The Journal. - Testosterone Clinics Sell Virility. Side Effects Sometimes Included.

Episode Date: September 11, 2024

Testosterone therapy is booming, touting a boost at the gym and in the bedroom, but the potential side effects (like infertility) are less well known. WSJ’s Rolfe Winkler on the clinics making millions on this growing industry. Further Reading: - Testosterone Clinics Sell Virility. Some Men End Up With Infertility.  Further Listening: - Trillion Dollar Shot, Episode 1: Birth of a Blockbuster  - The Rise of Botox and the Wrinkle in Its Future  Learn more about your ad choices. Visit megaphone.fm/adchoices

Like a lot of men, my colleague Rolf Winkler and I get bombarded online with content about testosterone therapy. I just got all the Instagram ads for tea. I guess I'm the demographic. I mean, they just sort of permeate my social media feeds of like, do you have low testosterone? Do you want to be ripped and shredded? And now you're able to burn fat easier because you started testosterone replacement therapy.

Now your ego is through the roof. Comment TRT below and I will send you a link. You're going to get a better libido. You know, your wife's going to love you. You'll lose that belly fat and and you're gonna get jacked. Joe Rogan has talked about it. Yeah, I do hormone replacement therapy. What type of things?

Testosterone and human growth hormone. RFK Jr., I remember a year ago, like he did that thirst trap video where he's shirtless doing pushups at Gold's Gym, and just looking incredibly muscular for a 70 year old. He came out in videos and was interviewed and said he does testosterone replacement therapy. I'm 69 years old.

I started doing TRT when I was 65, my doctor's advice. And I thought, I'll pull some prescription data to see how big this trend is. And I looked at the line and it was just stupendously you know sloped up into the right. It looks like an industry that is on steroids. Yeah right we had to get that line in there somewhere. I just came up with that right now. Since 2010 prescriptions for testosterone treatment have more than doubled. Today clinics offering the treatment are making tens of millions of dollars in sales,

and some men pay thousands of dollars a year for it. Benefits can include increased energy, libido, and muscle mass. But often, men who start this treatment aren't fully aware of all the possible downsides. And that's the thing about this story, is that testosterone has a lot of benefits. It also has a lot of side effects. Welcome to The Journal, our show about money, business, and power.

I'm Ryan Knudson. It's Wednesday, September 11th. Coming up on the show, the testosterone treatment business is booming. What's the catch? This episode is brought to you by Nespresso. Elevate your morning coffee ritual from the first sip of coffee in the morning to the on-the-go cup. Make every morning unforgettable with Nespresso.

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a hormone that people produce in their bodies. And as men age, their levels of testosterone naturally decrease. When a man's testosterone falls below normal levels, it's a condition called hypogonadism. It brings down libido, strength, and energy. And the solution for that has been to inject testosterone as a synthetic drug. That's why pharmaceutical companies started making it. But about a decade ago, one pharmaceutical company called AbbVie launched an ad campaign

to broaden the appeal of testosterone therapy. Lost your appetite for romance and your mood is on its way down. You might not just be getting older, you might have a treatable condition called low testosterone or low T. Millions of men 45 or older may have low T. So talk to your doctor about low T. The website was called is it low T.com. And to entice people about the product, the company included a quiz on the site. It's sort of this intake questionnaire that asks questions like, are you feeling sad or

grumpy lately? Do you feel like your energy is falling? One of my favorite questions, are you falling asleep after dinner? Which I think describes everybody and kind of standard pharmaceutical playbook where they're driving people to a web page to get them to ask their doctor about this treatment. And they tried to promote off-label prescribing, not just for hypogonadism but for all of these other things, low energy, low libido. We have a solution for you. The campaign kicked off a rise in interest around testosterone treatment.

But prescriptions for testosterone didn't really take off until the last few years, when men's health clinics and telehealth providers got involved. Companies like these are popping up everywhere. This is a business that ranges from single doctors running, you know, a man clinic and they're bringing people in all the way up to national telehealth operations. But one big part of the cottage industry is testosterone clinics, med spas. They're doing the weight loss drugs, they're doing hormone replacement therapy, and many of them target men specifically.

And when they target these men, these clinics have a big advantage. They don't face the same kind of advertising regulations that pharmaceutical companies do. And they don't need to have all of the risk information that you see in kind of, you know, drug ads that show up on the evening news from pharma companies. Some of them do put a little fine print at the bottom, but really, it's just some guy telling you about how amazing this drug is and you should come to us for it. Why? Why aren't they subject to these regulations? Why don't they have to put these disclaimers?

Oh, well, they operate in a gray area where the regulations the FDA rules about advertising drugs really apply to pharmaceutical makers of drugs and they don't make the drugs. Once someone goes to one of these clinics, how do these companies actually talk with them about this treatment? They talk about the benefits, right, as we've described. Better libido, more energy, better results in the gym. But they also talk about the difference between normal levels of testosterone and quote optimal levels.

Traditional doctors, you might go in and say, Doc, I don't know, I don't know if my testosterone is low. They'll get you tested and they'll say, you know, it's not high, but it's not out of the range of normal. So I don't think you're testosterone is low, they'll get you tested and they'll say, you know, it's not high, but it's not out of the range of normal. So I don't think you're a good candidate for this, but a clinic might say, yeah, you're normal, but do you want to feel optimal? Sure.

Doesn't everybody want to feel optimal? One man who was enticed by that question was David Pivovarov. He's 40 years old and lives in Miami, and he's always been in great shape. My entire life, I've never had any illnesses. I've never taken any medication. I've always enjoyed being physically active, whether that's in the gym or playing tennis

or swimming or running or whatever it is. But as David got into his late 30s, he noticed he wasn't feeling as energized as he used to, even though he maintained all his good habits. I've never been a drinker, I've never been a partier, I've always got a good amount of sleep. I maintained my habits, but the results just weren't there. I kept finding myself more and more fatigued.

I would need a nap to get through the day. I would find my joints aching. I would be sore. I would be limping, you know, throughout the week. About two years ago, a trainer at David's gym gave him some advice. He said, hey, why don't you go see Mr. T? And I'm like, Mr. T, what are you talking about? He's like, you know, testosterone therapy. So, David decided to give it a try.

He came across a clinic called the BioStation, which has nine locations in Florida. And hormone replacement therapy for both men and women is its best-selling service. I wanted something reliable. And the BioStation provided that. Like you walk in, it looks like any other doctor's office. You meet someone in the lab coats, and they have waiting rooms. When a nurse practitioner at the clinic looked at David's initial blood work, he said his testosterone levels were fine.

According to David, the nurse told him he wasn't a typical candidate for the treatment. And to be perfectly forthright, I knew I didn't need it. I wanted it. I wanted to go into my 40s at my maximum potential. I didn't want to be tired. I didn't need it. I wanted it. potential. And he said, okay, look, we'll get you started. So even though the nurse practitioner said, you're not actually a good candidate for this because your testosterone levels were normal, you said, I think I want to do it anyway. And he said, yes. Correct. Yeah. Yeah.

The biostation said it wouldn't comment on David's care because of confidentiality rules and that it prescribes testosterone only in cases where it's appropriate. So how did it go once you started taking the treatment? So for the first month or so, mentally I felt great, physically I felt great, within 72 hours, like my strength improved in the gym. I was sleeping like I've never slept before. And then after three or four weeks, just things kind of went sideways. improved in the gym. I was sleeping like I've never slept before.

And then after three or four weeks, just things kind of went sideways. I looked amazing, but I felt like trash. Introducing TD Insurance for Business with customized coverage options for your business. Because at TD Insurance, we understand that your business is unique, so your business insurance should be too. Whether you're a shop owner, a pet groomer, a contractor, or a consultant, you can get customized coverage for your business. Contact a licensed TD Insurance advisor to learn more. Contact a licensed TD Insurance Advisor to learn more. I'm not going back to university to be your friend. I'm going so I can get Uber One for students. It saves you on Uber and Uber Eats.

I'm there for $0 delivery fee on cheeseburgers, up to 5% off smoothies and 5% Uber cash back on rides. Just to be clear, I'm there for savings, not whatever you think university is for. Get Uber One for students, a membership Some men swear by testosterone therapy and say it's changed their lives for the better. But others have had to deal with side effects. Our colleague Rolf says one of the more common side effects is infertility. Testosterone is male birth control. If you're injecting that hormone, your body, it stops producing it naturally.

Your body stops sending a signal to your testicles to produce sperm. So your sperm count can go to zero. And this was a fascinating part of the reporting because I started to call reproductive urologists infertility doctors and they all said, I talked to 15 of them. They're like, oh yeah, 15, 20 years ago maybe it was one guy a year, a couple guys a year who were on testosterone and you

know, that was the reason why he and his wife couldn't conceive a kid. They were struggling with fertility. Now it's several times a week, several times a month. It's a standard question we have to ask now because it's so common, is what they all said. There are other side effects too. So, acne, blood clots, cardiovascular events over time are a risk, sleep apnea, male breast enlargement, and obviously mood swings, right? Roid rage. You can get, you can feel pretty amped and, you know, be quick to anger.

That can happen to people. feel pretty amped and, you know, be quick to anger. That can happen to people. For David Pivovarov, the problems began about a month after he started the testosterone prescribed by the biostation. I started just feeling emotionally flat. My libido, like, disappeared. And my blood pressure went up. And I brought this up to the nurse practitioner

and they looked at me as if this was the first time they've ever heard these side effects before. Had you talked to anybody at the clinic about these side effects before you started taking this treatment? I did not. They were not brought up to me. I wasn't told about the side effects. I did some cursory research. When you do your research, it kind of sounds like it's very low risk.

It happens to very few men. And I didn't think that I was going to get all of them at the same time. The senior doctor at the biostation said that he discusses side effects with patients and prescribes medications to manage them. Prescribing testosterone, he said, is a quote, art, not purely a science. David said he'd wished he'd known more about the risks before he started the therapy. How did the side effects start affecting your life? It was an added stress that I never had before.

I couldn't get more than four and a half, maybe five hours of sleep, anxiety, acne. Acne where I would wake up in the morning and there were spots of blood on my sheets, like it was painful. All of this combined, just, you know, it was extremely stressful. It's all I would think about all day long. David asked his doctor at the clinic for help. They offered him other hormonal replacements to try and balance out how he was feeling on the testosterone. But at a couple hundred dollars, it started getting expensive.

And any time that I would try some kind of additional medication, I would feel great for a couple of weeks, and then everything would fade away and go back to the way it was. And the thing about testosterone therapy is that you can't just stop taking it and go back to normal. Here's Rolf again. If you start taking it, your body stops producing natural testosterone. So in theory, it's a treatment you're on for the rest of your life. So if you start this in your 30s because you want to stay jacked and look like Sylvester

Stallone going into your 40s, are you going to be on this the rest of your life? You can go off it, and what happens is your testosterone level will crash to zero very quickly. Doctors who take people off it, they'll give you other things to naturally boost your testosterone while you're getting off the synthetic stuff. But it may not feel great. It can take a few months to recharge, six months to a year maybe, and you may not fully recharge ever.

Some doctors said they're not sure if you get back everything you had before. Earlier this year, David decided to stop taking testosterone. Within weeks, his blood pressure was back to normal, he was sleeping more at night, and his anxiety subsided. But libido and acne never recovered. And it was a strange feeling to be able to have sex and not feel a thing. I mean, this is very personal to even share, but that's the reality of it. Did you ever feel like,

oh my God, what have I done? Yeah, yeah. It definitely crossed my mind. You know, if I could step into a time machine and never pick up that first needle. I wish I would have done that. But unfortunately, it's like a game of chess. After you make a wrong move, you're playing a brand new game.

You can't undo that. Today, David's on a prescription for a different steroid that helps with testosterone's lingering symptoms. It comes with some extra risks to his heart, and he'll probably need to stay on it for the rest of his life. What would you say to other men who are thinking about taking testosterone?

I would say consider the risks very seriously. Don't take them lightly. I had nephews ask me, Uncle David, you look like Captain America. I want to get on TRT. This is, you know, guys in their mid-20s. And when I told them the side effects that I had and the trouble and the cost and the mental anguish, I think I did a good job of scaring the bejesus out of them. Just be aware that there are side effects there, that if you're perfectly healthy already, you might end up with a worse quality of life than before you started.

Despite problems like these, Rolf says the testosterone therapy industry doesn't seem to be slowing down. Everybody views this as a growth business, Wolf says the testosterone therapy industry doesn't seem to be slowing down. Everybody views this as a growth business and, you know, the baby boom isn't getting younger. That's a very large potential market, growing market for testosterone therapy. We're talking probably thousands of these kinds of clinics nationwide, thousands of doctors prescribing this Nationwide.

And there's a lot of money to be made here. That's all for today. Wednesday, September 11th. The Journal is a co-production of Spotify and The Wall Street Journal. If you like our show, follow us on Spotify or wherever you get your podcasts. We're out every weekday afternoon. Thanks for listening. See you tomorrow.