC) platforms (31.7%) and personal connections (19.5%). Privacy (n = 51, 62.2%) and cost (n = 45, 54.9%) were key considerations in obtaining medications. Despite 73.2% of individuals receiving counseling regarding risks/benefits and 84.1% receiving instructions for proper use, only 28.0% correctly identified essential aspects of proper/appropriate use. Overall, we found a high ED prevalence and medication utilization rate. The preference for privacy in procuring medications suggests ongoing stigma around men's sexual health. Despite extensive counseling, a significant knowledge gap remains indicating a pressing need for enhanced patient education.

Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper

PURPOSE

The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care.

LITERATURE SEARCH STRATEGY

A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.

Direct-to-Consumer Telemedicine Practices in the Health and Fertility of Men: A Systematic Review of the Literature

PURPOSE

Men are increasingly turning toward online direct-to-consumer (DTC) men's health platforms to fulfill their health needs. Research surrounding these platforms is lacking and the motivations and predictors underlying this online health-seeking behavior is largely unknown. This review scopes the existing literature concerning DTC men's health and identifies factors influencing engagement, as well as health outcomes of this platform.

MATERIALS AND METHODS

A structured search was performed following PRISMA guidelines. CINAHL via EBSCO, Embase, MEDLINE via Ovid, PsycINFO, PubMed and Web of Science were searched.

RESULTS

Peer-reviewed quantitative and qualitative studies with a focus on demographics and characteristics of those using DTC men's health platforms, as well as studies related to patient outcomes using such platforms, were included. Ten of the 3,003 studies identified met the inclusion and exclusion criteria. Four cross-sectional descriptive studies evaluated the motivations behind men's engagement with DTC platforms. Convenience, embarrassment and health motivation were identified as predominant factors associated with DTC platform use. The review identified a lack of qualitative studies, and major limitations were noted in the quantitative studies that impacted the accuracy of findings. Six further quantitative studies explored the quality of care provided by DTC platforms. DTC platforms were found to have a varying level of adherence to established clinical guidelines, but appeared to provide satisfactory patient outcomes with low levels of patient-reported side effects and adverse events.

CONCLUSIONS

There is a lack of research within the DTC men's health space given the infancy of the field. Important predictors and motivations underlying men's choices in accessing these platforms have been noted across several studies. However, further studies need to be conducted to investigate the psychosocial underpinnings of this behavior. Studies across a wider variety of male health conditions treated by these platforms will also help to provide insights to guide patient-centered care within the DTC landscape.

The Racial and Socioeconomic Characteristics of Men Using Mail-in Semen Testing Kits in the United States

OBJECTIVE

To describe the racial and socioeconomic characteristics of men using mail-in semen testing kits for their fertility care in the United States over 3 years.

METHODS

A cross-sectional analysis was conducted of men who used mail-in semen analyses from a single direct-to-consumer (DTC) fertility platform between 2020 and 2022. Age, race/ethnicity, place of residence, and education level of men using mail-in semen analysis kits was collected from user questionnaires. Zip code level socioeconomic status was estimated using the Area Deprivation Index (ADI). These characteristics were compared to the overall population of the United States.

RESULTS

4342 men used mail-in semen analyses from a single DTC fertility company between 2020 and 2022 and completed the questionnaire. The median age of this cohort was 36 (IQR: 32,40) years. The group consisted of predominantly white men (72%), with 7.9% Asian and only 5.1% Black, 3.2% Hispanic, 0.4% Indian American, 0.1% pacific islander, 5.8% mixed race, and 2.8% other groups. 45.8% of the group had completed college, 22% had a master's degree, and 9% had a doctoral degree. The mean ADI was 83.47 (SD 21.44) compared to the average ADI of 100 for the general US population (P < .005).

CONCLUSION

DTC mail-in semen analyses have the potential to improve access to affordable fertility care. Racial and ethnic minorities and lower socioeconomic classes are underrepresented for men seeking DTC fertility testing as they are for men presenting for in-office fertility care. Additional studies are needed to determine the factors responsible for these discrepancies.

Assessment of Patient Risk Profiles by a Male Sexual Health Direct-to-Consumer Prescription Platform: A Cross-Sectional Study

Background

Direct-to-consumer (DTC) online prescription platforms (OPP) for sexual health represent a potential paradigm shift in the diagnosis and treatment for sexual dysfunctions in the way men seek care. Knowledge of patients' risk profile using these platforms is limited.

Aim

To assess risk profiles of patients reaching out to health care professionals through their DTC.

Methods

Anonymized data originally collected between February 2021 to May 2022 by a DTC platform in the men's health care space were retrospectively analyzed. Data included the content of patient requests through a communication function, as well as the corresponding responses by the attending physician on staff. Each request was then assessed by two independent urologists and categorized by the level of the risk profile as well as the need to refer the patient to further medical evaluation.

Results

Of 585 patient requests, 531 (90.8%) were classified as low risk. In the high-risk group, 32 patients were recommended to schedule an urgent appointment at a specialist. Only three patients (0.5%) were advised to seek emergency care. The overall referral rate for both risk groups was 52.3%. The requests of 279 patients (47.7%) were assessed as digitally treatable. Almost all patients who were digitally treatable were low risk. Side effects accounted for only 9.6% of all requests in the low-risk group, compared with 46.3% in the high-risk group.

Conclusion

Overall, low-risk levels in the requests of patients using a DTC platform were reported, with almost half of them suitable to be solved digitally, whereas the other half required referral to an in-person specialist.